Association of Second and Third Trimester Weight Gain in Pregnancy with Maternal and Fetal Outcomes.docVIP

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Association of Second and Third Trimester Weight Gain in Pregnancy with Maternal and Fetal Outcomes.doc

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Association of Second and Third Trimester Weight Gain in Pregnancy with Maternal and Fetal Outcomes

AssociationofSecondandThirdTrimesterWeightGain inPregnancywithMaternalandFetalOutcomes MicheleDrehmer1*,BruceBartholowDuncan1,GilbertoKac2,MariaIne?sSchmidt1 1GraduateStudiesPrograminEpidemiology,DepartmentofSocialMedicine,FederalUniversityofRioGrandedoSul,PortoAlegre,Brazil,2DepartmentofSocialand AppliedNutrition,RiodeJaneiroFederalUniversity,Josue′ deCastroNutritionInstitute,RiodeJaneiro,Brazil Abstract Objective:Toinvestigatetheassociationbetweenweeklyweightgain,duringthesecondandthirdtrimesters,classified accordingtothe2009InstituteofMedicine(IOM/NRC)recommendations,andmaternalandfetaloutcomes. Methods:Gestationalweightgainwasevaluatedin2,244pregnantwomenoftheBrazilianStudyofGestationalDiabetes (EstudoBrasileirodoDiabetesGestacional–EBDG).Outcomeswerecesareandelivery,pretermbirthandsmallorlargefor gestationalagebirth(SGA,LGA).Associationsbetweeninadequateweightgainandoutcomeswereestimatedusingrobust Poisson regression adjusting for pre-pregnancy body mass index, trimester-specific weight gain, age, height, skin color, parity,education,smoking,alcoholconsumption,gestationaldiabetesandhypertensivedisordersinpregnancy. Results:Infullyadjustedmodels,inthesecondtrimester,insufficientweightgainwasassociatedwithSGA(relativerisk[RR] 1.72, 95% confidence interval [CI] 1.26–2.33), and excessive weight gain with LGA (RR 1.64, 95% CI 1.16–2.31); in third trimester,excessiveweightgainwithpretermbirth(RR1.70,95%CI1.08–2.70)andcesareandelivery(RR1.21,95%CI1.03– 1.44). Women with less than recommended gestational weight gain in the 2nd trimester had a lesser risk of cesarean deliveries(RR0.82,95%CI0.71–0.96)thanwomenwithadequategestationalweightgaininthistrimester. Conclusion: Though insufficient weight gain in the 3rd trimester was not associated with adverse outcomes, other deviations from recommended weight gain during second and third trimester were associated with adverse pregnancy outcomes. These findings support, in part, the 2009 IOM/NRC recommendations for nutrit