Gestational weight gain

Gestational weight gain is defined as the amount of weight gain a woman experiences between conception and birth of an infant.[1]

Recommendations

The Institute of Medicine (IOM) recommendations for gestational weight gain are based on body mass index (BMI) of women prior to pregnancy. However, early first trimester BMI appears to be a valid proxy for pre-conception BMI.[2] BMI is split up into four categories: underweight (<18.5 kg/m^2), normal weight (18.5-24.9 kg/m^2), overweight (25-29.9 kg/m^2), and obese (≥30.0 kg/m^2).[3] The IOM has recommended the ranges of weight gain to be 12.5–18 kg, 11.5–16 kg, 7-11.5 kg, and 5–9 kg respectively. That is, the smaller the BMI pre pregnancy, the more weight a woman is expected to gain during her pregnancy.[3]

Contributing factors

Excessive GWG has been shown to adversely affect maternal and baby health postpartum.[4] Only a little over a quarter of women have adequate GWG, meaning that their weight gain during pregnancy falls within the IOM recommended range. A little less than a quarter of women have inadequate GWG. However, excessive GWG is the most prevalent occurring in around half of pregnant women.[4][5][6][7]

Pre-pregnancy BMI

Having a higher BMI pre-pregnancy may leave you at a greater risk for excessive gestational weight gain and ultimately for cardio-metabolic diseases prenatally and postpartum.[7][8][9]

Food access

Food security is defined as consistent access, geographically or financially, to sufficient, nutritious, and affordable food and has been theorized to be a cause of excess gestational weight gain.[7] Women that only have access to fast food, for example, would be considered to be "lower food security", and these women might be more likely to suffer from excess gestational weight gain because the food available is cheap, but high in calories.[7][4][10] Having access to affordable and nutritious food has been linked to a lesser risk of impaired glucose tolerance.[10] which is related to excess gestational weight gain.[11]

It is not uncommon for there to be a correlation between socioeconomic status and food security; that is, women of low socioeconomic status have been reported to have low food security, particularly in terms of the affordability of nutritious food.[7] Some women of low socioeconomic status claim that they feel pressure to eat more during pregnancy out of the fear that they are not providing their babies with enough food.[7][12] With low food security, these women would consume high calorie food in significant quantities, potentially leading to excess gestational weight gain.[7] There seems to be a negative correlation between food security and excess gestational weight gain that is sometimes related to socioeconomic status.

Expectations

Overweight and obese women are significantly more likely to expect excessive gestational weight gain compared with normal-weight women, and women who report expecting to gain excessively are three times more likely to actually gain excessively than those who expect to gain within the guidelines.[13]

Income

Regardless of a relation to food security, having a low income might also predispose women to excess gestational weight gain, yet the reasoning is unclear.[10] One possibility is related to stress. Financial stress has been shown to be positively correlated with levels of CRP postpartum, a stress hormone associated with weight gain most likely because people eat increasingly unhealthy when stressed.[14] Women with a higher monthly budget for food may have a healthier gestational weight gain, while those with less money allocated for food may be more likely to experience excessive gestational weight gain.[15] However, the opposite may also be true: wealthier women may be more likely to suffer from excess gestational weight gain.[4][10] Women in wealthy communities have been reported to have higher postpartum weight retention than those in more poverty,[10] and since women who have excessive gestational weight gain are more likely to retain weight postpartum[16][17] women in less poverty might be more likely to have excess gestational weight gain.[4][10] This suggests that a greater household income does not necessarily provide protection against excess gestational weight gain.

Race/ethnicity

Race/ethnicity is an important variable to take into account when discussing gestational weight gain because women of racial/ethnic minorities demonstrate disproportionately higher obesity levels than non-Hispanic white women.[8][18] The IOM guidelines were created from data mostly consisting of white women, and thus may not be an appropriate measure for women of other races/ethnicities.[8]

African American women in general may have higher postpartum cardio-metabolic risk and more excess gestational weight gain than Latina women, who in turn have more than white women.[9] However, this is not always the case. One study reported that although African American women are more likely to be overweight or obese pre-pregnancy, they were less likely to have excessive weight gain than white women in one study.[8]

Poverty

Even though in many areas in the United States, there has been a decline in inequality on the basis of race/ethnicity, there still exists disproportionate social stratification.[4] Racial/ethnic minorities, such as blacks and Latinos, are more likely to be found in neighborhoods high in poverty.[4][9] African American women in poverty have been seen to have significantly higher postpartum cardio-metabolic risk than wealthier African American women,[9] which could be partially related to these impoverished women having excess gestational weight gain.[19] White women in poverty, on the other hand, had excess gestational weight gain and higher postpartum cardio-metabolic risk than the white women with higher incomes.[4][9] This was also true for Latina women in poverty compared to those wealthier.[9] The information regarding how race/ethnicity affects experience of excess gestational weight gain can be related to poverty levels, and the data available is limited and variable.

