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Maternal and neonatal outcomes in obese women who lose weight during pregnancy

Journal of Perinatology volume 36, pages 278–283 (2016)Cite this article

Subjects

Abstract

Objective:

To evaluate neonatal and maternal outcomes in obese pregnant women whose weight gain differed from the Institute of Medicine (IOM) recommendations.

Study Design:

Maternal and neonatal outcomes associated with weight change in pregnancy were retrospectively investigated in women with obesity (body mass index (BMI) ⩾30 kg m−2; N=10734) who gave birth at 12 hospitals. Using a 1:1:1:1 design (n=778 matched groups), we matched women with obesity who lost, maintained, gained appropriate (IOM recommended) and gained excessive weight during pregnancy by gestational age at delivery, maternal age, race/ethnicity, prepregnancy BMI, chronic hypertension, pregestational diabetes and smoking status. Regression techniques were used to adjust for confounders and compare outcomes across weight change categories.

Result:

Compared with IOM recommendations, weight loss was associated with twofold greater odds of low birth weight infants and a mean decrease in estimated blood loss of 30 ml; excessive weight gain was associated with doubled odds of gestational hypertension or preeclampsia, fourfold greater odds of macrosomia and a mean decrease in 5-min APGAR of 0.09. From lost to excessively gained weight, the odds of cesarean delivery increased 1.4 times and mean infant birth weight increased by 197 g. In contrast, the odds of small-for-gestational age were 1.8 times greater for women who lost than gained excessive weight.

Conclusion:

Weight loss in obese pregnant women is associated with increased risk for low birth weight neonates but significantly decreased or maintained risk for other maternal and neonatal morbidities, as compared with appropriate or excessive weight gain. This study supports re-evaluation of the current IOM guidelines for women with obesity.

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Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Aurora Health Center, Milwaukee, WI, USA

    C M Cox Bauer & D C Merrill

  2. Aurora Health Care, Milwaukee, WI, USA

    K A Bernhard & D M Greer

  3. Center for Urban Population Health, Milwaukee, WI, USA

    K A Bernhard & D M Greer

Authors
  1. C M Cox Bauer
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  2. K A Bernhard
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  3. D M Greer
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  4. D C Merrill
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Corresponding author

Correspondence to C M Cox Bauer.

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The authors declare no conflict of interest.

Additional information

This paper was presented at the ACOG Regional Meeting District VI 4–7 September 2014 in Napa California, USA and ACOG 63rd Annual Meeting 2–6 May 2015 in San Francisco, California, USA and is the winner of the Donald F Richardson Memorial Prize Paper for 2015.

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Cox Bauer, C., Bernhard, K., Greer, D. et al. Maternal and neonatal outcomes in obese women who lose weight during pregnancy. J Perinatol 36, 278–283 (2016). https://doi.org/10.1038/jp.2015.202

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