Different methods for assessing gestational weight gain and its association with birth weight

Araújo, Roberta Gabriela Pimenta da Silva; Gama, Silvana Granado Nogueira da; Barros, Denise Cavalcante de; Saunders, Cláudia; Pereira, Ana Paula Esteves

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Epidemiologia e Serviços de Saúde

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Original article • Epidemiol. Serv. Saúde 30 (1) • 2021 • https://doi.org/10.1590/S1679-49742021000100006 copy

Different methods for assessing gestational weight gain and its association with birth weight ^* * This article is part of the Ph.D. thesis entitled “Avaliação do ganho ponderal e construção de curvas para o ganho de peso na gestação, segundo índice de massa corporal pré-gestacional” [Assessment of weight gain and curve building for gestational weight gain, according to pre-gestational body mass index”, defended by Roberta Gabriela Pimenta da Silva Araújo at the Graduate Program in Epidemiology of the National School of Public Health/Fundação Instituto Oswaldo Cruz (ENSP/Fiocruz) in 2020. The study received support from the National Council for Scientific and Technological Development/Ministry of Science, Technology, Innovation and Communication, the Department of Science and Technology/Secretariat of Science, Technology and Strategic Inputs/Ministry of Health; the Sergio Arouca National School of Public Health/Fundação Instituto Oswaldo Cruz (Project Inova/ENSP – MCT/CNPq/CT-Saúde/MS/SCTID/DECIT No. 057/2009); as well as support from the Carlos Chagas Filho Research Support Foundation of the State of Rio de Janeiro (FAPERJ – File No. E-26/103.083/2011); and the Coordination for the Improvement of Higher Education Personnel/Ministry of Education (Capes/MEC – Funding Code 001).

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To analyze association of different methods of gestational weight gain assessment with live births small for gestational age (SGA) and large for gestational age (LGA).

Methods

This was a cross-sectional study with adult women, normal prepregnancy BMI, single pregnancy and gestational age at delivery ≥28 weeks, from the “Birth in Brazil” study, between 2011 and 2012.

Results

Among the 11,000 women participating in the study, prevalence of excessive weight gain was 33.1% according to the Brandão et al. and Institute of Medicine (IOM) methods, and 37.9% according to the Intergrowth method. The chance of being born SGA in the case of insufficient weight gain was OR=1.52 (95%CI 1.06;2.19), OR=1.52 (95%CI 1.05;2.20) and OR=1.56 (95%CI 1.06;2.30) for the Brandão et al., IOM and Intergrowth methods, respectively. Likelihood of excessive weight gain using the same methods was OR=1.53 (95%CI 1.28;1.82), OR=1.57 (95%CI 1.31;1.87) and OR=1.65 (95%CI 1.40;1.96), for LGA respectively.

Conclusion

Compared to the IOM recommendations, the Intergrowth and Brandão et al. methods show themselves to be alternatives for identifying SGA and LGA.

Keywords:
Pregnancy; Weight Gain; Birth Weight; Cross-Sectional Studies

Variables	Sample description		95%CI^b	Average gestational weight gain (kg)	p-value^c
Variables	n	%		Average gestational weight gain (kg)
Total	11,000	100.0				14.30
National macroregion
Southeast	4,699	42.7	40.0;45.5	14.41	0.015
Northeast	3,253	29.6	27.5;31.7	14.05
South	1,391	12.6	11.5;13.8	14.29
North	944	8.6	7.8;9.4	14.28
Midwest	713	6.5	5.7;7.4	14.77
Delivery payment source
Public	8,344	75.9	74.2;77.5	14.22	0.059
Private	2,656	24.1	22.5;25.8	14.57	0.059
Age group (years)
20-24	4,182	38.0	36.7;39.4	14.29	0.300
25-29	3,275	29.8	28.8;30.8	14.29
30-34	2,325	21.1	20.1;22.2	14.65
35-39	999	9.1	8.4;9.8	13.82
≥40	218	2.0	1.7;2.3	13.25
Race/skin color
Brown	6,066	55.1	53.0;57.2	14.33	1.000
White	3,953	35.9	33.8;38.2	14.26
Black	806	7.3	6.5;8.3	14.19
Asian	134	1.2	0.9;1.6	14.96
Indigenous	40	0.4	0.2;0.5	14.93
Maternal education level (years of study)
≤7	2,386	21.7	20.2;23.2	13.49	<0.001
8-11	2,329	21.2	19.9;22.4	14.29
12-14	4,963	45.1	43.0;47.3	14.65
≥15	1,322	12.0	10.4;13.8	14.46
Parity
First birth	4,618	42.0	40.6;43.3	14.71	<0.001
1 previous birth	3,583	32.6	31.5;33.7	14.13
2 previous births	1,620	14.7	13.8;15.7	14.01
3 previous births	609	5.5	5.0;6.2	13.76
4 or more previous births	569	5.2	4.5;6.0	13.48
Number of prenatal care medical appointments
No prenatal care	107	1.0	0.7;1.3	13.21	<0.001
1 to 3	901	8.2	7.3;9.6	13.49
4 to 6	3,081	28.0	27.5;30.1	13.98
7 or more	6,684	60.8	60.1;63.6	13.98
Type of delivery
Vaginal	5,145	46.8	44.3;49.4	13.60	<0.001
Caesarean	5,855	53.2	50.7;55.7	14.92	<0.001

