Obstetrics & Gynecology · 3 h ago
Gestational Weight Gain Outside Recommended Ranges Linked to Severe Maternal Morbidity
A retrospective cohort study of more than 1 million singleton pregnancies in Ontario examined gestational weight gain (GWG) and severe maternal morbidity (SMM). Weight gain above 2009 Institute of Medicine recommendations was associated with higher SMM rates across all prepregnancy BMI categories; associations with inadequate gain varied by BMI.
- Excessive gestational gain was associated with SMM across BMI groups.
- Inadequate gain associations varied by prepregnancy BMI.
- SMM occurred in 14.59 per 1,000 births.
- Observational findings do not establish causation or new targets.
Researchers linked birth registry and hospitalization data for 1,035,927 singleton pregnancies ending in hospital delivery in Ontario between April 2012 and March 2022. They assessed second- and third-trimester weight gain against 2009 Institute of Medicine recommendations and measured SMM during the delivery hospitalization using a 13-indicator composite. Overall, 15,119 pregnancies (14.59 per 1,000 births) involved SMM.
Compared with adequate GWG, excessive gain was associated with higher SMM rates across all prepregnancy BMI groups. Adjusted rate ratios ranged from 1.16 among those with overweight to 1.33 among those who were underweight. Inadequate gain was associated with higher rates primarily among those with normal weight (adjusted rate ratio, 1.13) or overweight (1.19). The continuous associations were nonlinear: risk was elevated at both low and high gain for underweight, normal-weight, and overweight groups, while in obesity classes I to III it was concentrated at higher gain.
This observational study found associations, not evidence that changing GWG would prevent SMM. The findings may complement existing guidance, but do not establish new weight-gain targets; results are from Ontario pregnancies with hospital delivery and may not generalize to other settings.
In practice
In this Ontario cohort of more than 1 million singleton pregnancies, weight gain above 2009 Institute of Medicine ranges was associated with higher SMM rates across all prepregnancy BMI categories; inadequate gain was associated with higher rates mainly in normal-weight and overweight groups. These observational findings may inform discussions of gestational weight gain, but do not show that changing weight gain prevents morbidity or justify replacing current targets. Applicability beyond pregnancies with hospital delivery in Ontario is uncertain.
AI-generated clinical interpretation · Not editor-reviewed
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JAMA Network Open: Weight Gain During Pregnancy and Severe Maternal Morbidity ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.