Deviation from Gestational Weight Gain Guidelines in the Obese Gravida An Adverse Impact on Maternal and Fetal Health

OBJECTIVE: To investigate the impact of gestational weight gain (GWG) on pregnancy outcomes and postpartum weight retention in obese gravidas. STUDY DESIGN: Retrospective cohort of patients referred or enrolled into Wake Forest University Perinatology prenatal care. Patients were stratified into groups based on adherence to Institute of Medicine GWG guidelines. Outcomes were tracked and analyzed by group. Univariate and multivariate analyses were used where appropriate. RESULTS: Of 310 obese gravidas, GWG was appropriate in 76 (24.5%), excessive in 138 (44.5%), and inadequate in 96 (30.9%). In women induced or spontaneously laboring, nonadherence to weight gain guidelines increased risk for cesarean section (OR 1.92, CI 1.18-3.22). In a regression model controlling for maternal age, parity, gestational age, diabetes mellitus, and hypertension, appropriate GWG continued to be associated with a lower rate of cesarean section (OR 0.70, 95% CI 0.43-0.90). Excessive weight gain increased risk for accelerated fetal growth trajectory (p<0.0001) and estimated fetal weight > 90th percentile by ultrasound >= 34 weeks (OR 2.98, 95% CI 1.36-6.54; p=0.0064). Breastfeeding mothers had greater weight loss following delivery regardless of GWG (OR 3.69, 95% CI 1.07-14.03; p=0.039). CONCLUSION: In our cohort, most obese gravidas failed to adhere to guidelines. Appropriate GWG reduces risk for cesarean, which provides strong evidence to encourage expectant mothers to aim for the target range provided by the Institute of Medicine. We also observed that breastfeeding was beneficial from the maternal standpoint by decreasing postpartum weight retention.