Gestational weight loss may increase perinatal risks for women with obesity
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Key takeaways:
- Women with vs. without gestational weight loss had an increased risk for composite adverse perinatal outcomes.
- Risk for adverse perinatal outcomes increased with obesity severity.
Gestational weight loss may increase risks for adverse perinatal outcomes for women in all obesity classes, with the prevalence increasing with obesity severity, according to cohort study results published in Obesity.
“There is no tailoring of gestational weight-gain recommendations by severity of obesity, and guidelines lack any information regarding risks related to gestational weight loss among individuals with obesity,” Yanfang Guo, PhD, MSc, MB, adjunct professor in the clinical epidemiology program at the Ottawa Hospital Research Institute, and colleagues wrote. “Consequently, the Institute of Medicine together with health care providers has called for research to review gestational weight-management recommendations for the population with obesity. Because clinical trials of gestational weight loss are not ethical due to potential perinatal risks, a high-quality, population-based observational study is urgently needed to explore risks related to gestational weight loss.”
Guo and colleagues conducted a population-based retrospective cohort study using data from 157,205 women with obesity who had a singleton pregnancy between 2012 and 2020 as documented in birth registry data in Ontario, Canada. Researchers estimated the association between gestational weight loss and risks for adverse perinatal outcomes.
The primary outcome was a composite of adverse perinatal outcomes including perinatal death and neonatal morbidity.
Overall, 6.1% of women had gestational weight loss. Gestational weight-loss prevalence increased with obesity severity with 3.9% of women in class I, 7.3% in class II, 11.3% in class III, 14.7% in class IV and 15.6% in class V.
Less than 10% of women had the primary outcome (8.4%). Women with vs. without gestational weight loss had an increased risk for composite adverse perinatal outcomes (adjusted RR = 1.31; 95% CI, 1.22-1.39).
In the restricted cubic spline regression analysis, researchers observed a nonlinear U-shaped association between average weekly gestational weight changes and risk for composite adverse perinatal outcomes. Women had a higher risk for adverse perinatal outcomes when experiencing gestational weight loss or excessive weight gain.
“Given that gestational weight loss has been associated with an increased risk of a composite of adverse perinatal outcomes across all obesity classes, health care providers should exercise caution during gestational weight-management counseling and alert their patients about potential perinatal risks associated with gestational weight loss,” the researchers wrote. “This study highlights the importance of updating the 2009 U.S. Institute of Medicine gestational weight-gain guidelines to include tailored recommendation based on obesity classes.”
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