References

  1. "Gestational Weight Gain". Health Stats. Ontario, Canada: Simcoe Muskoka District Health Unit.
  2. Krukowski RA, West DS, DiCarlo M, Shankar K, Cleves MA, Saylors ME, Andres A (November 2016). "Are early first trimester weights valid proxies for preconception weight?". BMC Pregnancy and Childbirth. 16 (1): 357. doi:10.1186/s12884-016-1159-6. PMC 5117552. PMID 27871260.
  3. Institute of Medicine (US) National Research Council (US) Committee to Reexamine IOM Pregnancy Weight Guidelines (2009-12-14). Rasmussen KM, Yaktine AL (eds.). Weight Gain During Pregnancy. doi:10.17226/12584. ISBN 978-0-309-13113-1. PMC 1646960. PMID 20669500.
  4. Headen I, Mujahid M, Deardorff J, Rehkopf DH, Abrams B (July 2018). "Associations between cumulative neighborhood deprivation, long-term mobility trajectories, and gestational weight gain". Health & Place. 52: 101–109. doi:10.1016/j.healthplace.2018.05.007. PMC 6960020. PMID 29883957.
  5. Deputy NP, Sharma AJ, Kim SY, Hinkle SN (April 2015). "Prevalence and characteristics associated with gestational weight gain adequacy". Obstetrics and Gynecology. 125 (4): 773–81. doi:10.1097/aog.0000000000000739. PMC 4425284. PMID 25751216.
  6. Goldstein RF, Abell SK, Ranasinha S, Misso M, Boyle JA, Black MH, et al. (June 2017). "Association of Gestational Weight Gain With Maternal and Infant Outcomes: A Systematic Review and Meta-analysis". JAMA. 317 (21): 2207–2225. doi:10.1001/jama.2017.3635. PMC 5815056. PMID 28586887.
  7. Nunnery D, Ammerman A, Dharod J (January 2018). "Predictors and outcomes of excess gestational weight gain among low-income pregnant women". Health Care for Women International. 39 (1): 19–33. doi:10.1080/07399332.2017.1391263. PMC 6198321. PMID 29068777.
  8. Zheng Z, Bennett WL, Mueller NT, Appel LJ, Wang X (March 2019). "Gestational Weight Gain and Pregnancy Complications in a High-Risk, Racially and Ethnically Diverse Population". Journal of Women's Health. 28 (3): 375–383. doi:10.1089/jwh.2017.6574. PMC 6444884. PMID 29920144.
  9. Ross KM, Guardino C, Dunkel Schetter C, Hobel CJ (July 2018). "Interactions between race/ethnicity, poverty status, and pregnancy cardio-metabolic diseases in prediction of postpartum cardio-metabolic health". Ethnicity & Health: 1–16. doi:10.1080/13557858.2018.1493433. PMC 6339606. PMID 29962223.
  10. Headen I, Laraia B, Coleman-Phox K, Vieten C, Adler N, Epel E (January 2019). "Neighborhood Typology and Cardiometabolic Pregnancy Outcomes in the Maternal Adiposity Metabolism and Stress Study". Obesity. 27 (1): 166–173. doi:10.1002/oby.22356. PMC 6309242. PMID 30516025.
  11. Saldana TM, Siega-Riz AM, Adair LS, Suchindran C (December 2006). "The relationship between pregnancy weight gain and glucose tolerance status among black and white women in central North Carolina". American Journal of Obstetrics and Gynecology. 195 (6): 1629–35. doi:10.1016/j.ajog.2006.05.017. PMID 16824460.
  12. Herring SJ, Cruice JF, Bennett GG, Rose MZ, Davey A, Foster GD (January 2016). "Preventing excessive gestational weight gain among African American women: A randomized clinical trial". Obesity. 24 (1): 30–6. doi:10.1002/oby.21240. PMC 4688057. PMID 26592857.
  13. Krukowski RA, West DS, DiCarlo M, Cleves MA, Saylors ME, Andres A (January 2017). "Association of Gestational Weight Gain Expectations and Advice on Actual Weight Gain". Obstetrics and Gynecology. 129 (1): 76–82. doi:10.1097/AOG.0000000000001780. PMID 27926649.
  14. Guardino CM, Dunkel Schetter C, Hobel CJ, Gaines Lanzi R, Schafer P, Thorp JM, Shalowitz MU (May 2017). "Chronic Stress and C-Reactive Protein in Mothers During the First Postpartum Year". Psychosomatic Medicine. 79 (4): 450–460. doi:10.1097/PSY.0000000000000424. PMC 6619505. PMID 27977503.
  15. Braightmeyer K, Beausang J (May 2018). "Food Deserts and Gestational Weight Gain: An Urban Problem?". Obstetrics & Gynecology. 131: 201S. doi:10.1097/01.aog.0000533274.03842.19.
  16. Haugen M, Brantsæter AL, Winkvist A, Lissner L, Alexander J, Oftedal B, et al. (June 2014). "Associations of pre-pregnancy body mass index and gestational weight gain with pregnancy outcome and postpartum weight retention: a prospective observational cohort study". BMC Pregnancy and Childbirth. 14 (1): 201. doi:10.1186/1471-2393-14-201. PMC 4062904. PMID 24917037.
  17. Nehring I, Schmoll S, Beyerlein A, Hauner H, von Kries R (November 2011). "Gestational weight gain and long-term postpartum weight retention: a meta-analysis". The American Journal of Clinical Nutrition. 94 (5): 1225–31. doi:10.3945/ajcn.111.015289. PMID 21918221.
  18. Krukowski RA, Bursac Z, McGehee MA, West D (June 2013). "Exploring potential health disparities in excessive gestational weight gain". Journal of Women's Health. 22 (6): 494–500. doi:10.1089/jwh.2012.3998. PMC 3678569. PMID 23751164.
  19. McClure CK, Catov JM, Ness R, Bodnar LM (November 2013). "Associations between gestational weight gain and BMI, abdominal adiposity, and traditional measures of cardiometabolic risk in mothers 8 y postpartum". The American Journal of Clinical Nutrition. 98 (5): 1218–25. doi:10.3945/ajcn.112.055772. PMC 3798077. PMID 24047920.
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