Elsevier

Nutrition

Volume 26, Issue 6, June 2010, Pages 617-623
Nutrition

Applied nutritional investigation
Determinant factors of insufficient and excessive gestational weight gain and maternal–child adverse outcomes

https://doi.org/10.1016/j.nut.2009.06.025Get rights and content

Abstract

Objective

To estimate the magnitude and determinant factors of insufficient and excessive gestational weight gain (GWG) and its relation with maternal–child adverse outcomes.

Methods

This was a prospective study with 173 pregnant women and their newborns monitored at a primary health care facility in Rio de Janeiro. Multinomial regression models were employed, having as the outcome the adequacy of GWG (insufficient, adequate, or excessive). Covariables were classified as biological, socioeconomic, reproductive, behavioral, and nutritional.

Results

Forty-one percent of pregnant women had insufficient GWG and 22.0% had excessive GWG. Pregestational overweight was associated with insufficient GWG (odds ratio [OR] 0.19, 95% confidence interval [CI] 0.05–0.78), and pregestational obesity was associated with excessive GWG (OR 4.66, 95% CI 1.34–19.08). Also associated with insufficient GWG were a stature <157 cm (OR 2.25, 95% CI 1.03–4.93) and ages 25–29 y (OR 3.70, 95% CI 1.26–10.84) and ≥30 y (OR 2.88, 95% CI 1.13–7.35) compared with the reference group (18–24 y). Age <12 y at menarche (OR 4.97, 95% CI 1.51–16.30) and being a former smoker (OR 5.18, 95% CI 1.62–16.52) demonstrated an association with excessive GWG compared with non-smokers (reference group). Sixty percent of pregnant women with excessive GWG delivered by cesarean section compared with 39.8% with adequate or insufficient GWG (P < 0.05). Prevalence of macrosomia in the excessive GWG group was 23.5% compared with 4.5% for pregnant women with insufficient GWG (P < 0.001).

Conclusion

Different determinant factors related to insufficient and excessive GWG were observed, which can be identified in the beginning of pregnancy, thus predicting unfavorable gestational outcomes. An increased percentage of women presented GWGs outside recommended levels.

Introduction

Pregestational body mass index (BMI) and gestational weight gain (GWG) constitute the most important anthropometric indicators employed during pregnancy [1], [2], because these are not only low-cost procedures but also reflective of maternal nutritional status before and after pregnancy [3].

The recommendation recognized worldwide [1], [4] instructs that weight gain during pregnancy should be differentiated in accordance with the pregestational nutritional status, being defined by BMI (weight in kilograms divided by height in meters squared). Women with pregestational underweight, normal weight, overweight, and obesity should gain 12.5 to 18.0, 11.5 to 16.0, 7.0 to 11.5, and 7.0 kg, respectively [4], [5]. This recommendation has as its objective restoring body fat storage levels in low-weight women and minimizing fat gain in overweight and obese women [1], [6]. However, most pregnant women have weight gains during pregnancy outside the recommended levels [1], [2].

Gestational weight gain within the recommended levels has a decisive function in favorable gestational outcomes. The scientific literature has demonstrated that inadequate GWG results in implications at the short, mid, and long terms to maternal and pediatric health [2], [3], [6]. Insufficient GWG is considered a risk factor for gestational complications and adverse outcomes, especially low birth weight, intrauterine growth restriction, and prematurity [7], [8], [9], [10], [11], [12]. Conversely, excessive GWG, aside from contributing to postpartum weight retention and risks of future obesity, is associated with several complications, among which are cesarean section delivery, hemorrhages, hypertensive syndromes in pregnancy, fetal macrosomia, and even low birth weight [7], [8], [9], [13], [14], [15], [16], [17].

Pregestational, gestational, and modifiable maternal behaviors contribute in different ways to GWG. Studies have identified several demographic, socioeconomic, biological, dietetic, psychological, and behavioral characteristics and health conditions during gestation and inadequate prenatal monitoring as risk factors for insufficient and excessive GWG [18], [19], [20], [21], [22], [23], [24]. Attempts to understand how each factor operates have become essential to adequately intervene ahead of time, due to the multi-causality of GWG deviations. The objective of this study was to estimate the magnitude and determinant factors of insufficient and excessive GWG and its relation to maternal–child adverse outcomes in a cohort of women monitored at a public primary health care clinic in the city of Rio de Janeiro, Brazil.

Section snippets

Materials and methods

This investigation inserts itself in a prospective study, Deviations in Gestational Weight Gain and the Effect in Reproductive Health Outcomes, with a dynamic sample composed of pregnant women monitored at a primary health care clinic that is part of the public services of the city of Rio de Janeiro, Brazil. Enrollment was free during 22 mo (June 2005 to April 2007). The monitoring protocol of the main study consisted of conducting individual interviews in five waves of follow-up: gestational

Results

The losses to follow-up that took place during the study amounted to 32.1% and did not differ between dropouts and completers according to several variables such as age, marital status, education, pregestational BMI, and family income. The 292 pregnant women who met the criteria presented a similar profile to those 255 women who were enrolled in the cohort and to the 173 women analyzed in this study regarding the above-mentioned variables (results not shown).

The distribution of GWG according to

Discussion

Previous analyses with the same dataset aiming mainly to estimate GWG velocity were conducted employing a mixed-effects linear longitudinal regression model. Mean weekly gestational weight gain was 0.413 kg, consistent with IOM recommendations [1], [4]. According to the longitudinal model, triacylglycerols, blood glucose, adequacy of energy intake, maternal age, and onset of menarche were associated with GWG velocity [25].

In the current study, we presented a different aim and analytical

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    This original research project was financed by the National Counsel of Technological and Scientific Development (CNPq), according to a call for projects CT SAÚDE/MCT/MS/CNPq no. 030/2004. Gilberto Kac is a research fellow from CNPq.

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