Association between weight gain during 24 gestational weeks and pregnancy outcomes: A retrospective study in Chinese population

Association between weight gain during 24 gestational weeks and pregnancy outcomes: A retrospective study in Chinese population | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Association between weight gain during 24 gestational weeks and pregnancy outcomes: A retrospective study in Chinese population Xiao-Wei Wei, Chuan-Mei Qin, De-Cui Cheng, Dong-Mei Zhou, Shi-Tong Zhan, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2954352/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Although the association between inadequate or excessive gestational weight gain (GWG) and adverse pregnancy outcomes has been investigated in China, most studies use the Institute of Medicine (IOM) guidelines, which might not be suitable for Chinese women characteristics. Besides, studies exploring association between GWG in the second trimester and pregnancy outcomes are relatively few. Methods A total of 976 cases of live-birth singleton pregnancies at the Shanghai General Hospital were included in this retrospective observational study. Patients were classified into three groups including GWG during 24 gestational weeks (G24WG) within, below and above the Standard of Recommendation for Weight Gain during Pregnancy Period published by Maternal and Child Health Standards Professional Committee of National Health Commission (NHC), China PR in 2022 (2022 Chinese GWG guidelines), which specifies the recommended value of weight gain of natural singleton pregnancy in China. Binary logistic regression was used to estimate the adjusted odds ratio (OR) and 95% confidence intervals (CIs) of adverse pregnancy outcomes among three G24WG groups. Results Of the 976 women analyzed, 12.6% had G24WG below the 2022 Chinese GWG guidelines, while 37.2% had G24WG above the 2022 Chinese GWG guidelines. Women with G24WG below the 2022 Chinese GWG guidelines had a higher risk of Small for Gestational Age (SGA, Adjusted OR = 2.690, 95% CI: 1.334–5.427, P = 0.006) and a lower risk of Large for Gestational Age (LGA, Adjusted OR = 0.435, 95% CI: 0.228–0.829, P = 0.011) than women who had G24WG within the 2022 Chinese GWG guidelines. Conclusions G24WG is a strong predictor of newborn anthropometric outcomes and help doctors provide appropriate nutritional counseling for pregnant women in China. gestational weight gain small for gestational age large for gestational age preeclampsia Introduction Weight management before and during pregnancy plays an important role in prenatal care because both maternal pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) are associated with increased risks of maternal and fetal metabolic diseases or other adverse pregnancy outcomes( 1 , 2 ). Generally, GWG in the first trimester is mainly attributed to expansion of maternal blood volume and early placental development, instead of fat deposits, while physiologic weight gain at term is comprised of fetus, fat stores, increased blood volume, increased extravascular fluid volume, amniotic fluid, breast enlargement, uterine hypertrophy and placenta( 3 , 4 ). GWG reflects the growth of the fetus and the health status of the mother( 5 ). Most of the GWG takes place in the second and third trimesters, contributing to about 80–90% of the total GWG( 5 ). Women with inadequate GWG tend to have increased risks of low birth weight( 6 ), small for gestational age (SGA)( 7 ) and preterm birth( 8 ), while excessive GWG in pregnant women has been associated with the occurrence of gestational diabetes mellitus (GDM)( 9 ), pre-eclampsia (PE)( 10 ), large for gestational age (LGA)( 11 ), and caesarean section( 12 ). In 2009, the Institute of Medicine (IOM) published specific recommendations regarding the optimal GWG for each of the pre-pregnancy BMI groups, which have been widely adopted by studies exploring the relationship between adverse pregnancy outcomes and GWG since then( 5 ). A systematic review and meta-analysis including over 1 million pregnant women suggested that GWG was above the IOM recommended weight gain range in 47% of pregnancies and 23% of pregnant women had GWG less than IOM recommendations( 8 ). Despite the prevalence of IOM guideline, the recommendations cannot be applicable all over the world mainly due to different ethnicities and lifestyles( 13 ). The IOM guideline’s generalizability to Asian women was limited because it was originally designed based on the Caucasian population data( 14 , 15 ). For example, the IOM recommended GWG range may be too great for Chinese pregnant women regarding each BMI category( 16 ). Thus it is necessary to study the correlation between GWG and pregnancy outcomes in Chinese pregnant women using GWG guidelines designed specific for Chinese population. What’s more, Studies exploring associations of second-trimester GWG with perinatal outcomes have been relatively few. In this study, we will study the effect of GWG during 24 gestational weeks on pregnancy outcomes based