Effects of Gestational Weight Gain on Delivery Outcomes in an Obese, Low-Income Population.

OBJECTIVE: To examine the effects of weight gain/loss on delivery outcomes stratified by class of obesity in an obese, low-income, predominantly minority population. METHODS: A retrospective review of a cohort of 1428 women receiving care at a large Medicaid clinic from 2013 to 2016 with pregravid body mass index ≥30 was conducted. Multinomial logistic regression analysis was used to compare differences in gestational weight change to the primary outcomes of birth-weight percentile and delivery type and secondary outcomes of preterm delivery, preterm labor, gestational diabetes mellitus, and gestational hypertension. RESULTS: Obesity class 1 patients who lost weight were more likely to have a small-for-gestational-age (SGA) infant compared with those who had recommended weight gain. Obesity classes 2 and 3 patients had no statistically significant increase in SGA infants with weight loss or weight gain below current recommendations. Obesity classes 1 and 2 patients with weight loss had a statistically significant increase in both preterm delivery and preterm labor; however, class 3 patients did not. Obesity class 3 patients who lost weight were significantly more likely to have gestational diabetes mellitus. CONCLUSIONS: Obesity class 3 women may benefit from less weight gain than current recommendations without increasing their risk of SGA infants or preterm birth, especially if gestational diabetes mellitus is present.

Social Determinants of Gestational Weight Gain in an Obese, Low-Income Population.

OBJECTIVE: To examine how social support factors affect compliance with gestational weight gain (GWG) recommendations in an obese, low-income, predominantly minority population. STUDY DESIGN: A retrospective cohort of 772 pregnant women with body mass index > 30 was reviewed. Univariate and multinomial logistic regression analyses were used to compare GWG with pregnancy planning, relationship status, participation in group prenatal care, nutritional education, and demographic factors. Subgroup analysis was performed to determine if differences existed in entry into prenatal care. RESULTS: Planned nature of pregnancy, relationship status, nutritional education, and group prenatal care did not significantly affect GWG. Women with planned pregnancies and in group prenatal care had their first appointment during the first trimester at a higher rate than those with unplanned pregnancy and in traditional care, respectively. Regardless of timing of nutrition consult, GWG was not affected. Nulliparous patients and Class 1 obese patients were more likely to have excessive GWG. CONCLUSION: Social support factors in this study did not individually affect compliance with GWG recommendations in a low-income, obese pregnant population, although some factors were associated with earlier entry to prenatal care. Multimodal, longitudinal programs are likely necessary to achieve increased compliance with GWG recommendations in this population.