Gestational weight gain outside the Institute of Medicine recommendations and adverse pregnancy outcomes: Analysis using individual participant data from randomised trials

Ewelina Rogozińska* (Corresponding Author), Javier Zamora, Nadine Marlin, Ana Pilar Betrán, Arne Astrup, Annick Bogaerts, Jose G. Cecatti, Jodie M. Dodd, Fabio Facchinetti, Nina R.W. Geiker, Lene A.H. Haakstad, Hans Hauner, Dorte M. Jensen, Tarja I. Kinnunen, Ben W.J. Mol, Julie Owens, Suzanne Phelan, Kristina M. Renault, Kjell Salvesen, Alexis ShubFernanda G. Surita, Signe N. Stafne, Helena Teede, Mireille N.M. Van Poppel, Christina A. Vinter, Khalid S. Khan, Shakila Thangaratinam, Arri Coomarasamy, Roland Devlieger, Nermean El Beltagy, Kym Guelfi, Cheryce Harrison, Janette Khoury, Riitta Luoto, Siv Mørkved, Narges Motahari, Fionnuala McAuliffe, Maria Perales, Elisabetta Petrella, Lucilla Poston, Kathrin Rauh, Linda R. Sagedal, Tânia T. Scudeller, Gary X. Shen, Serena Tonstad, Ingvild Vistad, Marcia Vitolo, Seonae Yeo

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

88 Citations (Scopus)


Background: High Body Mass Index (BMI) and gestational weight gain (GWG) affect an increasing number of pregnancies. The Institute of Medicine (IOM) has issued recommendations on the optimal GWG for women according to their pre-pregnancy BMI (healthy, overweight or obese). It has been shown that pregnant women rarely met the recommendations; however, it is unclear by how much. Previous studies also adjusted the analyses for various women's characteristics making their comparison challenging. Methods: We analysed individual participant data (IPD) of healthy women with a singleton pregnancy and a BMI of 18.5 kg/m2 or more from the control arms of 36 randomised trials (16 countries). Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were used to describe the association between GWG outside (above or below) the IOM recommendations (2009) and risks of caesarean section, preterm birth, and large or small for gestational age (LGA or SGA) infants. The association was examined overall, within the BMI categories and by quartile of GWG departure from the IOM recommendations. We obtained aOR using mixed-effects logistic regression, accounting for the within-study clustering and a priori identified characteristics. Results: Out of 4429 women (from 33 trials) meeting the inclusion criteria, two thirds gained weight outside the IOM recommendations (1646 above; 1291 below). The median GWG outside the IOM recommendations was 3.1 kg above and 2.7 kg below. In comparison to GWG within the IOM recommendations, GWG above was associated with increased odds of caesarean section (aOR 1.50; 95%CI 1.25, 1.80), LGA (2.00; 1.58, 2.54), and reduced odds of SGA (0.66; 0.50, 0.87); no significant effect on preterm birth was detected. The relationship between GWG below the IOM recommendation and caesarean section or LGA was inconclusive; however, the odds of preterm birth (1.94; 1.31, 2.28) and SGA (1.52; 1.18, 1.96) were increased. Conclusions: Consistently with previous findings, adherence to the IOM recommendations seem to help achieve better pregnancy outcomes. Nevertheless, even in the context of clinical trials, women find it difficult to adhere to them. Further research should focus on identifying ways of achieving a healthier GWG as defined by the IOM recommendations.

Original languageEnglish
Article number322
Pages (from-to)1-12
Number of pages12
JournalBMC Pregnancy and Childbirth
Publication statusPublished - 2 Sept 2019

Bibliographical note

The National Institute for Health Research Health Technology Assessment
programme (No. 12/01/50) and World Health Organization Research Training
Fellowship received by ER during conduct of this study.

Data Availability Statement

The full dataset or its subset and technical appendix are available from the
data custodian (Queen Mary University of London) at smd-iwipdata@qmul. Access to the dataset is regulated by terms and conditions available
on request. The presented data are anonymised, and risk of identification of
individual participants is low.


  • Body mass index
  • Gestational weight gain
  • Individual participant data
  • Institute of Medicine


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