Adolescent Gestational
Pregnancy
Weight Gain and Maternal and
Infant Outcomes
Catherine Stevens-Simon, MD, Elizabeth R. McAnarney, MD \s=b\
of
Objective.\p=m-\Toclarify the advantages and disadvantages large gestational weight gain among pregnant adoles-
cents.
Design.\p=m-\Prospective,longitudinal survey. Setting.\p=m-\Adolescent-orientedmaternity program in Rochester, NY. Participants.\p=m-\Onehundred forty-one poor, black, pregnant 12- through 19-year-olds grouped according to rate of gestational weight gain. Slow weight gain was defined as weight gain of less than 0.23 kg per week; average, 0.23 to 0.4 kg per week; and rapid, more than 0.4 kg per week. Interventions.\p=m-\None. Measurements/Main Results.\p=m-\Infants of rapid weight\x=req-\ gainers were significantly larger than infants of slower weight-gainers but did not experience fewer perinatal complications than other infants. Infants of slow weight-gainers were significantly smaller than infants of average and rapid weight-gainers and experienced more perinatal complications than other infants. Adolescents who gained weight rapidly retained more weight and, therefore, were more often obese after pregnancy. Conclusions.\p=m-\Theadvantages of large weight gains for
pregnant adolescents and their infants are well\x=req-\ documented; this study demonstrates the importance of
balancing the long-term potential morbidity of maternal obesity against the benefits of enhanced fetal growth in formulating weight-gain recommendations for pregnant adolescents.
(AJDC. 1992;146:1359-1364)
gestational weight gain for pregnant adoles¬ total Optimal (ie, pattern of weight optimal growth during ad¬ gain necessary cents
the
amount and
fetal olescent pregnancies) is disputed.1 Because larger gesta¬ tional weight gains are associated with the birth of larger infants and because birth weight is the most important predictor of infant survival during the first 28 days of life, to
assure
Accepted for publication July 6,
1992. From the Division of Adolescent Medicine, University of Colorado Health Science Center, Denver (Dr Stevens-Simon), and the Division of Adolescent Medicine, University of Rochester (NY) Medical Center (Dr
McAnarney).
Presented in part at the annual meeting of the American Pediatric Society and the Society for Pediatric Research, New Orleans, La, April
29, 1991.
Reprints
not
available.
inadequate gestational weight gain causes more concern than does excessive gestational weight gain.1,2 This is par¬ ticularly true for pregnant adolescents, who, because of their smaller size and possibly incomplete growth, are of¬ ten advised to gain more weight during pregnancy than are pregnant adults.14 Among adults, interventions de¬ signed to augment gestational weight gain have been as¬ sociated with unanticipated neonatal morbidities and ma¬ ternal complications both during and after pregnancy.5"11 The objective of this study was to clarify the advantages and disadvantages of large gestational weight gain among pregnant adolescents.
We hypothesized that (1) Adolescents who gain more than 0.4 kg per week during pregnancy (>16 kg total) ex¬ perience more glucose intolerance and pregnancy-induced hypertension and undergo more cesarean sections than do adolescents who gain weight more slowly during preg¬ nancy. (2) Adolescents who gain more than 0.4 kg per week during pregnancy give birth to larger, healthier babies than do adolescents who gain weight more slowly during pregnancy. (3) Adolescents who gain more than 0.4 kg per week during pregnancy are more likely to be overweight after pregnancy than are adolescents who gain weight more
slowly during pregnancy.
SUBJECTS AND METHODS
Subjects
The data were collected as part of the Rochester Study of Ad¬ olescent Pregnancy. This was a 3-year prospective study of the relationship among maternal age, weight gain, and infant out¬ come in 141 consecutively enrolled, poor, black 12- through 19year-olds (A. B. Hollingshead, unpublished data, 1976). Details of the study design and study population have been published.12"16 Briefly, all of the study subjects obtained prenatal care before the 23rd week of gestation, were free of chronic diseases, did not reg¬ ularly take any medications, had no known uterine anomalies, and gave birth to living, single infants at Strong Memorial Hos¬ pital, Rochester, NY, between January 1986 and January 1989. The study protocol was approved by the Committee on Investigations Involving Human Subjects at the University of Rochester Medi¬ cal Center.