on the Standard of Recommendation for Weight Gain during Pregnancy Period published by Maternal and Child Health Standards Professional Committee of National Health Commission (NHC), China PR in 2022( 17 ). Methods Study population In this retrospective study, the hospital records of a total of 1000 women giving birth at the Department of Obstetrics, Shanghai General Hospital between January 2021 and December 2021 were abstracted in a standardized fashion. Information about anthropological characteristics, obstetrical risk factors, delivery methods and maternal and neonatal outcomes were collected during prenatal visits, at time of delivery and at infant hospital discharge. Prenatal system at the Shanghai General Hospital includes scheduled appointments (eight prenatal visits and five ultrasounds on average) starting from 6 to 13 weeks of gestation. The typical schedule of routine antenatal visits are at weeks 11–13, week 24, week 28, and weeks 31–32 and, thereafter, every second week until birth. All women included in this study must be ≥ 18 years old and have a live-birth singleton pregnancy. Besides, all fetuses need to be delivered at ≥ 28 weeks of gestation and have a birth weight > 1,000 g. Among the 1,000 women who met the inclusion criteria, 21 cases without pre-pregnancy body mass index (BMI; kg/m2) or no gestational weight gain measurement and 3 cases complicated by the congenital malformation of the fetus or stillbirth were excluded. Ultimately, 976 cases were included in the analysis. This study was approved by the Ethics Committee of the Shanghai General Hospital. Informed consent was not required due to the retrospective nature of the study design. BMI and weight gain The eligible data collected in this study were obtained from self-reported pre-pregnancy weight (kg) and height (cm), while weight at gestational week 24 was routinely measured using the available electronic weighing device with a calibrated scale of 0.1 kg in the hospital. Pre-pregnancy body mass index (BMI; kg/m 2 ) was calculated as pre-pregnancy weight (kg) divided by height (m) 2 , while weight gain during 24 gestational weeks was calculated as weight at gestational week 24 minus pre-pregnancy weight. Considering our study is based on data of Chinese women, we use the Standard of Recommendation for Weight Gain during Pregnancy Period published by Maternal and Child Health Standards Professional Committee of National Health Commission (NHC), China PR in 2022, which specifies the recommended value of weight gain of natural singleton pregnancy in China( 18 ). According to the 2022 Chinese guidelines, we stratified pre-pregnancy BMI into four categories: underweight (BMI < 18.5), normal weight (BMI 18.5–23.9), overweight (BMI 24–27.9) and obese (BMI ≥ 28) ( 18 ). In addition, the 2022 recommendations suggest that range of gestational weight gain (GWG) in the first trimester (0–13 weeks) is 0–2.0 kg for all BMI categories, while range of recommended weekly weight gain for women in the second and third trimester is 0.37–0.56 kg/week for the underweight group, 0.26–0.48 kg/week for the normal weight group, 0.22–0.37 kg/week for the overweight group, and 0.15–0.30 kg/week for the obesity group( 18 ). Therefore, range of weight gain during 24 gestational weeks = range of gestational weight gain in first trimester + range of recommended weekly weight gain in the second trimester * (24 − 13) weeks. Accordingly, optimal weight gain during 24 gestational weeks is 4.07–8.16 kg for the underweight group, 2.86–7.28 kg for the normal weight group, 2.42–6.07 kg for the overweight group, and 1.65–5.3 kg for the obese group. In this study, women whose weight gain during 24 gestational weeks (G24WG) is among the recommended range were classified as “Average” group, while those below the recommended range were classified as “Below” group and those above the recommended range were classified as “Above” group. Outcome The outcomes included gestational diabetes mellitus (GDM), gestational hypertension, preeclampsia (PE), caesarean section, postpartum hemorrhage (PPH), Large for Gestational Age (LGA), Small for Gestational Age (SGA), macrosomia (birth weight > 4000 g) and low birth weight (birth weight ≤ 2500 g). LGA refers to infants who weigh more than 90% of newborns of the same gestational age (GA) at birth (above the 90th percentile)( 19 ). Similarly, SGA is defined as newborns whose birth weight is below the 10th percentile for their GA( 20 ). PPH is defined as blood loss in excess of 500 mL following vaginal delivery or more than 1000 mL following cesarean delivery( 21 ). Gestational diabetes mellitus (GDM) is defined as a glucose tolerance disorder, where pregnant women’s glucose value fall at or above the following thresholds: fasting 5.1 mmol/L, 1 hour 10.0 mmol/L and 2 hour 8.5 mmol/L, with first recognition during pregnancy and has caused a tremendous healthy and economic burden in China( 22 , 23 ). All women included in this study received a 75 g Oral Glucose Tolerance Test (OGTT) during 24–28 weeks of