Obstetric Outcomes in Normal Weight and Obese Women in Relation to Gestational Weight Gain: Comparison between Institute of Medicine Guidelines and Cedergren Criteria

 

 Buy Article Permissions and Reprints

ABSTRACT

We compared obstetric outcomes based on gestational weight gain in normal-weight and obese women using traditional Institute of Medicine (IOM) guidelines and newly recommended Cedergren criteria. Using the New Jersey Pregnancy Risk Assessment Monitoring System (PRAMS) database and electronic birth records, perinatal outcomes were analyzed to estimate the independent effects of prepregnancy body mass index (BMI) and gestational weight gain by IOM versus Cedergren criteria. Of 9125 subjects in PRAMS database from 2002 to 2006, 53.7% had normal BMI, 12.3% were overweight, 18.2% were obese, and the rest were underweight. Among normal-weight mothers, when compared with the IOM guidelines, macrosomia (6.45% versus 4.27%) and cesarean delivery rates (30.42% versus 29.83%) were lower using Cedergren criteria but the rates of preterm delivery (5.06% versus 9.44%), low birth weight (0.38% versus 2.42%), and neonatal intensive care unit (NICU) admissions (7.02% versus 10.86%) were higher with the Cedergren criteria. Similarly, among obese patients, when compared with IOM guidelines, macrosomia (10.79% versus 5.47%) and cesarean delivery rates (43.95% versus 40.71%) were lower using Cedergren criteria but the rates of preterm delivery (6.83% versus 8.32%), low birth weight (0.87% versus 1.88%), and NICU admissions (8.92% versus 13.78%) were higher with the Cedergren criteria. Based on our results, ideal gestational weight gain is presumably somewhere between the IOM and Cedergren's guidelines.

REFERENCES

• 1 Institute of Medicine (U.S.) .Subcommittee on Nutritional Status and Weight Gain during Pregnancy and Subcommittee on Dietary Intake and Nutrient Supplements during Pregnancy. Nutrition during Pregnancy. Washington (DC); National Academic Press 1990
  PubMedGoogle Scholar
• 2 Carmichael S, Abrams B, Selvin S. The pattern of maternal weight gain in women with good pregnancy outcomes.  Am J Public Health. 1997;  87 1984-1988
  CrossrefPubMedGoogle Scholar
• 3 Cedergren M I. Optimal gestational weight gain for body mass index categories.  Obstet Gynecol. 2007;  110 759-764
  CrossrefPubMedGoogle Scholar
• 4 DeVader S R, Neeley H L, Myles T D, Leet T L. Evaluation of gestational weight gain guidelines for women with normal prepregnancy body mass index.  Obstet Gynecol. 2007;  110 745-751
  CrossrefPubMedGoogle Scholar
• 5 Kiel D W, Dodson E A, Artal R, Boehmer T K, Leet T L. Gestational weight gain and pregnancy outcomes in obese women: how much is enough?.  Obstet Gynecol. 2007;  110 752-758
  CrossrefPubMedGoogle Scholar
• 6 Qayad M G, Zhang H. Accuracy of public health data linkages.  Matern Child Health J. 2009;  13 531-538
  CrossrefPubMedGoogle Scholar
• 7 NJ-PRAMS .Available at: http://www.state.nj.us/health/fhs/documents/methods_summary.pdf Accessed June 14, 2009
  PubMed
• 8 Baeten J M, Bukusi E A, Lambe M. Pregnancy complications and outcomes among overweight and obese nulliparous women.  Am J Public Health. 2001;  91 436-440
  CrossrefPubMedGoogle Scholar
• 9 Galtier-Dereure F, Boegner C, Bringer J. Obesity and pregnancy: complications and cost.  Am J Clin Nutr. 2000;  71(5 Suppl) 1242S-1248S
  PubMedGoogle Scholar
• 10 Hall L F, Neubert A G. Obesity and pregnancy.  Obstet Gynecol Surv. 2005;  60 253-260
  CrossrefPubMedGoogle Scholar
• 11 Usha Kiran T S, Hemmadi S, Bethel J, Evans J. Outcome of pregnancy in a woman with an increased body mass index.  BJOG. 2005;  112 768-772
  CrossrefPubMedGoogle Scholar
• 12 Rode L, Nilas L, Wøjdemann K, Tabor A. Obesity-related complications in Danish single cephalic term pregnancies.  Obstet Gynecol. 2005;  105 537-542
  CrossrefPubMedGoogle Scholar
• 13 Dietz P M, Callaghan W M, Cogswell M E, Morrow B, Ferre C, Schieve L A. Combined effects of prepregnancy body mass index and weight gain during pregnancy on the risk of preterm delivery.  Epidemiology. 2006;  17 170-177
  CrossrefPubMedGoogle Scholar
• 14 Cedergren M I. Maternal morbid obesity and the risk of adverse pregnancy outcome.  Obstet Gynecol. 2004;  103 219-224
  CrossrefPubMedGoogle Scholar

Sushma PottiM.D. 

Temple University Hospital, 3401 North Broad Street, Department of Obstetrics and Gynecology

7th Floor Outpatient Building, Philadelphia, PA 19140

Email: sushmapotti@gmail.com