Data Collection of determining maternal weight gain collection consisted Data and weight loss during and after gestation and defining maternal and environmental characteristics that might influence the amount of weight gained and/or the outcome of pregnancy.
Downloaded From: http://archpedi.jamanetwork.com/ by a New York University User on 06/06/2015
Gestational
Weight Gain
At each prenatal visit, maternal weight was measured to the nearest 10th of a kilogram.13 Total gestational weight gain was defined as the difference between the last weight measured before delivery and the patient-reported prepregnant weight.1317 This absolute difference was converted to a rate of weight gain per week to adjust for the duration of the observation period.13 Cur¬ rent recommendations for gestational weight gain were used to develop three weight-gain groups: slow-gain group (0.4 kg gained per week; N=47; median weight gain, 0.5 kg per week [range, 0.4 to 0.983 kg per week]).4
Maternal weight was measured 24 to 48 hours after delivery and again 2 to 11 weeks after delivery. These weight determina¬ tions defined the subject's delivery weight and postpartum weight, respectively. Total postpartum weight loss was defined as the difference between the delivery weight and the postpartum weight; it was converted to a rate of weight loss per week to ad¬ just for differences in the duration of the postpartum observation period.13 Only 107 (76%) of the original 141 study patients were included in the analyses of postpartum weight loss; the remain¬ ing 34 were excluded because they failed to return after delivery to be reweighed. The 34 study subjects who were excluded from the postpartum analyses did not differ significantly in age, body size, or gestational weight gain from the 107 included subjects. The excluded study subjects were evenly distributed among the three weight gain groups; five (18%) of the 28 slow gainers, 16 (24%) of the 66 average gainers, and 13 (28%) of the 47 rapid gainers were excluded.
Weight
weight was defined as the difference between the postpartum weight and the self-reported prepregnant weight. Retained
Determinants of Weight Gain and
for Women, Infants, and Children;
Pregnancy Outcome
Additional data concerning potentially confounding anteced¬ ent differences among members of the three weight-gain groups were obtained prospectively from patient interviews and physi¬ cal and laboratory examinations. The factors of interest were ma¬ ternal and environmental characteristics that could affect the amount of gestational weight gain and/or the outcome of preg¬ nancy. They included the following maternal characteristics:
Chronologic age.1415 Prepregnant body size and body habitus: prepregnant weight (self-reported, verified by health records), height (mea¬ sured), body mass index [weight (kg) / square of height (m2)], and percentage of ideal weight for height (obesity was defined as a weight-for-height of >120% of the ideal weight-for-height).13-16'18-19 The results of two prior studies1317 suggest that self-reports con¬ cerning prepregnant weight are sufficiently accurate for studies of the weight-gaining behavior of pregnant adolescents in Roch¬ 1. 2.
ester, NY.13-17
3. Dietary habits: the study dietitian obtained information twice during pregnancy about food availability, eating habits, and intake of specific nutrients.16 4. Health habits: three types of health habits were studied: ad¬ equacy of prenatal care,20 self-reported energy expenditure (level of daily activity and exercise pattern), and substance use (selfreported cigarette smoking, alcohol use, and illicit drug use, the latter of which was verified by urine testing).21 5. Social history: information about socioeconomic status and about past and present personal, behavioral, school, and legal problems was also obtained twice during gestation along with more specific, quantitative measures of stress (Newton's 24-item version of the Cochrane and Robertson Life Events Scale22),
more
objective
evidence of
marijuana use during pregnancy; and fewer supportive adults. By contrast, we found that those who gained weight rapidly reported more depressive symptoms and alcohol consumption both before and during pregnancy and were more visits than were other study subjects.
