A Systematic Review of Gestational Weight Gain by Obese Women and Maternal/Newborn Outcomes

Wednesday, 24 July 2013: 4:10 PM

Mary Ann Faucher, PhD, RN, CNM
Louise Herrington School of Nursing, Baylor University, Baylor University, Dallas, TX

Learning Objective 1: Describe maternal and newborn risks associated with gestational weight gain in obese women, stratified by obesity severity.

Learning Objective 2: Provide evidence based recommendations to obese women, varied by obesity severity, on optimal gestational weight gain in pregnancy.

Purpose: A systematic review of gestational weight gain (GWG) in obese women, stratified by obesity severity, evaluated a mix of maternal and newborn outcomes, since the Institute of Medicine’s recommendations is the same for all obese women, that is 5-9kg.

Methods: A literature search was conducted of peer-reviewed articles published from 2009 to March 2012 using key words obese or obesity, gestational weight gain, and outcomes of pregnancy.  Databases CINHAL, MEDLINE, and PubMed. Inclusion criteria were publication date, research, English language, and GWG associated with outcomes of pregnancy in obese women addressed in the study results. Questions posed were: 1. What is the range of GWG in obese women and does it vary with severity of obesity? 2. What are the risks for SGA and LGA in obese women and do risks vary with severity of obesity or GWG? 3. What are the risks for cesarean delivery and postpartum weight retention (PPWR) in obese women and do these risks vary with severity of obesity or GWG?

Results: Pooled analysis revealed obese women gain more weight than recommended.  Obese woman are at low risk for SGA. Women with class I obesity should gain within the guidelines.  Weight gain less than recommended but not weight loss may minimize risks in woman with class II obesity. Women with class III obesity minimize risks with GWG less than recommended and weight loss may be needed to decrease overall risks.  GWG above guidelines significantly increases risk for cesarean birth. Additionally, GWG above guidelines increases risk for PPWR and GWG less than IOM guidelines decreases PPWR.

Conclusions: The evidence suggests different GWG guidelines are needed for women with different classes of obesity. Research is warranted to evaluate weight loss in women with class II and class III obesity.