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Gestational Weight Gain and Adverse Neonatal Outcome Among Term Infants

From the ¹ Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco California; and ² School of Public Health, Division of Health Services and Policy Analysis, University of California, Berkeley, California.

OBJECTIVE: To examine the relationship between gestational weight gain and adverse neonatal outcomes among infants born at term (37 weeks or more).

METHODS: This was a retrospective cohort study of 20,465 nondiabetic, term, singleton births. We performed univariable and multivariable analyses of the associations between gestational weight gain and neonatal outcomes. We categorized gestational weight gain by the Institute of Medicine guidelines as well as extremes of gestational weight gain (less than 7 kg and more than 18 kg).

RESULTS: Gestational weight gain above the Institute of Medicine guidelines was more common than gestational weight gain below (43.3% compared with 20.1%). In multivariable analyses, gestational weight gain above guidelines was associated with a low 5-minute Apgar score (adjusted odds ratio [AOR] 1.33, 95% confidence interval [CI] 1.01–1.76), seizure (AOR 6.50, 95% CI 1.43–29.65), hypoglycemia (AOR 1.52, 95% CI 1.06–2.16), polycythemia (AOR 1.44, 95% CI 1.06–1.94), meconium aspiration syndrome (AOR 1.79, 95% CI 1.12–2.86), and large for gestational age (AOR 1.98, 95% CI 1.74–2.25) compared with women within weight gain guidelines. Gestational weight gain below guidelines was associated with decreased odds of neonatal intensive care unit admission (AOR 0.66, 95% CI 0.46–0.96) and increased odds of small for gestational age (SGA; AOR 1.66, 95% CI 1.44–1.92). Gestational weight gain less than 7 kg was associated with increased risk of seizure, hospital stay more than 5 days, and SGA. Gestational weight gain more than 18 kg was associated with assisted ventilation, seizure, hypoglycemia, polycythemia, meconium aspiration syndrome, and large for gestational age.

CONCLUSION: Gestational weight gain above guidelines was common and associated with multiple adverse neonatal outcomes, whereas gestational weight gain below guidelines was only associated with SGA status. Public health efforts among similar populations should emphasize prevention of excessive gestational weight gain.

LEVEL OF EVIDENCE: II-2

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