In Reply Dr Bodnar and colleagues question the use of a composite outcome based on equally weighted outcomes in our study on the associations of gestational weight gain with adverse maternal and infant outcomes1 because the individual outcomes are associated with gestational weight gain in different directions and might vary in importance. We do not consider the different directions of the associations problematic because the simultaneous inclusion of the outcomes in the composite reflects the fact that optimal gestational weight gain is a trade-off between outcomes occurring at both low and high levels of gestational weight gain.
Voerman E, Jaddoe VWV, Gaillard R, on behalf of the LifeCycle Project-Maternal Obesity and Childhood Outcomes Study Group. Optimal Gestational Weight Gain—Reply. JAMA. 2019;322(11):1107–1108. doi:10.1001/jama.2019.10950
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