Gestational weight gain (GWG) is a potentially modifiable risk factor for a number of important maternal and infant health outcomes. In 2009, the Institute of Medicine (IOM) Committee to Reevaluate Gestational Weight Gain Guidelines published resubmitted weight-gain recommendations. However, the resubmitted guidelines were established without a clear understanding of their impact on a number of important outcomes such as stillbirth, infant death, child neurocognitive status, preeclampsia, and long-term maternal and offspring obesity. Further, the IOM committee highlighted the importance of assessing pattern and timing of GWG in addition to total GWG. This application directly responds to those research needs by examining the influence of total GWG and pattern of GWG on a broad range of short- and long-term maternal and offspring outcomes. Our study design will employ existing electronic records from two retrospective cohorts (124,590 singleton births at Magee-Women's Hospital in Pittsburgh, Pennsylvania and 36,384 singleton births at Alta Bates Summit Medical Center in Berkeley, California), as well as data from a prospective cohort of 471 mother-child dyads born at Magee-Women's Hospital and followed for 22 years. This project seeks to determine the association between total GWG and 12 adverse outcomes for mothers (gestational diabetes, preeclampsia, and maternal postpartum body mass index change at 22 years postpartum) and offspring (stillbirth, infant mortality, spontaneous preterm birth, small- and large-for-gestational-age births, neurocognitive deficits, child obesity at age 6 adult obesity at age 22). To study this association, an innovative method to assess total GWG will be developed that removes the bias in the existing measures'correlation with gestational length. This project will also examine the relationship between maternal GWG trajectory and adverse perinatal outcomes. A novel growth curve analysis method will be used to determine the independent contribution of timing, amount, and velocity of GWG to poor pregnancy and birth outcomes. The successful completion of these aims will fill major gaps in knowledge about the weight gain ranges and patterns associated with optimal maternal and child health. The use of innovative methodology combined with the ability to study multiple adverse outcomes simultaneously will advance our understanding of GWG in an effort to inform future evidence-based guidelines. Our use of two diverse cohorts will increase our study's generalizability and potential to impact medical practice and public health policy.
The 2009 Institute of Medicine pregnancy weight gain guidelines are used by clinicians throughout the U.S. to optimize the short- and long-term health of both the mother and child, yet there are still major gaps in knowledge about ideal weight gain ranges. This project will inform future evidence-based weight gain guidelines by using cutting-edge analytic methodologies to study relationships between GWG and multiple adverse health outcomes of major medical, economic, and public health importance, including perinatal death, poor birth outcomes, child cognitive deficits, and maternal and child obesity. Although the causes of poor maternal and offspring outcomes are multifactorial, we focus on pregnancy weight gain because the association is plausible, potentially modifiable, and has important implications for mother and child well beyond the childbearing years.
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|Bodnar, Lisa M; Hutcheon, Jennifer A; Parisi, Sara M et al. (2015) Comparison of gestational weight gain z-scores and traditional weight gain measures in relation to perinatal outcomes. Paediatr Perinat Epidemiol 29:11-21|
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