Association between gestational weight gain and pregnancy outcomes in a Singaporean population: A prospective cohort study

Abstract

Objectives: Inadequate or excessive gestational weight gain (GWG) is associated with adverse pregnancy outcomes. We aimed to study GWG in a Singaporean population and its association with pregnancy outcomes, including small for gestational age (SGA), macrosomia, and caesarean section secondary to failure to progress (FTP) or cephalopelvic disproportion (CPD).

Study design: 926 women with low-risk singleton pregnancy were enrolled in a prospective cohort study from 2010 to 2014 in a Singapore tertiary maternity hospital. 704 patients without pre-existing diabetes or hypertension and had maternal weight information till term pregnancy were included in analyses. Participants were categorized according to their first antenatal visit body mass index (BMI) as underweight, normal weight, overweight and obese. Total GWG for each BMI group was calculated and compared to Institute of Medicine (IOM) 2009 GWG guidelines. Logistic regression analyses were performed to assess the association of GWG below or above IOM guidelines with pregnancy outcomes.

Results: GWG below IOM guidelines was associated with an increased risk of SGA (adjusted OR: 2.97 [1.71, 5.15]; p < 0.0001). GWG above IOM guidelines significantly increased the risk of caesarean section due to FTP or CPD (adjusted OR: 2.10 [1.09, 4.01]; p = 0.0275). GWG above IOM guidelines was associated with an increased risk of macrosomia (adjusted odds ratio: 2.27 [1.43, 3.63]; p = 0.0006), while GWG below IOM guidelines was associated with a reduced risk of macrosomia (adjusted odds ratio: 0.18 [0.08, 0.39]; p < 0.0001).

Conclusions: GWG not achieving the IOM recommendations has been found to be associated with adverse pregnancy outcomes in Singaporean women. Inadequate GWG is associated with an increased risk of SGA whereas excessive GWG is associated with increased risks of macrosomia and caesarean section due to failure to progress or CPD. Results of the current study add to our understanding on the association of GWG with pregnancy outcomes in the South-East Asia and suggest that appropriate weight management during pregnancy is important.

Keywords: Gestational weight gain; Pregnancy outcomes; South-East Asia.