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Poster session I Clinical obstetrics, epidemiology, fetus, medical-surgical complications, neonatalogy, physiology/endocrinology, prematurity: Abstracts 87 - 236| Volume 208, ISSUE 1, SUPPLEMENT , S64, January 01, 2013

122: The Institute of Medicine guidelines for gestational weight gain: effect on perinatal outcomes in obese, morbidly obese, and super obese women

      Objective

      To evaluate the impact of the updated Institute of Medicine (IOM) guidelines for gestational weight gain in obese, morbidly obese, and super obese women on maternal and neonatal outcomes.

      Study Design

      Retrospective cohort of obese women, defined as body mass index (BMI) > 30, delivering singletons > 36 weeks between 2000-2009. Women were included if they had a weight documented in the first trimester and one within 10 days prior to delivery. Women were stratified by obesity category: obese (BMI 30-39), morbidly obese (BMI 40-49), and super obese (BMI > 50). Gestational weight gain was categorized according to IOM guidelines, which recommend a gain of 5-9.1 kg for obese women. Selected perinatal outcomes were analyzed, and logistic regression was used to adjust for potential confounders.

      Results

      Of the 5364 women eligible for the study, 74% were obese, 21% were morbidly obese, and 5% were super obese. Compared to obese women who gained within the IOM guidelines, women with a BMI > 30 and gestational weight gain exceeding the IOM guidelines had a 38% increased risk of cesarean delivery and hypertensive disorders and a 60% increased risk of macrosomia. Weight gain less than the IOM guidelines was associated with a 30% decreased risk of amnionitis and a 39% decreased risk of macrosomia. When compared to obese women, morbidly obese and super obese women had increased risks of a multitude of perinatal morbidities (Table). Morbidly obese women exceeding the guidelines had an increased risk of hypertensive disorders. Super obese women with weight gain less than recommended had a decreased risk of hypertensive disorders.
      Tabled 1Perinatal outcomes in obese, morbidly obese, and super obese women according to gestational weight gain per IOM guidelines
      Table thumbnail grr23

      Conclusion

      Gestational weight gain exceeding 2009 IOM guidelines is associated with increased risks of adverse outcomes in obese women. Weight gain less than recommended appears to be protective against some morbidities. Strategies to promote limited gestational weight gain may improve perinatal outcomes in this population.