Variable	Sample description		Average gestational weight gain (kg)	p-value^d	SGA^d (n=732)	LGA^b (n=1,468)	p-value^e
Variable	n	%	Average gestational weight gain (kg)	p-value^d	SGA^d (n=732)	LGA^b (n=1,468)	p-value^e
Total	11,000	100.0			6.7	13.4
Total gestational weight gain - Brandão et al. (2020)¹⁰10. Brandão T, Padilha PC, Gama SGN, Leal MC, Araújo RGPS, Barros DC, et al. Gestational weight gain and adverse maternal outcomes in Brazilian women according to body mass index categories: an analysis of data from the Birth in Brazil survey. Clin Nutr ESPEN [Internet]. 2020 Jun [cited 2020 Oct 5];37:114-20. Available from: https://doi.org/10.1016/j.clnesp.2020.03.009 https://doi.org/10.1016/j.clnesp.2020.03...
Insufficient weight gain	3,050	27.7	8.00	<0.001	10.2	8.8	<0.001
Adequate weight gain	4,313	39.2	13.52		6.5	12.2
Excessive weight gain	3,636	33.1	20.51		3.9	18.5
Total gestational weight gain - IOM^f (2009)²
Insufficient weight gain	3,345	30.4	8.28	<0.001	9.9	9.4	<0.001
Adequate weight gain	4,019	36.5	13.53		6.4	12.0
Excessive weight gain	3,636	33.1	20.23		3.9	18.5
Total gestational weight gain - Intergrowth (2016)⁹9. Cheikh Ismail L, Bishop DC, Pang R, Ohuma EO, Kac G, Abrams B, et al. Gestational weight gain standards based on women enrolled in the Fetal Growth Longitudinal Study of the INTERGROWTH-21st Project: a prospective longitudinal cohort study. BMJ [Internet]. 2016 Feb [cited 2020 Oct 5];352:i555. Available from: https://doi.org/10.1136/bmj.i555 https://doi.org/10.1136/bmj.i555...
Insufficient weight gain	2,885	26.2	7.92	<0.001	10.4	8.9	<0.001
Adequate weight gain	3,951	35.9	13.16		6.6	11.4
Excessive weight gain	4,164	37.9	19.80		4.1	18.2

