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Pregnancy outcomes related to gestational weight gain in women defined by their body mass index, parity, height, and smoking status^1,2,3

¹ From the Departments of Epidemiology (EAN) and Biostatistics (MV), Institute of Public Health, University of Aarhus, Aarhus, Denmark; the Institute of Preventive Medicine, Copenhagen University Hospital, Centre of Health and Society, Copenhagen, Denmark (JLB and TIAS); the Department of Epidemiology, School of Public Health, University of California, Los Angeles, CA (JO); and the Division of Nutritional Sciences, Cornell University, Ithaca, NY (KMR).

² The Danish National Research Foundation established the Danish Epidemiology Science Centre, which initiated and created the Danish National Birth Cohort. The cohort is a result of a major grant from this Foundation. Additional support for the Danish National Birth Cohort was obtained from the Pharmacy Foundation, the Egmont Foundation, the March of Dimes Birth Defects Foundation, and the Augustinus Foundation.

³ Address correspondence to EA Nohr, Department of Epidemiology, Institute of Public Health, Vennelyst Boulevard 6, Building 260, University of Aarhus, 8000 Aarhus C, Denmark. E-mail: ean{at}soci.au.dk.

Background: Recommendations for gestational weight gain (GWG) account for a woman's prepregnancy body mass index (BMI), but other factors may be important.

Objectives: The objectives were to investigate whether, within BMI categories, the GWG with the lowest risks to mother and infant varied with parity and to describe these risks in short (<160 cm), young (<20 y), and smoking women.

Design: Of 27,030 primiparous and 31,407 multiparous women with term births within the Danish National Birth Cohort, self-reported GWG was divided into 6 categories (<5, 5–9, 10–15, 16–19, 20–24, and 25 kg). Population-based registers provided information about birth outcomes. GWG-specific absolute adjusted risks for emergency cesarean delivery, birth of a small-for-gestational-age (SGA) or large-for-gestational-age (LGA) infant, and postpartum (6 mo) weight retention (PPWR) were compared across different types of women.

Results: The risk of SGA decreased with increasing GWG in both parity groups, but SGA risk <10% was reached at 2–3 GWG categories lower in multiparae than in primiparae. An excess risk of LGA was present only in obese primiparae and multiparae, but the PPWR risk increased with increasing GWG irrespective of BMI and parity. Young primiparae had better outcomes than other primiparae. Short women had a higher risk of emergency cesarean delivery that varied minimally with GWG. Smokers had a higher SGA risk and had a PPWR risk similar to that of nonsmokers.

Conclusions: The tradeoff in risk between mother and infant is reached at lower GWG in multiparae than in primiparae; therefore, a lower GWG may be needed among multiparae. Differential guidelines seem unnecessary for short or young women or smokers.