Examining Gestational Weight Gain Using Two Surveillance Systems: Prevalence, Determinants and Quality of Maternal Weight Data Open Access

Abstract

Gestational weight gain is associated with important health consequences for mothers and infants. In 2009, the Institute of Medicine (IOM) revised gestational weight gain recommendations, which are specific to a mother's pre-pregnancy body mass index (BMI). Despite health outcomes associated with gestational weight gain, surveillance data are lacking in the United States and little is known about factors influencing weight gain outside recommendations.

To examine the prevalence of gestational weight gain below, within or above the 2009 recommendations (referred to as inadequate, appropriate and excessive, respectively), we combined 2013 birth certificate data from 43 jurisdictions with 2012 data from five states participating in the Pregnancy Risk Assessment Monitoring System (PRAMS). Among women delivering full-term, singleton infants, 48% had excessive gain, whereas 20% had inadequate and 32% had appropriate. Weight gain varied by jurisdiction: 21 had a prevalence of inadequate gain of 20% or more, whereas 17 had a prevalence of excessive gain of 50% or more.

Next, we examined maternal characteristics associated with gestational weight gain using data from 28 PRAMS states. Notably, pre-pregnancy BMI was strongly associated with excessive gain: overweight and obese women had nearly three-times the odds of excessive gain compared with normal weight. Among four PRAMS states, we examined healthcare provider advice about gestational weight gain and found 26% of women reported receiving advice consistent with 2009 IOM recommendations. Compared with women who reported receiving consistent advice, those receiving advice below or above recommendations were more likely to have inadequate or excessive gain, respectively.

Finally, we compared pre-pregnancy BMI and gestational weight gain variables from the birth certificate or PRAMS to variables from medical records to evaluate data quality. Overall, 87% and 84% of women were categorized into the same pre-pregnancy BMI category by the birth certificate or PRAMS, respectively, compared with medical record; 70% were categorized into the same gestational weight gain category by the birth certificate compared with medical record.

Our results signal a need for interventions that promote appropriate gestational weight gain and, importantly, strategies may need to focus beyond mothers to include healthcare providers. Ongoing, national surveillance of gestational weight gain will be needed to evaluate future intervention efforts.

Table of Contents

Chapter 1 - Introduction................................................................................................................... 9

Chapter 2 - Literature Review.......................................................................................................... 17

Overview of Gestational Weight Gain........................................................................................ 18

Overview of Gestational Weight Gain Recommendations.............................................................. 19

Prevalence of Gestational Weight Gain ..................................................................................... 21

Overview of Prevalence Estimates .................................................................................. 21

Birth Certificate Data .................................................................................................... 22

PRAMS Data ................................................................................................................ 24

Potential Determinants of Gestational Weight Gain......................................................................26

Overview of Potential Determinants................................................................................. 26

Maternal Characteristics ................................................................................................ 27

Healthcare Provider Advice............................................................................................. 32

Quality of Maternal Height and Weight Data.............................................................................. 33

Chapter 3 - Extended Methods ........................................................................................................ 44

The National Vital Statistics System Birth Data.......................................................................... 44

Key Variables............................................................................................................... 46

The Pregnancy Risk Assessment Monitoring System .................................................................. 47

PRAMS Sample Selection and Related Statistical Considerations ......................................... 48

The PRAMS Questionnaire ............................................................................................. 50

Key Variables............................................................................................................... 51

The PRAMS Data Quality Study .............................................................................................. 54

Key Variables....................................................................................................................... 54

Chapter 4 - Gestational Weight Gain -- 46 States, New York City and District of

Columbia, 2012 and 2013 ............................................................................................................. 60

Chapter 5 - Prevalence and Characteristics Associated With Gestational Weight Gain

Adequacy .................................................................................................................................... 61

Chapter 6 - Achieving Appropriate Gestational Weight Gain: the Role of Healthcare

Provider Advice ............................................................................................................................ 62

Abstract .............................................................................................................................. 63

Introduction......................................................................................................................... 65

Materials and Methods........................................................................................................... 66

Results................................................................................................................................ 71

Comment............................................................................................................................ 74

Tables and Figures ............................................................................................................... 82

Supplementary Tables and Figures ......................................................................................... 91

Chapter 7 - Pre-Pregnancy Body Mass Index and Gestational Weight Gain: How Well do

the Birth Certificate and Pregnancy Risk Assessment Monitoring System Agree with the

Medical Record? ........................................................................................................................... 94

Abstract ............................................................................................................................. 95

Introduction........................................................................................................................ 96

Methods............................................................................................................................. 97

Results............................................................................................................................. 101

Discussion ....................................................................................................................... 104

Tables and Figures ............................................................................................................ 111

Supplementary Tables........................................................................................................ 116

Chapter 8 - Summary, Implications and Conclusions....................................................................... 147

Main Findings ................................................................................................................... 147

Strengths and Limitations .................................................................................................. 150

Public Health Implications and Future Directions.................................................................... 154

Summary ........................................................................................................................ 162

About this Dissertation

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School	Laney Graduate School
Department	Nutrition and Health Sciences
Degree	PhD
Submission	Dissertation
Language	English
Research Field	Health Sciences, Nutrition Health Sciences, Obstetrics and Gynecology Health Sciences, Epidemiology
Keyword	pregnancy gestational weight gain nutrition
Committee Chair / Thesis Advisor	Sharma, Andrea, Centers for Disease Control and Prevention Ramakrishnan, Usha, Emory University
Committee Members	Schieve, Laura, Centers for Disease Control and Prevention Lash, Timothy L, Emory University Stein, Aryeh D, Emory University

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