gestation. Gestational hypertension is defined as new onset hypertension (systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg) on 2 occasions at least 4 hours apart after 20 weeks of gestation( 24 ). Preeclampsia (PE) is defined as hypertension (BP ≥ 140/90 mmHg) with proteinuria (excretion of 0.3 g protein or higher in the 24-hour urine collection) or other end-organ influence, including thrombocytopenia < 100 × 10 9 / L, renal insufficiency, impaired liver function, pulmonary edema, and new onset headache or visual symptoms( 25 ). The incidence of adverse pregnancy outcomes were examined among three WG24 groups. Statistical analyses Maternal demographic characteristics were compared among three WG24 groups. Categorical variables were described by frequencies (%), while continuous variables were described by mean with standard deviation (SD). Categorical data were analyzed by chi-square tests or Fisher’s exact tests, while continuous data were analyzed by one-way analysis of variance or Kruskal-Wallis H tests. Binary logistic regression was used to estimate the adjusted odds ratio (OR) and 95% confidence intervals (CIs) of SGA among three WG24 groups. P value < 0.05 was considered statistically significant. All analyses were performed using Statistical Package for the Social Sciences (SPSS 26). Results Overall, data of a total of 976 pregnant women following the inclusion criteria were analyzed in this study. According to the 2022 Chinese GWG recommendations, 123 (12.6%), 490 (50.2%), and 363 (37.2%) pregnant women had inadequate (Below group), adequate (Average group), and excessive G24WG (Above group), respectively. As shown in Table 1 , 8.6% of the pregnant women were underweight (BMI < 18.5 kg/m 2 ), 16.7% were overweight (BMI 24–27.9 kg/m 2 ), and 8.0% were obese (BMI ≥ 28 kg/m 2 ). Women with inadequate G24WG and women with excessive G24WG were more likely to have a higher pre-pregnancy BMI compared with women with adequate G24WG. The proportion of women with G24WG below the 2022 Chinese GWG guidelines was similar in the underweight (10.7%) and normal weight (9.7%) categories, while the proportion was much higher in the overweight (16.6%) and obese (30.8%) categories. The proportion of women with G24WG within the 2022 Chinese GWG guidelines was highest in underweight (61.9%) category, followed by 53.1% in the normal weight category, 41.7% in the overweight category, and 30.8% in the obese category. The proportion of women with G24WG above the 2022 Chinese GWG guidelines was lowest in the underweight category and highest in the overweight category (27.4% and 41.7%, respectively). Maternal age, parity and fetal gender among the three groups did not have significant difference. Women with excessive G24WG tended to have more gravidity compared with two other groups. Baby's birth weight of women with inadequate G24WG was significantly less than that of women with adequate G24WG, while women with excessive G24WG tended to have heavier babies. Table 1 Study population baseline characteristics overall and by status of GWG during 24 gestational weeks GWG during 24 gestational weeks (2022 Chinese GWG guidelines) Below (n = 123, 12.6%) Average (n = 490, 50.2%) Above (n = 363, 37.2%) P value Total (n = 976) Maternal age (year), mean ± SD 31.42 ± 4.48 31.32 ± 4.13 31.58 ± 4.73 0.699 31.43 ± 4.40 Gravidity, mean ± SD 2.24 ± 1.22 2.22 ± 1.30 2.32 ± 1.34 0.026 * 2.32 ± 1.34 Parity 0.363 Primiparity, n(%) 60(11.4) 273(51.9) 193(36.7) 526 Multiparity, n(%) 63(14) 217(48.2) 170(37.8) 450 Height (cm) 159.30 ± 4.99 160.15 ± 5.21 160.65 ± 5.18 0.040 * 160.23 ± 5.18 Weight (kg) 61.00 ± 11.98 56.03 ± 8.76 57.96 ± 9.70 0.000 * 57.38 ± 9.70 Pre-pregnancy BMI(kg/m2),mean ± SD 23.95 ± 4.26 21.83 ± 3.19 22.60 ± 3.35 0.000 * 22.39 ± 3.47 Pre-pregnancy BMI categories, n(%) 0.000 * Underweight (< 18.5 kg/m 2 ) 9(10.7) 52(61.9) 23(27.4) 84 (8.6) Normal weight (18.5–23.9 kg/m2) 63(9.7) 346(53.1) 242(37.2) 651 (66.7) Overweight (24-27.9 kg/m2) 27(16.6) 68(41.7) 68(41.7) 163 (16.7) obese (≥ 28 kg/m2) 24(30.8) 24(30.8) 30(38.5) 78 (8.0) GWG at gestational week 24 by BMI categories (kg), mean ± SD All women 0.58 ± 2.50 5.06 ± 1.39 9.80 ± 5.69 0.000 * 6.15 ± 3.62 Underweight (< 18.5 kg/m 2 ) 1.50 ± 3.68 6.37 ± 1.12 10.07 ± 1.58 0.000 * 6.86 ± 2.98 Normal weight (18.5–23.9 kg/m2) 1.22 ± 1.45 5.13 ± 1.29 9.58 ± 1.98 0.000 * 6.41 ± 3.12 Overweight (24-27.9 kg/m2) (-0.06) ± 3.09 4.28 ± 1.04 9.57 ± 3.15 0.000 * 5.77 ± 4.33 Obese (≥ 28 kg/m2) (-0.71) ± 2.87 3.31 ± 1.02 8.35 ± 5.46 0.001 * 4.01 ± 5.33 Baby's birth weight (kg) 3.14 ± 0.44 3.26 ± 0.46 3.32 ± 0.48 0.001 * 3.27 ± 0.47 Gender 0.610 Female, n(%) 65(13.4) 246(50.7) 174(35.9) 485 Male, n(%) 58(11.8) 244(49.7) 189(38.5) 491 OGTT level OGTT (0 h)(mmol/L) 4.70 ± 0.88 4.59 ± 0.58 4.59 ± 0.61 0.197 4.60 ± 0.64 OGTT (1 h)(mmol/L) 8.50 ± 2.12 8.03 ± 2.01 7.78 ± 1.90 0.002 * 8.00 ± 1.99 OGTT (2 h)(mmol/L) 7.29 ± 1.99 6.94 ± 1.76 6.89 ± 1.86 0.100 6.96 ± 1.83 *, P value < 0.05 was considered statistically significant. The data are presented as the mean ± standard deviation, the number and frequency, or the number and percentage. GWG: gestational weight gain, SD: standard deviation, BMI: body mass index, OGTT: oral glucose tolerance test. The 2022 Chinese GWG guidelines provided recommended ranges of weekly GWG rate during the 2nd and 3rd trimesters (kg/week) by pre-pregnancy BMI status: 0.37––0.56 kg/week for underweight (BMI < 18.5 kg/m 2 ), 0.26–0.48 kg/week for normal body weight (18.5 kg/m 2 ≤ BMI < 24.0 kg/m 2 ), 0.22–0.37 kg/week for overweight (24.0 kg/m 2 ≤ BMI < 28.0 kg/m 2 ), and 0.15–0.30 kg/week for obesity (BMI ≥ 28.0 kg/m 2 ). The recommended ranges of gestational weight gain in the first trimester were 0–2.0 kg for all BMI categories. BMI categories were defined based on Chinese women characteristics. G24WG-related characteristics and adverse pregnancy outcomes were summarized in Table 2 . With respect to the pregnancy outcomes, a total of 271 cases of GDM, 70 cases of PE, 99 cases of gestational hypertension, 46 cases of LBW, 50 cases of macrosomia, 159 cases of LGA, and 60 cases of SGA, were observed (Table 2 ). The proportion of PE patients (50%) was highest in the G24WG group above the 2022 Chinese guidelines, which was similar for gestational hypertension (45.5%). However, the proportion of SGA, LGA, GDM and LBW were highest in the G24WG group within the 2022 Chinese guidelines (48.3%, 49.1%, 49.1%, and 52.2%, respectively). The proportion of macrosomia (44%) was highest in the G24WG group above the 2022 Chinese guidelines. Table 2 Summary characteristics of pregnancy outcomes in the study population overall and by G24WG status Adverse pregnancy outcome GWG at gestational week 24 (G24WG) Total n = 976 Below, n (%) Average, n (%) Above, n (%) GDM P 44 (16.2) 133 (49.1) 94 (34.7) 271 N 79 (11.2) 357 (50.6) 269 (38.2) 705 PE P 8 (11.4) 27 (38.6) 35 (50) 70 N 115 (12.7) 463 (51.1) 328 (36.2) 907 Gestational hypertension P 13 (13.1) 41 (41.4) 45 (45.5) 99 N 110 (12.5) 449 (51.2) 318 (36.3) 877 Macrosomia P 3 (6.0) 22 (44) 25 (50) 50 N 120 (13.0) 468 (50.5) 338 (36.5) 726 Low birth weight P 6 (13.0) 24 (52.2) 16 (34.8) 46 N 117 (12.6) 466 (50.1) 347 (37.3) 930 SGA P 14 (23.3) 29 (48.3) 17 (28.3) 60 N 109 (11.9) 461 (50.3) 346 (37.8) 916 LGA P 14 (8.8) 78 (49.1) 67 (42.1) 159 N 109 (13.3) 412 (50.4) 296 (36.2) 817 P: positive, N: negative, G24WG: gestational weight gain during 24 gestational weeks, GDM: gestational diabetes mellitus, PE: preeclampsia, SGA: small for gestational age, LGA: large for gestational age As shown at Table 3 , the result of univariate logistic regression showed that excessive G24WG significantly increased the risk of PE compared with the average group (crude OR = 1.830, 95% CI: 1.086–3.083, P = 0.023), which is consistent with a previous study( 26 ). However, after adjusting pre-pregnancy BMI, maternal age, primiparity and gravidity, there was no statistical significance in the risk of PE between the excessive group and the average group (Adjusted OR = 1.566, 95% CI: 0.908–2.702, P = 0.107). The reason for this contradiction might be that parity is a strong confounding factor for the occurrence of PE because PE status in a woman’s first pregnancy strongly predicts her risks of PE in subsequent pregnancies( 27 ). Table 3 Associations between G24WG and adverse pregnancy outcomes Pregnancy outcomes, odds ratio (95% CI), P value Groups GDM PE Gestational hypertension Macrosomia LBW SGA LGA Below (Crude ORs) 1.495 (0.983–2.273) p = 0.060 1.193 (0.528–2.695) p = 0.671 1.294 (0.670–2.499) p = 0.442 0.532 (0.157–1.806) p = 0.311 0.996 (0.398–2.492) p = 0.993 2.042 (1.044–3.995) p = 0.037 0.678 (0.370–1.245) p = 0.210 Average (Crude ORs) Ref (OR = 1.00) Ref (OR = 1.00) Ref (OR = 1.00) Ref (OR = 1.00) Ref (OR = 1.00) Ref (OR = 1.00) Ref (OR = 1.00) Above (Crude ORs) 0.938 (0.689–1.276) p = 0.684 1.830 (1.086–3.083) p = 0.023 * 1.550 (0.991–2.423) p = 0.055 1.573 (0.872–2.838) p = 0.132 0.895 (0.468–1.711) p = 0.828 0.781 (0.422–1.444) p = 0.431 1.196 (0.835–1.712) p = 0.329 Below (Adjusted ORs) 0.939 (0.594–1.485) p = 0.788 0.663 (0.277–1.583) p = 0.354 0.747 (0.366–1.523) p = 0.422 0.333 (0.094–1.173) p = 0.087 1.125 (0.441–2.868) p = 0.805 2.690 1.334–5.427 0.006 * 0.435 (0.228–0.829) 0.011 * Average (Adjusted ORs) Ref (OR = 1.00) Ref (OR = 1.00) Ref (OR = 1.00) Ref (OR = 1.00) Ref (OR = 1.00) Ref (OR = 1.00) Ref (OR = 1.00) Above (Adjusted ORs) 1.301 (0.7938–1.804) p = 0.115 1.566 (0.908–2.702) p = 0.107 1.344 (0.840–2.150) p = 0.218 1.404 (0.765–2.574) p = 0.273 0.936 (0.486–1.801) p = 0.843 0.885 (0.473–1.653) 0.701 1.062 (0.732–1.541) 0.751 *, P value < 0.05 was considered statistically significant. G24WG: gestational weight gain during 24 gestational weeks, OR: odds ratio, CI: confidence interval, Ref: reference, GDM: gestational diabetes mellitus, PE: preeclampsia, SGA: small for gestational age, LGA: large for gestational age, LBW: low birth weight Compared to the reference group with average G24WG, women with inadequate G24WG had a significantly higher risk of SGA (Adjusted OR = 2.690, 