The Occurrence of Small for Gestational Age Infants and
Perinatal and Maternal Outcomes in Normal and Poor
Maternal Weight Gain Singleton Pregnancies
Chutima Jariyapitaksakul MD*,
Yuen Tannirandorn MD*
Affiliation :
* Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
Objective : To assess the occurrence of small for gestational age (SGA) infants and perinatal and maternal outcomes in
singleton pregnancies with normal and poor maternal weight gain.
Material and Method: Pregnant women with normal pre-pregnancy body mass index (BMI) and attending the antenatal
clinic at King Chulalongkorn Memorial Hospital (KCMH) between 2006 and 2010 were eligible for the present study. The
Thai population guidelines recommend a total weight gain of 10 to16 kg or ≥0.27 kg/week during pregnancy. In contrast,
in 2009 the Institute of Medicine (IOM) guidelines recommended a total weight gain of 11.5 to16 kg or ≥0.31 kg/week. Our
patients were analyzed using both sets of guidelines based on a normal pre-pregnancy BMI (18.5-24.9 kg/m2). SGA infants,
perinatal outcomes, and maternal outcomes were compared between women whose weight gain met or exceeded the
recommendations (normal weight gain) and women who did not meet these recommendations (poor weight gain).
Results : A case-control of 1,152 singleton pregnancies was used for the analyses. Women with poor weight gain by the
recommendation of the Thai population guidelines were significantly associated with SGA infants (1% in normal weight
gain group and 2.6% in poor weight gain group adjusted odd ratio (aOR) 2.77, 95% confidence interval (CI) 1.06 to 7.28),
preterm births (aOR 2.20, 95% CI 1.43 to 3.38), and low birth weight (LBW) infants (aOR 2.57, 95% CI 1.60 to 4.13).
Women with poor weight gain by the recommendation in the 2009 IOM guidelines were significantly associated with
preterm births (aOR 2.04, 95% CI 1.31 to 3.17), LBW infants (aOR 2.75, 95% CI 1.66 to 4.55), but not SGA infants (aOR1.97,
95% CI 0.74 to 5.20). Maternal weight gain <0.27 kg/week (Thai guidelines) was more likely to associate with SGA infants
than maternal weight gain <0.31 kg/week (2009 IOM guidelines). Women with normal weight gain by both recommendations
were more likely to have pregnancy-induced hypertension and less likely to have gestational diabetes compared with women
with poor weight gain.
Conclusion : Poor maternal weight gain during pregnancy was associated with SGA infants, preterm births, and LBW
infants. The Thai guidelines were a better predictor of SGA infants. The 2009 IOM guidelines should be used with caution
in Thai patients.
Keywords : Maternal weight gain, Small for gestational age (SGA), Poor weight gain
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