The effect of pre-pregnancy body mass index and gestational weight gain on pregnancy outcomes in urban care settings in Urmia-Iran Determinants of excessive gestational weight gain in urban, low-income women. Prediction of gestational weight gain - a biopsychosocial model. The role of gestational diabetes, pre-pregnancy body mass index and gestational weight gain on the risk of newborn macrosomia: results from a prospective multicentre study Limiting antenatal weight gain improves maternal health outcomes in severely obese pregnant women: findings of a pragmatic evaluation of a midwife-led intervention. Perspectives on weight gain and lifestyle practices during pregnancy among women with a history of macrosomia: a qualitative study in the Republic of Ireland Effects of gestational weight gain and body mass index on obstetric outcome in Sweden. Association of maternal gestational weight gain with short- and long-term maternal and child health outcomes. Influence of maternal nutrient intake and weight gain on neonatal birth weight: A prospective cohort study in southern Thailand Determinants of weight gain in pregnant women attending a public prenatal care facility in Rio de Janeiro, Brazil: a prospective study, 2005-2007. Pre-pregnancy Body Mass Index, Gestational Weight Gain, and Other Maternal Characteristics in Relation to Infant Birth Weight Excessive Early Gestational Weight Gain and Risk of Gestational Diabetes Mellitus in Nulliparous Women Determinant factors of insufficient and excessive gestational weight gain and maternal-child adverse outcomes. Risk factors and outcomes of maternal obesity and excessive weight gain during pregnancy. [Adherence to dietary recommendations by the Institute of Medicine and the effect on body weight during pregnancy]. Identification of those most likely to benefit from a low-glycaemic index dietary intervention in pregnancy. Gestational weight gain and postpartum behaviors associated with weight change from early pregnancy to 1 y postpartum
Background Nutritional status of women has been considered an important prognostic indicator of pregnancy outcomes . Few studies have evaluated patterns of weight gain and pre-pregnancy body mass index in developing regions where malnutrition and poor weight gain as well as maternal obesity have significant influences on the pregnancy outcome . This study aims to show effect of pregnancy body mass index and the corresponding gestational weight gain on the outcome of pregnancy . Methods On a prospect i ve cross sectional study , two hundred and seventy women from urban areas of Northwest Iran were recruited for participation during their first eight weeks of pregnancy .  Body mass index ( BMI ) was categorized and gestational weight gain was divided into two groups of normal and abnormal based on recommendations of Institute of Medicine ( IOM ) published in 1990 . Chi square and one way ANOVA were used in the univariate analysis of the association between weight gain and corresponding adverse outcomes including cesarean , preterm labor and low neonatal birth weight . Adjusted odds ratios for adverse outcomes were determined by multiple logistic regression models , while controlling for the following factors : maternal age , parity , and education . Results Both pre-pregnancy BMI < 19 and abnormal weight gain during pregnancy were found to be associated with low neonatal birth weight defined as < 2500 g. Abnormal weight gain , during pregnancy was not related to an increased risk of preterm labor or cesarean delivery but it was highly associated with low birth weight (LBW)(P < 0.05 ) . Conclusion Low pre-pregnancy BMI is an established risk factor for LBW . Abnormal gestational weight gain may further complicate the pregnancy as an additional risk factor for neonatal LBW . All women , regardless of their pre-pregnancy BMI may be at risk for abnormal weight gain and hence low birth weight . Pre-pregnancy and gestation nutritional assessment s remain significant part of all prenatal visits BACKGROUND Factors influencing excessive weight gain in pregnancy have not been well-studied among urban , low-income women . METHODS This prospect i ve cohort study of 94 prenatal care patients at a large university hospital in Philadelphia examined associations of modifiable midpregnancy behaviors and nonmodifiable or early pregnancy factors with  excessive gestational weight gain . Data were collected through question naires and medical record abstract ion from 2009 to 2011 . FINDINGS The majority of women were African American ( 83 % ) and all ( 100 % ) received Medicaid . Nearly two