95% CI: 1.334–5.427, P = 0.006) and a a significantly lower risk of LGA (Adjusted OR = 0.435, 95% CI: 0.228–0.829, P = 0.011), which was consistent with a previous study demonstrating that inadequate second-trimester GWG might be associated with increased risk of SGA in underweight women( 28 ). There was also a higher risk of LBW and a lower risk of macrosomia in the group below the 2022 Chinese guideline without statistical significance. For the group of excessive G24WG, no significant difference in risks was observed across the outcomes including GDM, LBW, macrosomia, PE, gestational hypertension, SGA or LGA compared to the reference group (Table 3 ), which was inconsistent with previous studies demonstrating that excessive total GWG significantly increased the risk of LGA and GDM ( 29 , 30 ). It was possible that the amount of GWG difference between excessive vs. average GWG groups in our study may not be sufficient enough to detect a significant difference in outcome risks due to a relatively small sample size. Discussion In this study, we found that women with inadequate weight gain during 24 gestational weeks (G24WG) had a significantly higher risk of SGA and a significantly lower risk of LGA. The significant effect of excessive G24WG on the increased risk of PE was counteracted after considering the influence of maternal age, primiparity, gravidity and pre-pregnancy BMI. No significant difference in risks of adverse pregnancy outcomes between excessive and average G24WG group was observed, which may be due to the limited sample in this study. Associations between inadequate or excessive weight gain during the whole pregnancy and outcomes for mothers and infants have been well described( 31 – 34 ). A systemic review demonstrated that GWG was below or above the IOM guidelines in 23% and 47% of pregnancies, respectively. The 23% of women who gained inadequate weight had an increased risk of SGA compared with those whose gestational weight gain was within the IOM guidelines( 8 ). However, the IOM recommendations are based on population information from North America, which restricts its use among populations from different countries and different ethnicities ( 35 ). Asian women usually have a lower pre-pregnancy BMI compared with those in Western countries, so the BMI criteria in the IOM guidelines are not appropriate for Asian populations, which might result in error of classification. Previous studies have shown that Asians have increased risk of diabetes or cardiovascular diseases, which are all obesity-related, at lower BMI levels than Caucasians( 36 , 37 ). Therefore, lower BMI cut-off and lower recommended GWG should be more suitable for Asian populations. Many Asian countries including Singapore( 38 ), Japan( 39 ), and Korea( 15 ) have proposed their own recommendations of GWG, which implies that the optimal GWG may vary due to different population characteristics and each country should consider its own optimal GWG range. Thus in this study, we use the Standard of Recommendation for Weight Gain during Pregnancy Period published by Maternal and Child Health Standards Professional Committee of National Health Commission (NHC), China PR in 2022( 17 ). According to the IOM guideline, pre-pregnancy BMI is classified as: underweight (BMI < 18.5 kg/m 2 ), normal weight (BMI 18.5–24.9 kg/m 2 ), overweight (BMI 25.0-29.9 kg/m 2 ), and obese (BMI ≥ 30 kg/m 2 ), which might be too big for Chinese women. In the 2022 Chinese standard, pre-pregnancy BMI is stratified into four categories: underweight (BMI < 18.5 kg/m 2 ), normal weight (BMI 18.5–23.9 kg/m 2 ), overweight (BMI 24–27.9 kg/m 2 ) and obese (BMI ≥ 28 kg/m 2 ). This study has some strengths compared with other studies reported in the literature. First, we applied the Standard of Recommendation for Weight Gain during Pregnancy Period designed specific for Chinese pregnant women instead of the 2009 IOM guidelines more suitable for Caucasian people. Second, the study contains detailed clinical data including pre-pregnancy weight and weight measurements during 24 gestational weeks, which made it possible to study GWG in the second trimester. In addition, it is difficult to disentangle the effect caused by GWG from the effect caused by duration of pregnancy due to the strong correlation between GWG and gestational duration. However, the use of gestational weight gain during 24 gestational weeks (G24WG) in our study can overcome this limitation, ensuring that the weight gain of women who experience adverse pregnancy outcomes would be compared with the weight gain of women without adverse outcomes at the same point in pregnancy. Besides, studies exploring the effect of GWG during the second trimester on adverse pregnancy outcomes are relatively few. Our study fill this gap. There are also limitations in our study. First, the pre-pregnancy weight data in this study was self-reported at the first prenatal visit within the first 13 weeks of pregnancy, which may lead to recalling bias. Second, we only investigated the short-term