Evaluation of
Weight Loss
Retained
depression (Center for Epidemiologie Studies depression scale23) and social support (Family Apgar Scale24). We have already reported the similarities and differences be¬ tween the dietary and health habits and the social histories of subjects in the three weight-gain groups.16 Briefly, statistically significant (P
Pregnancy
Weight Gain and Maternal and
Infant Outcomes
Catherine Stevens-Simon, MD, Elizabeth R. McAnarney, MD \s=b\
of
Objective.\p=m-\Toclarify the advantages and disadvantages large gestational weight gain among pregnant adoles-
cents.
Design.\p=m-\Prospective,longitudinal survey. Setting.\p=m-\Adolescent-orientedmaternity program in Rochester, NY. Participants.\p=m-\Onehundred forty-one poor, black, pregnant 12- through 19-year-olds grouped according to rate of gestational weight gain. Slow weight gain was defined as weight gain of less than 0.23 kg per week; average, 0.23 to 0.4 kg per week; and rapid, more than 0.4 kg per week. Interventions.\p=m-\None. Measurements/Main Results.\p=m-\Infants of rapid weight\x=req-\ gainers were significantly larger than infants of slower weight-gainers but did not experience fewer perinatal complications than other infants. Infants of slow weight-gainers were significantly smaller than infants of average and rapid weight-gainers and experienced more perinatal complications than other infants. Adolescents who gained weight rapidly retained more weight and, therefore, were more often obese after pregnancy. Conclusions.\p=m-\Theadvantages of large weight gains for
pregnant adolescents and their infants are well\x=req-\ documented; this study demonstrates the importance of
balancing the long-term potential morbidity of maternal obesity against the benefits of enhanced fetal growth in formulating weight-gain recommendations for pregnant adolescents.
(AJDC. 1992;146:1359-1364)
gestational weight gain for pregnant adoles¬ total Optimal (ie, pattern of weight optimal growth during ad¬ gain necessary cents
the
amount and
fetal olescent pregnancies) is disputed.1 Because larger gesta¬ tional weight gains are associated with the birth of larger infants and because birth weight is the most important predictor of infant survival during the first 28 days of life, to
assure
Accepted for publication July 6,
1992. From the Division of Adolescent Medicine, University of Colorado Health Science Center, Denver (Dr Stevens-Simon), and the Division of Adolescent Medicine, University of Rochester (NY) Medical Center (Dr
McAnarney).
Presented in part at the annual meeting of the American Pediatric Society and the Society for Pediatric Research, New Orleans, La, April
29, 1991.
Reprints
not
available.
inadequate gestational weight gain causes more concern than does excessive gestational weight gain.1,2 This is par¬ ticularly true for pregnant adolescents, who, because of their smaller size and possibly incomplete growth, are of¬ ten advised to gain more weight during pregnancy than are pregnant adults.14 Among adults, interventions de¬ signed to augment gestational weight gain have been as¬ sociated with unanticipated neonatal morbidities and ma¬ ternal complications both during and after pregnancy.5"11 The objective of this study was to clarify the advantages and disadvantages of large gestational weight gain among pregnant adolescents.
We hypothesized that (1) Adolescents who gain more than 0.4 kg per week during pregnancy (>16 kg total) ex¬ perience more glucose intolerance and pregnancy-induced hypertension and undergo more cesarean sections than do adolescents who gain weight more slowly during preg¬ nancy. (2) Adolescents who gain more than 0.4 kg per week during pregnancy give birth to larger, healthier babies than do adolescents who gain weight more slowly during pregnancy. (3) Adolescents who gain more than 0.4 kg per week during pregnancy are more likely to be overweight after pregnancy than are adolescents who gain weight more
slowly during pregnancy.
SUBJECTS AND METHODS
Subjects
The data were collected as part of the Rochester Study of Ad¬ olescent Pregnancy. This was a 3-year prospective study of the relationship among maternal age, weight gain, and infant out¬ come in 141 consecutively enrolled, poor, black 12- through 19year-olds (A. B. Hollingshead, unpublished data, 1976). Details of the study design and study population have been published.12"16 Briefly, all of the study subjects obtained prenatal care before the 23rd week of gestation, were free of chronic diseases, did not reg¬ ularly take any medications, had no known uterine anomalies, and gave birth to living, single infants at Strong Memorial Hos¬ pital, Rochester, NY, between January 1986 and January 1989. The study protocol was approved by the Committee on Investigations Involving Human Subjects at the University of Rochester Medi¬ cal Center.