thirds ( 60 % ) were overweight or obese in early pregnancy and 41 % experienced excessive gain . In multivariable logistic regression analyses , significant predictors of excessive gestational weight gain included high early pregnancy body mass index ( odds ratio [ OR ] , 4.20 ; 95 % confidence interval [ CI ] , 1.43 - 12.34 for overweight/obese vs. normal weight ) , nulliparity ( OR , 3.35 ; 95 % CI , 1.17 - 9.62 for nulliparity vs. multiparity ) , and clinician advice discordant with Institute of Medicine guidelines ( OR , 5.88 ; 95 % CI , 1.04 - 33.32 for discordant vs. concordant advice ) . Watching under 2 hours of television daily ( OR , 0.18 ; 95 % CI , 0.03 - 1.03 ) , and engaging in regular physical activity during pregnancy ( OR , 0.35 ; 95 % CI , 0.11 - 1.09 ) were suggestive of a reduced risk of excessive gain . CONCLUSIONS In this sample of urban , low-income women , high early pregnancy body mass index , nulliparity , and discordant clinician advice were directly associated with excessive gestational weight gain , with a trend toward decreased risk for viewing fewer hours of television and engaging in regular physical activity . Intervening on these targets may optimize gestational weight gain and promote long-term maternal health OBJECTIVE To examine the influence of health behaviours and psychological well-being on  gestational weight gain  using a biopsychosocial model . DESIGN A prospect i ve cohort study of pregnant women consecutively recruited at their first antenatal care visit . A self-administered question naire was used to collect data on health behaviours and psychological well-being in early pregnancy . Linear regression and logistic regression were used to identify predictors of total weight gain in kilograms and weight gain outside the current Institute of Medicine recommendations , respectively . SETTING A maternity hospital in the Republic of Irel and . SUBJECTS Data on 799 women were analysed . RESULTS Pre-pregnant BMI ≥30·0 kg/m2 , short stature , parity > 0 , decreased food intake and absence of health insurance predicted lower absolute gestational weight gain , while foreign nationality , consumption of takeaway meals more than once weekly and increased food intake predicted higher absolute gestational weight gain . Overweight and obesity , foreign nationality , increased food intake and height > 170 cm were risk factors for excessive weight gain , while antenatal depression was protective against excessive weight gain . Notably , physical activity measures were not related to the gestational weight gain outcomes . Pre-pregnancy overweight and increased food intake were the strongest predictors of excessive gestational weight gain . CONCLUSIONS None of the psychological well-being measures examined , with the exception of antenatal depression , was associated with any of the weight gain outcomes . The behavioural predictors of gestational weight gain were increased food intake and takeaway consumption . Public health promotions should target pre-pregnancy BMI and pregnancy-associated change in food intake Background It is crucial to identify in large population sample s the most important determinants of excessive fetal growth . The aim of the study was to evaluate the independent role of pre-pregnancy body mass index ( BMI ) , gestational weight gain and gestational diabetes on the risk of macrosomia . Methods A prospect i ve study collected data on mode of delivery and maternal/neonatal outcomes in eleven Hospitals in Italy . Multiple pregnancies and preterm deliveries were excluded . The sample included 14109 women with complete records . Associations between exposure variables and newborn macrosomia were analyzed using Pearson ’s chi squared test . Multiple logistic regression models were built to assess the independent association between potential predictors and macrosomia . Results Maternal obesity ( adjusted OR 1.7 , 95 % CI 1.4 - 2.2 ) , excessive gestational weight gain ( adjusted OR 1.9 , 95 % CI 1.6 - 2.2 ) and diabetes ( adjusted OR 2.1 , 95 % CI 1.5 - 3.0 for gestational ; adjusted OR 3.0 , 95 % CI 1.2 - 7.6 for pre-gestational ) result ed to be independent predictors of macrosomia , when adjusted for other recognized risk factors . Since no significant interaction was found between pre-gestational BMI and gestational weight gain , excessive weight gain should be considered an independent risk factor for macrosomia . In the sub-group of women affected by gestational or pre-gestational diabetes , pre-gestational BMI was not significantly associated to macrosomia , while excessive pregnancy weight gain , maternal height and gestational age at delivery were significantly associated . In this sub- population , pregnancy weight gain less than recommended was not significantly associated to a reduction in macrosomia . Conclusions Our findings indicate that maternal obesity , gestational weight gain excess and diabetes should be considered as independent risk factors for newborn macrosomia . To adequately evaluate the clinical evolution of pregnancy all three variables need to be carefully assessed and monitored BACKGROUND Antenatal obesity in pregnancy is associated with complications of pregnancy and poor obstetric outcomes . Although most guidance on pregnancy weight is focused on the prepregnancy period , pregnancy is widely viewed as a period where women are open to lifestyle change to optimise their health . METHODS The hospital-based Bumps and Beyond intervention invited all pregnant women with a body mass index ( BMI ) > 35 kg m(-2 ) to take part in a programme of health education around diet and exercise , accompanied by one-to-one guidance and monitoring of dietary change . This service evaluation compares 89 women who completed at a programme of seven sessions with healthy lifestyle midwives and advisors ( intervention ) versus a group of 89 women who chose not to attend ( non-intervention ) . RESULTS Mean ( SD ) weight gain in the intervention group [ 4.5 ( 4.6 ) kg ] was less than in the non-intervention group [ 10.3 ( 4.4 ) kg ] between antenatal booking and 36 weeks of gestation ( < 0.001 ) . This was associated with a 95 % reduction in the risk of gestational hypertension during pregnancy and a general reduction in pregnancy complications . There was no effect of the intervention upon gestational diabetes or complications in labour other than post-partum haemorrhage ( reduced by 55 % ) . The impact of the intervention on gestational weight gain was greater in women with BMI > 40 kg m(-2 ) at booking . There were no adverse effects of the intervention , even though 21 % of the intervention group lost weight during their pregnancy . CONCLUSIONS Intensive , personalised weight management intervention may be an effective strategy for the prevention of hypertensive disorders during pregnancy Background Excessive  weight gain  during pregnancy is a major risk factor for macrosomia ( high birth weight delivery ) . This study aim ed to explore views about weight gain and lifestyle practice s during pregnancy among women with a history of macrosomia . Methods A qualitative descriptive study was conducted . Twenty-one second-time mothers whose first infant was macrosomic ( > 4 kg ) were recruited from a r and omised trial in a large maternity hospital in the Republic of Irel and .  Semi-structured interviews were conducted with participants at both 6 and 12 months after their second pregnancy . Inductive thematic analysis was used to identify distinct themes . Results The mothers believed in following their prenatal food cravings to meet their baby ’s needs , but this led some to eat excessively . Many of the women cut back heavily on physical activity during pregnancy due to perceived risks to the baby . Physical conditions and discomforts during pregnancy often limited maternal control over weight and lifestyle practice s. The women were not particularly concerned about weight gain during pregnancy and most did not favour the notion of introducing weight gain guidelines into routine antenatal care . Common differences perceived by the women between their first and second pregnancy included : increased concern about weight gain in their second pregnancy due to prior difficulties with postpartum weight loss and increased time dem and s in their second pregnancy impeded healthy lifestyle practice s. Most women did not alter their perspectives on weight gain and lifestyle practice s in their second pregnancy in response to having a macrosomic infant in their first pregnancy . Conclusions This analysis exposed numerous barriers to healthy pregnancy weight gain . The findings suggest that women may need to be advised to follow their prenatal food cravings in moderation . Pregnant women with children already may benefit from education on time-efficient methods of integrating healthy eating practice s and physical activity into their lifestyles . Women with a history of macrosomia may need information about the importance of avoiding high weight gain in subsequent pregnancies OBJECTIVE The objective of this study was to estimate the effects of low and high gestational weight gain , in different maternal Body Mass Index ( BMI ) classes , on obstetric