perinatal outcomes, without considering long-term complications such as cardiometabolic diseases and obesity in later life. Third, the nature of our study is a single-centered retrospective study. In the future, more powered randomized trials are needed. Our findings may have clinical implications. We have demonstrated that inadequate GWG during 24 gestational weeks (in the mid-pregnancy period) may affect subsequent maternal and neonatal outcomes. To mitigate the harms of inadequate weight gain, doctors need to take measures to increase the proportion of women who adhere to the 2022 Chinese guidelines for weight gain during pregnancy, including appropriate nutritional supplement, exercise, counseling and a variety of mobile technology interventions. Maintaining the appropriate amount of weight gain during the second trimester may be a driver to prevent pregnancy complications and should be integrated into routine prenatal care. Conclusion In this investigation, we found that women with inadequate weight gain during 24 gestational weeks (G24WG) had a significantly higher risk of SGA and a significantly lower risk of LGA using the Standard of Recommendation for Weight Gain during Pregnancy Period published by Maternal and Child Health Standards Professional Committee of National Health Commission (NHC), China PR in 2022, which is more suitable for Chinese women. Our study is the first study to demonstrate the association between weight gain during 24 gestational weeks and pregnancy outcomes using the 2022 Chinese guidelines based on Chinese population and help doctors provide appropriate nutritional counseling. In the future, more multi-centered, randomized controlled trials are needed to make appropriate gestational weight gain guidelines for Chinese people. List Of Abbreviations GWG gestational weight gain G24WG weight gain during 24 gestational weeks OR odds ratio CI confidence interval SD standard deviation GDM gestational diabetes mellitus SGA small for gestational age LGA large for gestational age BMI body mass index PE preeclampsia OGTT oral glucose tolerance test NHC National Health Commission IOM Institute of Medicine PPH postpartum hemorrhage Declarations Ethics approval and consent to participate This study was approved by the Ethics Committee of the Shanghai General Hospital. All methods were carried out in accordance with the Declaration of Helsinki. Written informed consent was waived by Shanghai General Hospital Ethic committee due to the retrospective nature of this study. Consent for publication Not applicable. Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding Shanghai Jiao Tong University Trans-Med Awards Research (STAR) (Major Project) (20210201) Authors' contributions Xian-Ming Xu and Jie Ma designed the study; De-Cui Cheng and Jie Ma provided study materials; Dong-Mei Zhou, Shi-Tong Zhan, Hao-Yi Jia collected and assembled data; Xue-Qing Liu and Yi Lin performed data analysis and interpretation; Xiao-Wei Wei and Chuan-Mei Qin wrote the manuscript; All authors reviewed the manuscript. Acknowledgements Not applicable. References Jin D, Rich-Edwards JW, Chen C, Huang Y, Wang Y, Xu X, et al. Gestational Diabetes Mellitus: Predictive Value of Fetal Growth Measurements by Ultrasonography at 22-24 Weeks: A Retrospective Cohort Study of Medical Records. Nutrients. 2020;12(12). 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Associations of maternal pre-pregnancy obesity and excess pregnancy weight gains with adverse pregnancy outcomes and length of hospital stay. BMC Pregnancy Childbirth. 2011;11:62. Xu Z, Wen Z, Zhou Y, Li D, Luo Z. Inadequate weight gain in obese women and the risk of small for gestational age (SGA): a systematic review and meta-analysis. J Matern Fetal Neonatal Med. 2017;30(3):357-67. Goldstein RF, Abell SK, Ranasinha S, Misso M, Boyle JA, Black MH, et al. Association of Gestational Weight Gain With Maternal and Infant Outcomes: A Systematic Review and Meta-analysis. Jama. 2017;317(21):2207-25. Hedderson MM, Gunderson EP, Ferrara A. Gestational weight gain and risk of gestational diabetes mellitus. Obstet Gynecol. 2010;115(3):597-604. Premru-Srsen T, Kocic Z, Fabjan Vodusek V, Geršak K, Verdenik I. Total gestational weight gain and the risk of preeclampsia by pre-pregnancy body mass index categories: a population-based cohort study from 2013 to 2017. J Perinat Med. 2019;47(6):585-91. Santos S, Voerman E, Amiano P, Barros H, Beilin LJ, Bergström A, et al. Impact of maternal body mass index and gestational weight gain on pregnancy complications: an individual participant data meta-analysis of European, North American and Australian cohorts. Bjog. 2019;126(8):984-95. Wu Y, Wan S, Gu S, Mou Z, Dong L, Luo Z, et al. Gestational weight gain and adverse pregnancy outcomes: a prospective cohort study. BMJ Open. 2020;10(9):e038187. Chen D, Zhou X, Yan S, Li W, Yang X, Lv C, et al. Optimal Gestational Weight Gain for Tibetans Based on Prepregnancy Body Mass Index. Scientific Reports. 