Association of Gestational Weight Gain With Maternal and Infant Outcomes: A Systematic Review and Meta-analysis

Excessive and insufficient gestational weight gain are associated with adverse pregnancy outcomes, including small for gestational age (SGA), large for gestational age (LGA), macrosomia, cesarean delivery, gestational diabetes mellitus (GDM), preeclampsia, postpartum weight retention, and offspring obesity. The Institute of Medicine (IOM; now known as the National Academy of Medicine) recommendations on gestational weight gain were developed in 1990 to guide clinical practice. These aimed to reduce the incidence of low-birth-weight babies and were based on a 1980 National Natality Survey of a largely white population. The updated IOM guidelines in 2009 incorporated World Health Organization (WHO) categories of maternal body mass index (BMI; for underweight, <18.5; normal weight, 18.5-24.9; overweight, 25-29.9; and obese, ≥30) and recommended less gestational weight gain for obese women. The 2009 guidelines identified maternal and infant relationships with gestational weight gain but were based on lower general population BMI with limited ethnic diversity. The 2009 IOM guidelines are endorsed by the American College of Obstetricians and Gynecologists, although they are not universally implemented.