and neonatal outcomes . METHOD A prospect i ve population -based cohort study of 245,526 singleton term pregnancies . Women were grouped in five categories of BMI and in three gestational weight gain categories ; < 8 kg ( low weight gain ) , 8 - 16 kg and > 16 kg ( high weight gain ) . Obstetric and neonatal outcomes were evaluated after adjustments for maternal age , parity , smoking , year of birth . RESULT Obese women with low gestational weight gain had a decreased risk for the following outcomes ( adjusted odds ratio ; 95 % confidence interval ) : preeclampsia ( 0.52 ; 0.42 - 0.62 ) , cesarean section ( 0.81 ; 0.73 - 0.90 ) , instrumental delivery ( 0.75 ; 0.63 - 0.88 ) , and LGA births ( 0.66 ; 0.59 - 0.75 ) . There was a 2-fold increased risk for preeclampsia and LGA infants among average and overweight women with excessive weight gain . High gestational weight gain increased the risk for cesarean delivery in all maternal BMI classes . CONCLUSION The effects of high or low gestational weight gain differ depending on maternal BMI and the outcome variable studied . Obese women may benefit from a low weight gain during pregnancy OBJECTIVE The purpose of this study was to investigate the associations between  gestational weight gain ( GWG ) and small- and large-for-gestational-age ( SGA , LGA ) , cesarean delivery , child overweight , and maternal postpartum weight retention  in a diverse sample of women in the Unites States . STUDY DESIGN We estimated associations between GWG ( continuous and within categories defined by the Institute of Medicine ) , maternal prepregnancy body mass index , and each outcome in 4496 births in the National Longitudinal Survey of Youth 1979 , which was a prospect i ve cohort . RESULTS GWG ( kilograms ) was associated with decreased risk of SGA and increased risk of LGA , cesarean delivery , postpartum weight retention , and child overweight independent of maternal demographic and pregnancy characteristics . Gain above the Institute of Medicine guidelines was associated with decreased risk of SGA and increased risk of all other outcomes . CONCLUSION Excessive gain may have long-term consequences for maternal and child body size , but the benefits of lower gain must be balanced against risk of SGA Objectives . To assess the  nutritional intake and gestational weight gain of pregnant women and the relationship between nutritional intake , gestational weight gain , and neonatal birth weight . Methods . A prospect i ve cohort study was carried out in three districts of Songkhla Province in southern Thail and . Nutritional intakes were calculated based on a 24-h food record and a food frequency checklist . The women were followed until delivery and the neonatal birth weight recorded . Results . Two hundred and thirty-six pregnant women with a mean age of 27.2 ± 6.2 years were recruited . The average daily energy intake was 1806 ± 482 kcal . The average gestational weight gain was 12.2 ± 4.6 kg and the average neonatal birth weight was 3054 ± 474 g. Micronutrient intakes were overall inadequate averaging only 50–80 % of recommended levels . Neonatal birth weight was significantly positively correlated with gestational weight gain ( r = 0.17 , p = 0.01 ) , but was not correlated with maternal nutritional intakes . Conclusions . Pregnant women in rural areas of Songkhla Province consume adequate macronutrients with appropriate gestational weight gain , but generally consume inadequate micronutrients . A nutritional education program explaining the importance of micronutrients should be a focus of a public education program The objective of this study was to evaluate the determinants of weight gain during pregnancy . The study adopted a prospect i ve cohort design with four follow-up waves and included a sample of 255 pregnant women that received prenatal care at a public health care facility in Rio de Janeiro , Brazil . A mixed-effects linear longitudinal regression model was used , having as the dependent variable the weight assessed in four follow-up waves , and as independent variables : demographic , socioeconomic , reproductive , behavioral , and nutritional data . Mean weight gain was 0.413 kg per gestational week , consistent with recommendations by the Institute of Medicine . Per capita family income and smoking were associated with total weight gain during gestation . According to the longitudinal multiple linear regression model , age ( beta = 0.6315 ) , menarche ( beta = -2.3861 ) , triglycerides ( beta = 0.0437 ) , blood glucose ( beta = 0.1544 ) , and adequacy of energy consumption ( beta = -0.0642 ) were associated with gestational weight gain . Special attention should be given to these sub-groups , due to increased risk of excessive weight gain Objectives Infant birth weight is influenced by modifiable maternal pre-pregnancy behaviors and characteristics . We evaluated the relationship among pre-pregnancy body mass  index ( BMI ) , gestational weight gain , and infant birth weight , in a prospect i ve cohort study . Methods Women were enrolled at ≤20 weeks gestation , completed in-person interviews and had their medical records review ed after delivery .  