2020;10(1):10690. Morisaki N, Nagata C, Jwa SC, Sago H, Saito S, Oken E, et al. Pre-pregnancy BMI-specific optimal gestational weight gain for women in Japan. Journal of Epidemiology. 2017;27(10):492-8. Choi SK, Lee G, Kim YH, Park IY, Ko HS, Shin JC. Determining optimal gestational weight gain in the Korean population: a retrospective cohort study. Reproductive Biology and Endocrinology. 2017;15(1):67. Jiang X, Liu M, Song Y, Mao J, Zhou M, Ma Z, et al. The Institute of Medicine recommendation for gestational weight gain is probably not optimal among non-American pregnant women: a retrospective study from China. J Matern Fetal Neonatal Med. 2019;32(8):1353-8. Standard of Recommendation for Weight Gain during Pregnancy Period. Biomed Environ Sci. 2022;35(10):875-7. Standard of Recommendation for Weight Gain during Pregnancy Period. - Biomedical and Environmental Sciences. 2022;- 35(- 10):- 875. Zhao Y, Li DZ. Born large for gestational age: not just bigger. Am J Obstet Gynecol. 2023;228(3):366-7. Battaglia FC, Lubchenco LO. A practical classification of newborn infants by weight and gestational age. J Pediatr. 1967;71(2):159-63. Chandraharan E, Krishna A. Diagnosis and management of postpartum haemorrhage. Bmj. 2017;358:j3875. Mierzyński R, Poniedziałek-Czajkowska E, Sotowski M, Szydełko-Gorzkowicz M. Nutrition as Prevention Factor of Gestational Diabetes Mellitus: A Narrative Review. Nutrients. 2021;13(11). Juan J, Yang H. Prevalence, Prevention, and Lifestyle Intervention of Gestational Diabetes Mellitus in China. Int J Environ Res Public Health. 2020;17(24). Sinkey RG, Battarbee AN, Bello NA, Ives CW, Oparil S, Tita ATN. Prevention, Diagnosis, and Management of Hypertensive Disorders of Pregnancy: a Comparison of International Guidelines. Curr Hypertens Rep. 2020;22(9):66. Rana S, Lemoine E, Granger JP, Karumanchi SA. Preeclampsia: Pathophysiology, Challenges, and Perspectives. Circ Res. 2019;124(7):1094-112. Ren M, Li H, Cai W, Niu X, Ji W, Zhang Z, et al. Excessive gestational weight gain in accordance with the IOM criteria and the risk of hypertensive disorders of pregnancy: a meta-analysis. BMC Pregnancy and Childbirth. 2018;18(1):281. Hernández-Díaz S, Toh S, Cnattingius S. Risk of pre-eclampsia in first and subsequent pregnancies: prospective cohort study. Bmj. 2009;338:b2255. Wei X, Shen S, Huang P, Xiao X, Lin S, Zhang L, et al. Gestational weight gain rates in the first and second trimesters are associated with small for gestational age among underweight women: a prospective birth cohort study. BMC Pregnancy Childbirth. 2022;22(1):106. Shi P, Liu A, Yin X. Association between gestational weight gain in women with gestational diabetes mellitus and adverse pregnancy outcomes: a retrospective cohort study. BMC Pregnancy and Childbirth. 2021;21(1):508. Lautredou M, Pan-Petesch B, Dupré P-F, Drugmanne G, Nowak E, Anouilh F, et al. Excessive gestational weight gain is an independent risk factor for gestational diabetes mellitus in singleton pregnancies: Results from a French cohort study. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2022;275:31-6. Cheikh Ismail L, Bishop DC, Pang R, Ohuma EO, Kac G, Abrams B, et al. Gestational weight gain standards based on women enrolled in the Fetal Growth Longitudinal Study of the INTERGROWTH-21st Project: a prospective longitudinal cohort study. Bmj. 2016;352:i555. Caughey AB. Gestational Weight Gain and Outcomes for Mothers and Infants. Jama. 2017;317(21):2175-6. Ukah UV, Bayrampour H, Sabr Y, Razaz N, Chan WS, Lim KI, et al. Association between gestational weight gain and severe adverse birth outcomes in Washington State, US: A population-based retrospective cohort study, 2004-2013. PLoS Med. 2019;16(12):e1003009. Badon SE, Dublin S, Nance N, Hedderson MM, Neugebauer R, Easterling T, et al. Gestational weight gain and adverse pregnancy outcomes by pre-pregnancy BMI category in women with chronic hypertension: A cohort study. Pregnancy Hypertension. 2021;23:27-33. Goldstein RF, Abell SK, Ranasinha S, Misso ML, Boyle JA, Harrison CL, et al. Gestational weight gain across continents and ethnicity: systematic review and meta-analysis of maternal and infant outcomes in more than one million women. BMC Medicine. 2018;16(1):153. Deurenberg-Yap M, Deurenberg P. Is a re-evaluation of WHO body mass index cut-off values needed? The case of Asians in Singapore. Nutr Rev. 2003;61(5 Pt 2):S80-7. Chiu M, Austin PC, Manuel DG, Shah BR, Tu JV. Deriving ethnic-specific BMI cutoff points for assessing diabetes risk. Diabetes Care. 2011;34(8):1741-8. Ee TX, Allen JC, Jr., Malhotra R, Koh H, Østbye T, Tan TC. Determining optimal gestational weight gain in a multiethnic Asian population. J Obstet Gynaecol Res. 2014;40(4):1002-8. Morisaki N, Nagata C, Jwa SC, Sago H, Saito S, Oken E, et al. Pre-pregnancy BMI-specific optimal gestational weight gain for women in Japan. J Epidemiol. 2017;27(10):492-8. Additional Declarations No competing interests reported. 