CC-BY-NC-ND 4.0 · AJP Rep 2017; 07(03): e145-e150
DOI: 10.1055/s-0037-1604076
Case Report
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Evaluation of Institute of Medicine Guidelines for Gestational Weight Gain in Women with Chronic Hypertension

Anne M. Siegel1, Alan T. Tita1, Hannah Machemehl1, Joseph R. Biggio1, Lorie M. Harper1
  • 1Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Center for Women's Reproductive Health at the University of Alabama at Birmingham, Birmingham, Alabama
Further Information

Publication History

07 March 2017

25 May 2017

Publication Date:
12 July 2017 (online)


Objective To assess the impact of gestational weight gain (GWG) outside the Institute of Medicine (IOM) recommendations on perinatal outcomes in pregnancies complicated by chronic hypertension (HTN).

Methods The study consisted of a retrospective cohort of all singletons with HTN from 2000 to 2014. Maternal outcomes examined were superimposed preeclampsia and cesarean delivery. Neonatal outcomes were small for gestational age (SGA), large for gestational age (LGA), and preterm birth (PTB). Groups were compared using analysis of variance and chi-squared test for trend. Backward stepwise logistic regression was adjusted for confounding factors.

Results Of 702 subjects, 106 (15.1%) gained within, 176 (25.0%) gained less, and 420 (59.8%) gained more weight than the IOM recommendations. After adjusting for confounders, GWG above IOM recommendations remained associated with LGA (adjusted odds ratio [AOR]: 2.53, confidence interval [CI] 95%:1.29–4.95). Weight gain less than recommended was associated with a decreased risk of superimposed preeclampsia (AOR: 0.49, CI 95%: 0.26–0.93) without increasing the risk of SGA (AOR: 1.03, CI 95%: 0.57–1.86).

Conclusion Women with pregnancies complicated by chronic HTN should be counseled regarding the association of LGA with excessive GWG. Additionally, they should be counseled that weight gain below recommendations may be associated with a decreased risk of superimposed preeclampsia; however, this association deserves further investigation.


The findings were presented at the 36th Annual Society of Maternal Fetal Medicine Pregnancy meeting in Atlanta, GA from February 2 to 6, 2016 at a poster session.