Infant birth weight was first analyzed as a continuous variable , and then grouped into Low birth weight ( LBW ) ( < 2,500 g ) , normal birth weight ( 2,500–3,999 g ) , and macrosomia ( ≥4,000 g ) in categorical analysis . Pre-pregnancy BMI and gestational weight gain were categorized based on Institute of Medicine BMI groups and gestational weight gain guidelines . Associations among infant birth weight and pre-pregnancy BMI , gestational weight gain , and other factors were evaluated using multivariate regression . Risk ratios were estimated using generalized linear modeling procedures . Results Pre-pregnancy BMI was independently and positively associated with infant birth weight ( β = 44.7 , P = 0.001 ) after adjusting for confounders , in a quadratic model . Gestational weight gain was positively associated with infant birth weight ( β = 19.5 , P < 0.001 ) . Lower infant birth weight was associated with preterm birth ( β = −965.4 , P < 0.001 ) , nulliparity ( β = −48.6 , P = 0.015 ) , and female babies ( β = −168.7 , P < 0.001 ) . Less than median gestational weight gain was associated with twice the risk of LBW ( RR = 2.04 , 95 % CI 1.34–3.11 ) . Risk of macrosomia increased with increasing pre-pregnancy BMI and gestational weight gain ( P for linear trend < 0.001 ) . Conclusions These findings support the need to balance pre-pregnancy weight and gestational weight gain against the risk of LBW and macrosomia among lean and obese women , respectively OBJECTIVE : To estimate whether there is an association between excessive early gestational weight gain and the development of gestational diabetes mellitus ( GDM ) and excessive fetal growth . METHODS : This is a secondary analysis of a r and omized controlled trial of vitamins C and E in nulliparous low-risk women . Maternal weight gain from prepregnancy ( self-reported ) to 15–18 weeks of gestation was measured , and expected gestational weight gain was determined using the Institute of Medicine 2009 guidelines for each prepregnancy body mass index category . Excessive early gestational weight gain was defined as gestational weight gain greater than the upper range of the Institute of Medicine guidelines . Rates of GDM , birth weight greater than 4,000 g , and large for gestational age ( LGA , birth weight 90th percentile or higher ) were calculated and compared between women with excessive early gestational weight gain and early nonexcessive gestational weight gain ( within or below Institute of Medicine guidelines ) . RESULTS : A total of 7,985 women were studied .  Excessive early gestational weight gain occurred in 47.5 % of women . Ninety-three percent of women with excessive early gestational weight gain had total gestational weight gain greater than Institute of Medicine guidelines . In contrast , only 55 % of women with nonexcessive early gestational weight gain had total gestational weight gain greater than Institute of Medicine guidelines ( P<.001 ) . Rates of GDM , LGA , and birth weight greater than 4,000 g were higher in women with excessive early gestational weight gain . CONCLUSION : In our population , excessive early gestational weight gain occurred in 93 % of women who had total gestational weight gain greater than the Institute of Medicine guidelines . In low-risk nulliparous women , excessive early gestational weight gain is associated with the development of GDM and excessive fetal growth . LEVEL OF EVIDENCE : OBJECTIVE To estimate the magnitude and determinant factors of insufficient and excessive gestational weight gain ( GWG ) and its relation with  maternal-child adverse outcomes . METHODS This was a prospect i ve study with 173 pregnant women and their newborns monitored at a primary health care facility in Rio de Janeiro .  