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Am J Perinatol
DOI: 10.1055/a-2568-9060
Original Article

Association of Prepregnancy Obesity versus Excessive Gestational Weight Gain with Adverse Maternal Outcomes in the United States

Rodney A. McLaren Jr.
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
,
Deepa Rastogi
2   Division of Pediatric Pulmonology and Sleep Medicine, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
,
Shantanu Rastogi 
3   Division of Neonatology, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
› Author Affiliations
Funding This work was supported by the U.S. Department of Health and Human Services, National Institutes of Health, National Heart, Lung, and Blood Institute (grant number: HL141849).
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Abstract

Objective

Prepregnancy body mass index (BMI) >30 kg/m2 or prepregnancy obesity (PPO) and excessive gestational weight gain (eGWG) are associated with increased risks for adverse maternal outcomes. There is little is known regarding the individual effects of PPO and eGWG. The objective of this study was to compare the effects of PPO and eGWG with adverse maternal outcomes.

Study Design

This was a retrospective cohort study of singleton, live births in the United States in 2018 using data from the National Vital Statistics System. Pregnancies complicated by pregestational diabetes, chronic hypertension, and with unknown maternal BMI were excluded. Institute of Medicine recommendations were used to define gestational weight gain (GWG). These births were divided into four groups: (1) normal prepregnancy BMI and normal GWG, (2) normal prepregnancy BMI and eGWG, (3) PPO and normal GWG, and (4) PPO and eGWG. Outcomes such as gestational diabetes, hypertensive disorders of pregnancy, cesarean delivery, maternal transfusion, and medical intensive care unit admissions were compared among groups using analysis of variance and multivariable logistic regression analysis.

Results

Of the 1,432,602 births included in the study, 22.2, 42.3, 10.1, and 25.4% were in Groups 1 to 4, respectively. Compared with pregnancies in Group 1 (adjusted odds ratio [95% confidence interval]), Groups 3 and 4 had higher risk for gestational diabetes (2.80 [2.72–2.88] and 2.28 [2.22–2.34]), respectively, whereas Groups 2 to 4 had higher risk of hypertensive disease of pregnancy (1.58 [1.53–1.64], 3.88 [3.74–4.03], and 5.07 [4.90–5.23]); eclampsia (1.61 [1.33–1.95], 2.99 [2.42–3.69], and 3.57 [2.97–4.29]), and cesarean delivery (1.21 [1.19–1.23], 1.97 [1.92–2.02], and 2.45 [2.40–2.50]), respectively.

Conclusion

Both PPO and eGWG are independently associated with higher odds of gestational diabetes, gestational hypertension, preeclampsia, and cesarean sections, with the highest risk among pregnancies with both PPO and eGWG. These data support the importance of prepregnancy weight management in preventing adverse pregnancy outcomes.

Key Points

  • Maternal obesity is associated with adverse maternal outcomes.

  • Maternal obesity is due to PPO or eGWG.

  • To study the contribution of adverse maternal outcomes by PPO as distinct from eGWG.

Keywords

maternal obesity - prepregnancy obesity - excessive gestational weight gain - maternal outcomes


Publication History

Received: 08 October 2024

Accepted: 28 March 2025

Accepted Manuscript online:
28 March 2025

Article published online:
17 April 2025

© 2025. Thieme. All rights reserved.

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