Associations of Gestational Weight Gain with Preterm Birth among Underweight and Normal Weight Women

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Associations of Gestational Weight Gain with Preterm Birth among Underweight and Normal Weight Women Andrea J. Sharma • Kimberly K. Vesco • Joanna Bulkley William M. Callaghan • F. Carol Bruce • Jenny Staab • Mark C. Hornbrook • Cynthia J. Berg



Ó Springer Science+Business Media New York (outside the USA) 2015

Abstract Studies report increased risk of preterm birth (PTB) among underweight and normal weight women with low gestational weight gain (GWG). However, most studies examined GWG over gestational periods that differ by term and preterm which may have biased associations because GWG rate changes over the course of pregnancy. Furthermore, few studies have specifically examined the amount and pattern of GWG early in pregnancy as a predictor of PTB. Within one integrated health care delivery system, we examined 12,526 singleton pregnancies between 2000 and 2008 among women with a body mass index \25 kg/m2, who began prenatal care in the first trimester and delivered a live-birth [28 weeks gestation. Using self-reported pregravid weight and serial measured antenatal weights, we estimated GWG and the area under the GWG curve (AUC; an index of pattern of GWG) during the first and second trimesters of pregnancy (B28 weeks). Using logistic regression adjusted for covariates, we examined associations between each GWG Disclaimer The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. A. J. Sharma (&)  W. M. Callaghan  F. C. Bruce  C. J. Berg Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, MS F-74, Atlanta, GA 30341, USA e-mail: [email protected] A. J. Sharma U.S. Public Health Service Commissioned Corps, Atlanta, GA, USA K. K. Vesco  J. Bulkley  J. Staab  M. C. Hornbrook The Center for Health Research, Northwest/Hawai‘i/Southeast, Kaiser Permanente Northwest, Portland, OR, USA

measure, categorized into quartiles, and PTB (\37 weeks gestation). We additionally examined associations according to the reason for PTB by developing a novel algorithm using diagnoses and procedure codes. Low GWG in the first and second trimesters was not associated with PTB [aOR 1.11, (95 % CI 0.90, 1.38) with GWG \8.2 kg by 28 weeks compared to pregnancies with GWG [12.9]. Similarly, pattern of GWG was not associated with PTB. Our findings do not support an association between GWG in the first and second trimester and PTB among underweight and normal weight women. Keywords Pregnancy  Gestational weight gain  Weight gain measures  Preterm birth Abbreviations AOR Adjusted odds ratio BMI Body mass index GA Gestational age CI Confidence interval GWG Gestational weight gain ICD9-CM International classification of diseases, 9th revision, clinical modification

Preterm birth (\37 weeks of gestation) is the leading predictor of infant death and long-term neurological disabilities in children [1]. With one