Multinomial regression models were employed , having as the outcome the adequacy of GWG ( insufficient , adequate , or excessive ) . Covariables were classified as biological , socioeconomic , reproductive , behavioral , and nutritional . RESULTS Forty-one percent of pregnant women had insufficient GWG and 22.0 % had excessive GWG . Pregestational overweight was associated with insufficient GWG ( odds ratio [ OR ] 0.19 , 95 % confidence interval [ CI ] 0.05 - 0.78 ) , and pregestational obesity was associated with excessive GWG ( OR 4.66 , 95 % CI 1.34 - 19.08 ) . Also associated with insufficient GWG were a stature < 157 cm ( OR 2.25 , 95 % CI 1.03 - 4.93 ) and ages 25 - 29 y ( OR 3.70 , 95 % CI 1.26 - 10.84 ) and > or=30 y ( OR 2.88 , 95 % CI 1.13 - 7.35 ) compared with the reference group ( 18 - 24 y ) . Age < 12 y at menarche ( OR 4.97 , 95 % CI 1.51 - 16.30 ) and being a former smoker ( OR 5.18 , 95 % CI 1.62 - 16.52 ) demonstrated an association with excessive GWG compared with non-smokers ( reference group ) . Sixty percent of pregnant women with excessive GWG delivered by cesarean section compared with 39.8 % with adequate or insufficient GWG ( P < 0.05 ) . Prevalence of macrosomia in the excessive GWG group was 23.5 % compared with 4.5 % for pregnant women with insufficient GWG ( P < 0.001 ) . CONCLUSION Different determinant factors related to insufficient and excessive GWG were observed , which can be identified in the beginning of pregnancy , thus predicting unfavorable gestational outcomes . An increased percentage of women presented GWGs outside recommended levels OBJECTIVE The prevalence of overweight and obesity among women of reproductive age is increasing . We aim ed to determine risk factors and maternal , fetal and childhood consequences of maternal obesity and excessive gestational weight gain . DESIGN AND METHODS The study was embedded in a  population -based prospect i ve cohort study among 6959 mothers and their children . The study was based in Rotterdam , The Netherl and s ( 2001 - 2005 ) . RESULTS Maternal lower educational level , lower household income , multiparity , and FTO risk allel were associated with an increased risk of maternal obesity , whereas maternal European ethnicity , nulliparity , higher total energy intake , and smoking during pregnancy were associated with an increased risk of excessive gestational weight gain ( all p-values < 0.05 ) . As compared to normal weight , maternal obesity was associated with increased risks of gestational hypertension ( OR 6.31 ( 95 % CI 4.30 , 9.26 ) ) , preeclampsia ( OR ( 3.61 , ( 95 % CI 2.04 , 6.39 ) ) , gestational diabetes ( OR 6.28 ( 95%CI 3.01 , 13.06 ) ) , caesarean delivery ( OR 1.91 ( 95 % CI 1.46 , 2.50 ) ) , delivering large size for gestational age infants ( OR 2.97 ( 95 % CI 2.16 , 4.08 ) ) , and childhood obesity ( OR 5.02 ( 95 % CI:2.97 , 8.45 ) ) . Weaker associations of excessive gestational weight gain with maternal , fetal and childhood outcomes were observed , with the strongest effects for first trimester weight gain . CONCLUSIONS Our study shows that maternal obesity and excessive weight gain during pregnancy are associated with socio-demographic , lifestyle , and genetic factors and with increased risks of adverse maternal , fetal and childhood outcomes . As compared to prepregnancy overweight and obesity , excessive gestational weight gain has a limited influence on adverse pregnancy outcomes The study 's objective was to estimate the effect of adherence to dietary recommendations by the Institute of Medicine ( IOM ) concerning energy intake and /or macronutrient composition of diet on weight during pregnancy . This was a prospect i ve study with observations at three time points , with a sample of 255 pregnant women . The dependent variable was gestational weight , and the independent variable was dietary adequacy according to IOM recommendations for energy and macronutrient intake , categorized as adequate versus excessive intake . Statistical analyses were performed using mixed effects models for repeated measures . Pregnant women with excessive intake were 3.59 kg lighter at baseline ( SE = 0.92 kg ; p < 0.01 ) . On average , gestational weight varied by 1.83 kg ( SE = 0.40 kg ) per trimester , but pregnant women with excessive intake showed a higher weight increase of 1.70 kg ( SE = 0.43 kg ) during the same period as compared to women with adequate intake ( p < 0.01 ) . Women who adhered to IOM dietary recommendations gained less weight during pregnancy The present study is a secondary analysis of the ROLO study , a r and omised control trial of a low-glycaemic index ( GI ) diet in pregnancy to prevent the recurrence of fetal macrosomia . The objectives of the present study were to identify which women are most likely to respond to a low-GI dietary intervention in pregnancy with respect to three outcome measures : birth weight ; maternal