Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL.
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, IL.
Am J Obstet Gynecol MFM. 2020 Nov;2(4):100231. doi: 10.1016/j.ajogmf.2020.100231. Epub 2020 Sep 22.
Nearly half of all women exceed the 2009 Institute of Medicine guidelines for gestational weight gain. Excess gestational weight gain is associated with adverse pregnancy outcomes.
Our objective was to determine whether having a personal gestational weight gain goal consistent with the Institute of Medicine's recommendations for appropriate gestational weight gain and whether having a discussion with one's obstetrical provider regarding that goal were associated with appropriate gestational weight gain.
This is a secondary analysis of the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-To-Be study, a prospective cohort study of nulliparous women. We asked women at their first study visit (between 6 and 13 weeks' gestation) whether they had a gestational weight gain goal and what that goal was. Furthermore, we asked whether their provider discussed a gestational weight gain goal and what that goal was. We classified personal and provider-recommended gestational weight gain goals as consistent or inconsistent with the Institute of Medicine guidelines, taking into account a woman's initial body mass index category (underweight, normal weight, overweight, and obese). We included women with live singleton term deliveries (between 37 and 43 weeks' gestation) in this analysis. We classified the primary outcome, which was gestational weight gain (defined as the difference between first visit weight and final weight before delivery), as inadequate, appropriate, or excessive, based on the Institute of Medicine guidelines and initial body mass index category. We used Student t, Wilcoxon rank-sum, and chi-square tests for bivariable analyses, and multinomial logistic regression was performed to control for confounding variables.
Of 6727 eligible women, 3799 (56.5% of all eligible women) stated they had a gestational weight gain goal. Of the 3799 women with a stated goal, 2589 (38.5% of all women) had a goal consistent with the Institute of Medicine's recommendations. In addition, of the 6727 eligible women, 2188 (32.5%) reported that they discussed gestational weight gain with their provider, and 1548 of these (23.0% of all women) recalled that their provider gave a gestational weight gain goal in accordance with the Institute of Medicine guidelines. Although having any gestational weight gain goal was not associated with appropriate gestational weight gain, having a gestational weight gain goal that was consistent with the Institute of Medicine's recommendations was associated with a reduced risk of excessive (adjusted relative risk ratio, 0.77; 95% confidence interval, 0.64-0.92) and inadequate weight gain (adjusted relative risk ratio, 0.66; 95% confidence interval, 0.53-0.82). Conversely, discussing gestational weight gain goals with a provider was not associated with either inadequate or excessive gestational weight gain even if the provider's recommendations for gestational weight gain were consistent with the guidelines.
Nulliparas who delivered singleton pregnancies at term who had a personal gestational weight gain goal consistent with the Institute of Medicine's recommendations were less likely to have excessive or inadequate gestational weight gain. Further study is required to evaluate the most effective way to communicate this information to patients.
近半数女性的孕期体重增长超过了 2009 年美国医学研究所的指导标准。孕期体重增长过多与不良妊娠结局有关。
我们旨在确定是否存在符合美国医学研究所推荐的适宜孕期体重增长目标的个人孕期体重增长目标，以及是否与产科医生讨论了这一目标，这些因素是否与适宜的孕期体重增长有关。
这是 Nulliparous Pregnancy Outcomes Study：Monitoring Mothers-To-Be 研究的二次分析，这是一项针对初产妇的前瞻性队列研究。我们在第一次研究访视时（妊娠 6 至 13 周）询问女性是否有孕期体重增长目标，以及该目标是什么。此外，我们还询问了她们的提供者是否讨论过孕期体重增长目标，以及该目标是什么。我们将个人和提供者推荐的孕期体重增长目标分为符合或不符合美国医学研究所指南，同时考虑了女性的初始体重指数类别（体重过轻、正常体重、超重和肥胖）。我们将在此分析中纳入具有活产单胎足月分娩（37 至 43 周妊娠）的女性。我们根据美国医学研究所指南和初始体重指数类别，将主要结局（定义为首次就诊体重与分娩前的最终体重差异）定义为不足、适宜或过多。我们使用学生 t 检验、Wilcoxon 秩和检验和卡方检验进行双变量分析，并进行多分类逻辑回归以控制混杂变量。
在 6727 名符合条件的女性中，有 3799 名（所有符合条件女性的 56.5%）表示她们有孕期体重增长目标。在 3799 名有目标的女性中，有 2589 名（所有女性的 38.5%）的目标符合美国医学研究所的建议。此外，在 6727 名符合条件的女性中，有 2188 名（32.5%）报告她们与提供者讨论了孕期体重增长，其中 1548 名（所有女性的 23.0%）回忆说提供者按照美国医学研究所的指南给出了孕期体重增长目标。尽管有任何孕期体重增长目标与适宜的孕期体重增长无关，但目标与美国医学研究所的建议一致与过多（调整后的相对风险比，0.77；95%置信区间，0.64-0.92）和不足体重增长（调整后的相对风险比，0.66；95%置信区间，0.53-0.82）的风险降低有关。相反，即使提供者的孕期体重增长建议符合指南，与提供者讨论孕期体重增长目标也与不足或过多的孕期体重增长无关。需要进一步研究以评估向患者传达这些信息的最有效方法。
