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Excessive gestational weight gain is associated with deleterious health consequences for both mothers and children. However, women who experience excessive gestational weight gain early in their pregnancies are at unique risk for serious health conditions including gestational hypertension, preeclampsia, hyperglycemia, gestational diabetes, and fetal macrosomia. 

In a recent Journal of Obstetrics and Gynaecology study, investigators including Rachel Conlon, PhD (Research Instructor in Psychiatry), Marsha Marcus, PhD (Emeritus Professor of Psychiatry and Psychology), and senior author Michele Levine, PhD (Associate Professor of Psychiatry, Psychology, and Obstetrics, Gynecology, and Reproductive Sciences) documented the prevalence of—and identified factors associated with—excessive gestational weight gain during the first half of pregnancy among women with pre-pregnancy overweight or obesity. The team focused on sociodemographic, pregnancy-related, and psychiatric factors.

Study participants, 247 women older than age 14 who were 12–20 weeks pregnant, self-reported sociodemographic and pregnancy information, and their pre-pregnancy weight. During a baseline assessment, height and weight were measured, and pre-pregnancy body mass index (BMI) was calculated. Participants were categorized, based on their pre-pregnancy BMI, as having had an early gestational weight gain below, within, or exceeding Institute of Medicine (IOM) guidelines for total gestational weight gain. Per the IOM, excessive gestational weight gain was defined as weight gain of more than 25 lbs. among women with pre-pregnancy overweight, or more than 20 lbs. for women with pre-pregnancy obesity.

The investigators found wide variability in early gestational weight gain among women with pre-pregnancy overweight or obesity. Furthermore, although analyses showed race, income, and pre-pregnancy weight status to be related to gestational weight gain in the first half of pregnancy, only race and pre-pregnancy weight status remained significant in the multivariate model. Black women and women with pre-pregnancy obesity were specifically found to be the most likely to meeting or exceeding guidelines for total gestational weight gain by the first half of pregnancy.

“Rates of severe maternal morbidity among Black American women are higher than rates among other racial groups and these data contribute to growing evidence of disparities in maternal health,” said Dr. Levine. “The current findings also highlight the critical need to examine social determinants of maternal morbidity such as racial discrimination, health care access and food insecurity prior to and early in pregnancy that may be addressable to improve maternal health outcomes.”

Factors associated with early gestational weight gain among women with pre-pregnancy overweight or obesity
Emery RL, Benno MT, Conlon RPK, Marcus MD, Levine MD.
Journal of Obstetrics and Gynaecology 2020 Oct 20;1-6. doi: 10.1080/01443615.2020.1803242.