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To evaluate the relationship between gestational weight gain and maternal and neonatal outcomes in obese women.
Retrospective cohort study of obese women, defined as having a body mass index (BMI) of >30, delivering singletons >20 weeks between 2000-2009. All included women had a weight documented in the first trimester and within 3 weeks prior to delivery. Women were stratified into quartiles according to the average gestational weight gain in kg/week. Maternal and neonatal outcomes were compared using the chi-squared test and the Mantel-Haenszel test for trend.
6251 obese women were eligible for the study. As shown in the Table, increased gestational weight gain (>0.53 kg/week; highest quartile of gestational weight gain) was associated with a multitude of adverse maternal and neonatal outcomes, including cesarean delivery, infections, shoulder dystocia, hypertensive disorders, and macrosomia. Minimal weight gain (<0.16 kg/week; lowest quartile of gestational weight gain) was associated with lower birthweights. Several outcomes, such as spontaneous preterm delivery, 5-minute Apgar <5, and fetal demise, displayed a bimodal distribution, with increased rates associated with minimal and increased gestational weight gain.
1Perinatal outcomes (%) in obese women according to gestational weight gain
Both minimal and excessive gestational weight gain in obese gravidas is associated with adverse maternal and neonatal outcomes. Obese women with moderate weight gain have the most favorable perinatal outcomes.