Influence of Pregnancy Weight on Maternal and Child Health Workshop Report (2007) / Chapter Skim
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3 Determinants of Gestational Weight Gain
3 Determinants of Gestational Weight Gain
Pages 18-32
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Many processes involve both components. GESTATIONAL WEIGHT GAIN Janet King observed that gestational weight gain includes three components: (1)
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. Pattern of Gestational Weight Gain Studies of the pattern of gestational weight gain help to determine when the greatest rate of gain occurs and how it varies with maternal prepregnancy BMI.
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Prepregnancy Body Mass Index In 1990, the IOM committee concluded that maternal prepregnancy BMI is a primary determinant of gestational weight gain and referenced all of its recommendations to prepregnancy BMI (Institute of Medicine, 1990)
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. The interactions among maternal prepregnancy BMI status and stature in affecting gestational weight gain need further evaluation.
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In one study, women in the highest quartile for fasting insulin concentrations when they registered for prenatal care had a twofold increased risk for excessive gestational weight gain and a 3.6-fold increased risk of excess weight retained postpartum, suggesting that the excess weight gained was fat (Scholl and Chen, 2002)
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For women with low or normal prepregnancy weight, none of the social factors they considered was associated with increased risk of, or actual, insufficient gestational weight gain, but several factors were associated with decreased risk. Among women with low or normal weight, being U.S.-born, being primiparous, being under age 29, having a planned pregnancy, and having a close relative die during the pregnancy decreased the risk of insufficient gestational weight gain.
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found that decreased self-reported physical activity was associated with excessive gestational weight gain. Caloric Intake Before the 1990 IOM report, most studies of caloric intake during pregnancy were supplementation trials conducted in developing countries.
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A higher energy intake in late pregnancy was associated with a lower risk of insufficient gestational weight gain and a higher risk of excessive gestational gain. The researchers also considered both overall energy intake and change in energy intake between the first and second survey points.
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Overall Health Status Few studies consider overall health status and gestational weight gain. One study found that chronic or gestational diabetes was associated with increased risk of insufficient gestational weight gain (Brawarsky et al., 2005)
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Receiving no advice on gestational weight gain, a fairly prevalent situation, was associated with weight gain outside the guidelines. Provider advice to gain below the IOM recommendations was associated with actual weight gain below the recommendations (an adjusted odds ratio of 3.6)
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Maternal biological factors, such as age, parity, and stature, along with maternal genetic and metabolic state, appear to influence both the amount and composition of gestational weight gain. Complex interactions among the biological factors influencing gestational weight gain vary widely among different populations of women.
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report: · Lower socioeconomic status/education · High energy intake · Cigarette smoking · Increase in energy intake · Low energy intake Identified since the 1990 report: · Use of illegal substances · Decrease in physical activity Identified since the 1990 report: · High-glycemic diet · Low dairy intake · High-fat diet · Unintended pregnancy · Consumption of sweets · Domestic violence · Lack of provider advice/advice · Anorexia nervosa greater than the guidelines · Short interpregnancy interval Possible predictors: · Lack of provider advice/advice less · Type of providera than the guidelines · Type of prenatal carea NOTE: IOM = Institute of Medicine. aPossible social predictors of gestational weight gain that have not been extensively explored.
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2003 Composition of gestational weight gain impacts maternal fat retention and infant birth weight. American Journal of Obstetrics and Gynecology 189:14231432.
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2003 Modifiable behavioral factors in a biopsychosocial model predict inadequate and excessive gestational weight gain. Journal of the American Dietetic Association 103(1)
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Wells, C.S., Schwalberg, R., Noonan, G., and Gabor, V 2006 Factors influencing inadequate and excessive weight gain in pregnancy: Colorado, 20002002.
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