Variable	Small for gestational age
Variable	OR^b not adjusted	95% CI^c	OR^d adjusted	95% CI^c
Brandão et al. (2020)¹⁰10. Brandão T, Padilha PC, Gama SGN, Leal MC, Araújo RGPS, Barros DC, et al. Gestational weight gain and adverse maternal outcomes in Brazilian women according to body mass index categories: an analysis of data from the Birth in Brazil survey. Clin Nutr ESPEN [Internet]. 2020 Jun [cited 2020 Oct 5];37:114-20. Available from: https://doi.org/10.1016/j.clnesp.2020.03.009 https://doi.org/10.1016/j.clnesp.2020.03...
Insufficient weight gain	1.58	1.11;2.26	1.52	1.06;2.19
Adequate weight gain	1.00	-	1.00	-
Excessive weight gain	0.63	0.48;0.83	0.61	0.46;0.81
IOM^e (2009)²2. Institute of Medicine - IOM; National Research Council (USA) Committee to Reexamine IOM Pregnancy Weight Guidelines. Weight gain during pregnancy: reexamining the guidelines. Rasmussen KM, Yaktine AL, editor. Washington, D.C.: National Academies Press; 2009 [cited 2020 Oct 5]. 868 p. Available from: https://doi.org/10.17226/12584 https://doi.org/10.17226/12584...
Insufficient weight gain	1.57	1.09;2.24	1.52	1.05;2.20
Adequate weight gain	1.00	-	1.00	-
Excessive weight gain	0.64	0.48;0.84	0.62	0.47;0.83
Intergrowth (2016)⁹9. Cheikh Ismail L, Bishop DC, Pang R, Ohuma EO, Kac G, Abrams B, et al. Gestational weight gain standards based on women enrolled in the Fetal Growth Longitudinal Study of the INTERGROWTH-21st Project: a prospective longitudinal cohort study. BMJ [Internet]. 2016 Feb [cited 2020 Oct 5];352:i555. Available from: https://doi.org/10.1136/bmj.i555 https://doi.org/10.1136/bmj.i555...
Insufficient weight gain	1.61	1.12;2.33	1.56	1.06;2.30
Adequate weight gain	1.00	-	1.00	-
Excessive weight gain	0.66	0.51;0.86	0.65	0.50;0.84

Variable	Large for gestational age
Variable	OR^b not adjusted	95% CI^c	OR^d adjusted	95% CI^c
Brandão et al. (2020)¹⁰10. Brandão T, Padilha PC, Gama SGN, Leal MC, Araújo RGPS, Barros DC, et al. Gestational weight gain and adverse maternal outcomes in Brazilian women according to body mass index categories: an analysis of data from the Birth in Brazil survey. Clin Nutr ESPEN [Internet]. 2020 Jun [cited 2020 Oct 5];37:114-20. Available from: https://doi.org/10.1016/j.clnesp.2020.03.009 https://doi.org/10.1016/j.clnesp.2020.03...
Insufficient weight gain	0.73	0.61;0.87	0.68	0.57;0.83
Adequate weight gain	1.00	-	1.00	-
Excessive weight gain	1.59	1.34;1.88	1.53	1.28;1.82
IOM^e (2009)²2. Institute of Medicine - IOM; National Research Council (USA) Committee to Reexamine IOM Pregnancy Weight Guidelines. Weight gain during pregnancy: reexamining the guidelines. Rasmussen KM, Yaktine AL, editor. Washington, D.C.: National Academies Press; 2009 [cited 2020 Oct 5]. 868 p. Available from: https://doi.org/10.17226/12584 https://doi.org/10.17226/12584...
Insufficient weight gain	0.80	0.65;0.98	0.76	0.61;0.93
Adequate weight gain	1.00	-	1.00	-
Excessive weight gain	1.63	1.36;1.94	1.57	1.31;1.87
Intergrowth (2016)⁹9. Cheikh Ismail L, Bishop DC, Pang R, Ohuma EO, Kac G, Abrams B, et al. Gestational weight gain standards based on women enrolled in the Fetal Growth Longitudinal Study of the INTERGROWTH-21st Project: a prospective longitudinal cohort study. BMJ [Internet]. 2016 Feb [cited 2020 Oct 5];352:i555. Available from: https://doi.org/10.1136/bmj.i555 https://doi.org/10.1136/bmj.i555...
Insufficient weight gain	0.80	0.63;1.01	0.76	0.59;0.97
Adequate weight gain	1.00	-	1.00	-
Excessive weight gain	1.69	1.43;2.00	1.65	1.40;1.96

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[1] Correspondence: Roberta Gabriela Pimenta da Silva Araújo - Fundação Instituto Oswaldo Cruz, Escola Nacional de Saúde Pública Sergio Arouca, Departamento de Epidemiologia e Métodos Quantitativos em Saúde, Rua Leopoldo Bulhões, No. 1480, Rio de Janeiro, RJ, Brazil. Postcode: 21041-210. E-mail: roberta.araujo.nut@gmail.com.