glucose intolerance ; gestational weight gain ( GWG ) . In early pregnancy , 372 women had their mid-upper arm circumference recorded and BMI calculated . Concentrations of glucose , insulin and leptin were measured in early pregnancy and at 28 weeks . At delivery , infant birth weight was recorded and fetal glucose , C-peptide and leptin concentrations were measured in the cord blood . Women who benefited in terms of infant birth weight were shorter , with a lower education level . Those who maintained weight gain within the GWG guidelines were less overweight in both their first and second pregnancies , with no difference being observed in maternal height . Women who at 28 weeks of gestation developed glucose intolerance , despite the low-GI diet , had a higher BMI and higher glucose concentrations in early pregnancy with more insulin resistance . They also had significantly higher-interval pregnancy weight gain . For each analysis , women who responded to the intervention had lower leptin concentrations in early pregnancy than those who did not . These findings suggest that the maternal metabolic environment in early pregnancy is important in determining later risks of excessive weight gain and metabolic disturbance , whereas birth weight is mediated more by genetic factors . It highlights key areas , which warrant further interrogation before future pregnancy intervention studies , in particular , maternal education level and inter-pregnancy weight gain OBJECTIVES : ( 1 ) To describe the relative importance of gestational weight gain , postpartum exercise , food intake and breastfeeding to weight change from early pregnancy to 1 y postpartum ; and ( 2 ) to identify subgroups of women at greatest risk for major weight gain surrounding childbearing . DESIGN : A prospect i ve cohort study of women who registered for obstetrical care in a hospital and primary care clinic system serving a 10 county area of upstate New York . SUBJECTS : A total of 540 healthy adult women who gave birth to full-term singleton infants . MEASUREMENTS : Sociodemographic characteristics , exercise , food-related behaviors and breastfeeding were assessed using the medical record and a mailed question naire .  Body weight was measured at prenatal visits and 1 y postpartum . Weight retained and major weight gain ( 4.55 kg ) at 1 y postpartum were the main outcomes . ANALYSIS : Linear and logistic regression analyses were conducted . RESULTS : Women were on average 1.51±5.95 kg heavier at 1 y postpartum than they were in early pregnancy . Nearly 25 % of women experienced a major weight gain of 4.55 kg or more at 1 y postpartum . Gestational weight gain , exercise frequency , change in food intake and breastfeeding were each significantly related to postpartum weight retention . With the exception of breastfeeding , all of these factors were also associated with major weight gain .  Women under 20 y or over 40 y at delivery , and single women retained significantly more weight .  Lower income women with gestational weight gains above the Institute of Medicine ( IOM ) range retained 3.73 kg more than lower income women who gained within the range . They were also 4.7 times more likely to experience major weight gain with childbearing . The impact of exceeding the IOM gestational weight gain guidelines was three times greater in lower income women than it was in higher income women . CONCLUSION : Gestational weight gain , postpartum exercise frequency , and food intake are significantly associated with weight change from early pregnancy to 1 y postpartum and major weight gain with childbearing . Lower income women who gain more weight in pregnancy than the IOM recommends are at high risk for major weight gain with childbearing
Maternal fat intake ( n = 25 ) might be associated with gestational weight gain as suggested by observational studies , although the direction of this association might depend on specific types of fat ( e.g. , saturated fat ) .
Macronutrient intake was not consistently associated with the prevalence of inadequate or excessive gestational weight gain .
CONCLUSIONS The current literature provides evidence that energy intake is associated with gestational weight gain , but the roles of individual macronutrients are inconsistent .
BACKGROUND  Abnormal gestational weight gain is associated with unfavorable pregnancy outcomes .
Several risk factors have been identified , but the effect of macronutrient intake during pregnancy on gestational weight gain has not been systematic ally evaluated in both high-income countries and low- and middle-income countries .