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Original Investigation
June 6, 2017

Association of Gestational Weight Gain With Maternal and Infant Outcomes: A Systematic Review and Meta-analysis

Author Affiliations
  • 1Monash Centre for Health Research and Implementation, Monash University, Victoria, Australia
  • 2Monash Diabetes and Endocrine Units, Monash Health, Victoria, Australia
  • 3Kaiser Permanente, Southern California, Los Angeles
  • 4Ambry Genetics, Aliso Viejo, California
  • 5Tianjin Women’s and Children’s Health Center, Tianjin, China
  • 6Pennington Biomedical Research Center, Baton Rouge, Louisiana
  • 7University Hospital, Messina, Italy
  • 8Department of Biochemistry, Copenhagen University Hospital, Righospitalet, Copenhagen, Denmark
  • 9Department of Obstetrics and Gynecology, School of Medicine, Ewha Womans University, Seoul, Republic of Korea
  • 10Norwegian Institute of Public Health, Oslo, Norway
  • 11Michigan State University, East Lansing
  • 12Dankook University College of Medicine, Seoul, Republic of Korea
  • 13Department of Development and Regeneration KU Leuven, University of Leuven, Leuven, Belgium
  • 14Faculty of Medicine and Health Sciences, Centre for Research and Innovation in Care, University of Antwerp, Antwerp, Belgium
  • 15Faculty of Health and Social Work, Research Unit Healthy Living, UC Leuven-Limburg, Leuven, Belgium
  • 16Department of Obstetrics and Gynaecology, University Hospitals KU Leuven, Leuven, Belgium
  • 17Department of Obstetrics, Gynaecology and Fertility, GZA Campus Sint-Augustinus, Wilrijk, Belgium
  • 18University of California, Irvine
JAMA. 2017;317(21):2207-2225. doi:10.1001/jama.2017.3635
Key Points

Question  What is the association between gestational weight gain above or below the Institute of Medicine guidelines and maternal and infant outcomes?

Findings  In this systematic review and meta-analysis of 1 309 136 pregnancies, gestational weight gain below recommendations (in 23% of women) was associated with higher risk of small for gestational age (odds ratio [OR], 1.53) and preterm birth (OR, 1.70) and lower risk of large for gestational age (OR, 0.59) and macrosomia (OR, 0.60). Gestational weight gain above recommendations (47%) was associated with lower risk of small for gestational age (OR, 0.66) and preterm birth (OR, 0.77) and higher risk of large for gestational age (OR, 1.85), macrosomia (OR, 1.95), and cesarean delivery (OR, 1.30).

Meaning  Gestational weight gain below or above the Institute of Medicine guidelines was associated with higher risk of some adverse maternal and infant outcomes.


Importance  Body mass index (BMI) and gestational weight gain are increasing globally. In 2009, the Institute of Medicine (IOM) provided specific recommendations regarding the ideal gestational weight gain. However, the association between gestational weight gain consistent with theIOM guidelines and pregnancy outcomes is unclear.

Objective  To perform a systematic review, meta-analysis, and metaregression to evaluate associations between gestational weight gain above or below the IOM guidelines (gain of 12.5-18 kg for underweight women [BMI <18.5]; 11.5-16 kg for normal-weight women [BMI 18.5-24.9]; 7-11 kg for overweight women [BMI 25-29.9]; and 5-9 kg for obese women [BMI ≥30]) and maternal and infant outcomes.

Data Sources and Study Selection  Search of EMBASE, Evidence-Based Medicine Reviews, MEDLINE, and MEDLINE In-Process between January 1, 1999, and February 7, 2017, for observational studies stratified by prepregnancy BMI category and total gestational weight gain.

Data Extraction and Synthesis  Data were extracted by 2 independent reviewers. Odds ratios (ORs) and absolute risk differences (ARDs) per live birth were calculated using a random-effects model based on a subset of studies with available data.

Main Outcomes and Measures  Primary outcomes were small for gestational age (SGA), preterm birth, and large for gestational age (LGA). Secondary outcomes were macrosomia, cesarean delivery, and gestational diabetes mellitus.

Results  Of 5354 identified studies, 23 (n = 1 309 136 women) met inclusion criteria. Gestational weight gain was below or above guidelines in 23% and 47% of pregnancies, respectively. Gestational weight gain below the recommendations was associated with higher risk of SGA (OR, 1.53 [95% CI, 1.44-1.64]; ARD, 5% [95% CI, 4%-6%]) and preterm birth (OR, 1.70 [1.32-2.20]; ARD, 5% [3%-8%]) and lower risk of LGA (OR, 0.59 [0.55-0.64]; ARD, −2% [−10% to −6%]) and macrosomia (OR, 0.60 [0.52-0.68]; ARD, −2% [−3% to −1%]); cesarean delivery showed no significant difference (OR, 0.98 [0.96-1.02]; ARD, 0% [−2% to 1%]). Gestational weight gain above the recommendations was associated with lower risk of SGA (OR, 0.66 [0.63-0.69]; ARD, −3%; [−4% to −2%]) and preterm birth (OR, 0.77 [0.69-0.86]; ARD, −2% [−2% to −1%]) and higher risk of LGA (OR, 1.85 [1.76-1.95]; ARD, 4% [2%-5%]), macrosomia (OR, 1.95 [1.79-2.11]; ARD, 6% [4%-9%]), and cesarean delivery (OR, 1.30 [1.25-1.35]; ARD, 4% [3%-6%]). Gestational diabetes mellitus could not be evaluated because of the nature of available data.

Conclusions and Relevance  In this systematic review and meta-analysis of more than 1 million pregnant women, 47% had gestational weight gain greater than IOM recommendations and 23% had gestational weight gain less than IOM recommendations. Gestational weight gain greater than or less than guideline recommendations, compared with weight gain within recommended levels, was associated with higher risk of adverse maternal and infant outcomes.