Excessive gestational weight gain common among military health beneficiaries
Click Here to Manage Email Alerts
Key takeaways:
-
Excessive gestational weight gain was found among 75% of pregnant women who were TRICARE beneficiaries in 2018 and 2019.
-
Prepregnancy overweight and obesity increased odds for excessive gestational weight gain.
Data were derived from Krukowski RA, et al. Obesity. 2024;doi:10.1002/oby.24016.
Gestational weight gain that exceeded National Academy of Medicine guidelines occurred among 75% of pregnant women who were TRICARE beneficiaries and gave birth in 2018 or 2019, according to findings published in Obesity.
“This study demonstrates that the rates of gestational weight gain above the national guidelines among military health care beneficiaries are concerning, given the relationship between excessive gestational weight gain and maternal and fetal health complications,” Rebecca A. Krukowski, PhD, professor of public health sciences in the School of Medicine at University of Virginia, told Healio. “There were significant consequences for women who had gestational weight gain above the national guidelines, as women with pregnancy weight gain above the national guidelines were three times more likely to have substantial postpartum weight retention of more than 10 lb. Postpartum weight retention may make it challenging to regain the required fitness levels for active-duty women and for these women to maintain their career in the military.”
Krukowski and colleagues collected data from the Military Health System Mart from 48,391 TRICARE beneficiaries who gave birth to a single infant in 2018 or 2019. Prepregnancy weight was assessed from 52 weeks before conception to 4 weeks after conception. The weight closest to each woman’s delivery date was defined as maternal delivery weight. Gestational weight gain was assessed by comparing prepregnancy weight to delivery weight. National Academy of Medicine guidelines were used to define inadequate, normal or excessive gestational weight gain. Preeclampsia, pregnancy-induced hypertension, gestational diabetes and cesarean delivery were assessed as maternal clinical outcomes. Neonatal outcomes included intrauterine growth restriction, small for gestational age, large for gestational age, low birth weight and neonatal ICU admission. Postpartum weight was assessed at 12 months. Substantial postpartum weight retention was defined as an increase of at least 10 lb in postpartum weight compared with prepregnancy weight.
Of the study group, 75% had excessive gestational weight gain and 42% had substantial postpartum weight retention. Krukowski said both figures were higher than what previous studies have found in nonmilitary populations.
“Surprisingly, gestational weight gain above the national guidelines was particularly prevalent among women who were active-duty personnel, compared to spouses and other family members of active-duty personnel,” Krukowski said. “These higher rates may be surprising given the lower rates of overweight and obesity in the active-duty population as well as the higher levels of physical activity.”
Excessive gestational weight tied to complications
Compared with women with prepregnancy normal weight, those with overweight (OR = 2.26; 95% CI, 2.06-2.47) or obesity (OR = 1.41; 95% CI, 1.28-1.56) before pregnancy were more likely to have excessive gestational weight gain. Prepregnancy overweight (OR = 1.18; 95% CI, 1.04-1.34) and obesity (OR = 2.69; 95% CI, 2.39-3.03) were also associated with higher odds for inadequate gestational weight gain compared with normal weight, according to the study.
Substantial postpartum weight retention was more likely for women with overweight (OR = 1.41; 95% CI, 1.32-1.51) or obesity (OR = 1.14; 95% CI, 1.05-1.23) before pregnancy compared with women with normal weight. Excessive gestational weight gain was linked to increased odds for substantial postpartum weight retention compared with normal gestational weight gain (OR = 3.57; 95% CI, 3.14-4.06), whereas women with inadequate gestational weight gain had a lower likelihood for postpartum weight retention (OR = 0.72; 95% CI, 0.6-0.86), the researchers reported.
Women with inadequate gestational weight gain had higher odds for gestational diabetes and for intrauterine growth restriction or small for gestational age infants compared with those with normal gestational weight gain. Women with excessive gestational weight gain were more likely to have preeclampsia, pregnancy-induced hypertension or cesarean delivery and large for gestational age infants than women with normal gestational weight gain, according to the researchers. Excessive gestational weight gain was also associated with lower likelihood for gestational diabetes, and children of mothers with excessive gestational weight gain were less likely to have intrauterine growth restriction, low birth weight or small for gestational age than children of mothers with normal gestational weight gain.
Women with overweight or obesity before pregnancy were more likely to develop preeclampsia, pregnancy-induced hypertension, gestational diabetes and cesarean delivery and to have children who were large for gestational age or admitted to the neonatal ICU, the researchers reported.
Programs to manage gestational weight
Krukowski said gestational weight management programs may help reduce the odds of excessive gestational weight gain. Programs include self-monitoring weight gain trajectory, moderate increases of caloric intake during the second and third trimester and physical activity goals.
“Further research is needed to determine how to implement gestational weight gain programs in the clinical setting in a sustainable way,” Krukowski said. “These results also emphasize the importance of weight management before, during and after pregnancy for military populations, given the high health care costs of weight-related health complications affecting the mother and baby as well as the importance of maintaining fitness in the active-duty population.”
For more information:
Rebecca A. Krukowski, PhD, can be reached at bkrukowski@virginia.edu.
Collapse
Click Here to Manage Email Alerts