Data Collection of determining maternal weight gain collection consisted Data and weight loss during and after gestation and defining maternal and environmental characteristics that might influence the amount of weight gained and/or the outcome of pregnancy.
Downloaded From: http://archpedi.jamanetwork.com/ by a New York University User on 06/06/2015
Gestational
Weight Gain
At each prenatal visit, maternal weight was measured to the nearest 10th of a kilogram.13 Total gestational weight gain was defined as the difference between the last weight measured before delivery and the patient-reported prepregnant weight.1317 This absolute difference was converted to a rate of weight gain per week to adjust for the duration of the observation period.13 Cur¬ rent recommendations for gestational weight gain were used to develop three weight-gain groups: slow-gain group (0.4 kg gained per week; N=47; median weight gain, 0.5 kg per week [range, 0.4 to 0.983 kg per week]).4
Maternal weight was measured 24 to 48 hours after delivery and again 2 to 11 weeks after delivery. These weight determina¬ tions defined the subject's delivery weight and postpartum weight, respectively. Total postpartum weight loss was defined as the difference between the delivery weight and the postpartum weight; it was converted to a rate of weight loss per week to ad¬ just for differences in the duration of the postpartum observation period.13 Only 107 (76%) of the original 141 study patients were included in the analyses of postpartum weight loss; the remain¬ ing 34 were excluded because they failed to return after delivery to be reweighed. The 34 study subjects who were excluded from the postpartum analyses did not differ significantly in age, body size, or gestational weight gain from the 107 included subjects. The excluded study subjects were evenly distributed among the three weight gain groups; five (18%) of the 28 slow gainers, 16 (24%) of the 66 average gainers, and 13 (28%) of the 47 rapid gainers were excluded.
Weight
weight was defined as the difference between the postpartum weight and the self-reported prepregnant weight. Retained
Determinants of Weight Gain and
for Women, Infants, and Children;
Pregnancy Outcome
Additional data concerning potentially confounding anteced¬ ent differences among members of the three weight-gain groups were obtained prospectively from patient interviews and physi¬ cal and laboratory examinations. The factors of interest were ma¬ ternal and environmental characteristics that could affect the amount of gestational weight gain and/or the outcome of preg¬ nancy. They included the following maternal characteristics:
Chronologic age.1415 Prepregnant body size and body habitus: prepregnant weight (self-reported, verified by health records), height (mea¬ sured), body mass index [weight (kg) / square of height (m2)], and percentage of ideal weight for height (obesity was defined as a weight-for-height of >120% of the ideal weight-for-height).13-16'18-19 The results of two prior studies1317 suggest that self-reports con¬ cerning prepregnant weight are sufficiently accurate for studies of the weight-gaining behavior of pregnant adolescents in Roch¬ 1. 2.
ester, NY.13-17
3. Dietary habits: the study dietitian obtained information twice during pregnancy about food availability, eating habits, and intake of specific nutrients.16 4. Health habits: three types of health habits were studied: ad¬ equacy of prenatal care,20 self-reported energy expenditure (level of daily activity and exercise pattern), and substance use (selfreported cigarette smoking, alcohol use, and illicit drug use, the latter of which was verified by urine testing).21 5. Social history: information about socioeconomic status and about past and present personal, behavioral, school, and legal problems was also obtained twice during gestation along with more specific, quantitative measures of stress (Newton's 24-item version of the Cochrane and Robertson Life Events Scale22),
more
objective
evidence of
marijuana use during pregnancy; and fewer supportive adults. By contrast, we found that those who gained weight rapidly reported more depressive symptoms and alcohol consumption both before and during pregnancy and were more visits than were other study subjects.
Evaluation of
Weight Loss
Retained
depression (Center for Epidemiologie Studies depression scale23) and social support (Family Apgar Scale24). We have already reported the similarities and differences be¬ tween the dietary and health habits and the social histories of subjects in the three weight-gain groups.16 Briefly, statistically significant (P
