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Comment & Response
September 17, 2019

Optimal Gestational Weight Gain

Author Affiliations
  • 1Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
  • 2Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
  • 3Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada
JAMA. 2019;322(11):1106-1107. doi:10.1001/jama.2019.10946

To the Editor The LifeCycle Project-Maternal Obesity and Childhood Outcomes Study Group compiled 196 670 participant records from 25 cohorts to estimate optimal pregnancy weight gain ranges.1 We are concerned that the methods used to establish the optimal weight gain ranges have several serious shortcomings.

Optimal weight gain was based on a composite adverse outcome consisting of 7 equally weighted perinatal end points. This approach is problematic for several reasons. The composite components are associated with weight gain in different directions and vary in their importance to women and clinicians (eg, early preterm birth is more serious than cesarean delivery). Less severe outcomes occur the most; thus, the optimal weight gain range will be disproportionately driven by outcomes that are less important to women and clinicians.