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Qin","email":"","orcid":"","institution":"The International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Chuan-Mei","middleName":"","lastName":"Qin","suffix":""},{"id":204037011,"identity":"e6e2be28-1abf-4918-87ce-86f0c43d9f53","order_by":2,"name":"De-Cui Cheng","email":"","orcid":"","institution":"Ruijin Hospital, Shanghai Jiao Tong University School of Medicine","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"De-Cui","middleName":"","lastName":"Cheng","suffix":""},{"id":204037012,"identity":"65b24e8e-5aa2-4493-9113-2e9b2d25eade","order_by":3,"name":"Dong-Mei Zhou","email":"","orcid":"","institution":"Shanghai Jiao Tong University School of Medicine, South Hospital of Shanghai General 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Liu","email":"","orcid":"","institution":"The International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Xue-Qing","middleName":"","lastName":"Liu","suffix":""},{"id":204037019,"identity":"5d1ef88d-ae4e-4aec-9ffe-d7939b6dab0c","order_by":7,"name":"Yi Lin","email":"","orcid":"","institution":"Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Yi","middleName":"","lastName":"Lin","suffix":""},{"id":204037022,"identity":"072a0d6f-a2e6-4dd5-bc61-3bae29759d0c","order_by":8,"name":"Xian-Ming Xu","email":"","orcid":"","institution":"Shanghai Jiao Tong University School of Medicine, South Hospital of Shanghai General Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Xian-Ming","middleName":"","lastName":"Xu","suffix":""},{"id":204037023,"identity":"da9e7e1b-42c8-47c5-a1f8-1028cff4adfc","order_by":9,"name":"Jie Ma","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0ElEQVRIiWNgGAWjYBACefbGBgYGHgkGfgbGBuK0GPYchmiRbCBWC8ONdIhKgwPEOoyxIbF1ww8ZCznj84fbHvxgsJPTJWQZO8PBtps9PBLGZjcS2w17GJKNzQhZx9jY2HaDh0cicdsNxjYJHoYDidsIuvAwY9vNPzwS9Zv7D7ZJ/iFKyzHGtttAWxIMGBLbpImyxbAHqEWGR8Jwxg2gFhkDIvwiL//82c23PXXy/P3Hn0m+qbCTI6gFDBh7YCwDYpSDwQ+iVY6CUTAKRsFIBAB23kKoh4TB2QAAAABJRU5ErkJggg==","orcid":"","institution":"Shanghai Jiao Tong University School of Medicine, South Hospital of Shanghai General Hospital","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Jie","middleName":"","lastName":"Ma","suffix":""}],"badges":[],"createdAt":"2023-05-19 02:44:18","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-2954352/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2954352/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":38455186,"identity":"347bef13-1f50-4dba-a60e-79df8d52f2ba","added_by":"auto","created_at":"2023-06-13 09:44:29","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":329336,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2954352/v1/d1a9f416-e2f8-496b-b6a7-ffd8a2140144.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Association between weight gain during 24 gestational weeks and pregnancy outcomes: A retrospective study in Chinese population","fulltext":[{"header":"Introduction","content":"\u003cp\u003eWeight management before and during pregnancy plays an important role in prenatal care because both maternal pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) are associated with increased risks of maternal and fetal metabolic diseases or other adverse pregnancy outcomes(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Generally, GWG in the first trimester is mainly attributed to expansion of maternal blood volume and early placental development, instead of fat deposits, while physiologic weight gain at term is comprised of fetus, fat stores, increased blood volume, increased extravascular fluid volume, amniotic fluid, breast enlargement, uterine hypertrophy and placenta(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). GWG reflects the growth of the fetus and the health status of the mother(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Most of the GWG takes place in the second and third trimesters, contributing to about 80\u0026ndash;90% of the total GWG(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Women with inadequate GWG tend to have increased risks of low birth weight(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e), small for gestational age (SGA)(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) and preterm birth(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e), while excessive GWG in pregnant women has been associated with the occurrence of gestational diabetes mellitus (GDM)(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e), pre-eclampsia (PE)(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e), large for gestational age (LGA)(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e), and caesarean section(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn 2009, the Institute of Medicine (IOM) published specific recommendations regarding the optimal GWG for each of the pre-pregnancy BMI groups, which have been widely adopted by studies exploring the relationship between adverse pregnancy outcomes and GWG since then(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). A systematic review and meta-analysis including over 1\u0026nbsp;million pregnant women suggested that GWG was above the IOM recommended weight gain range in 47% of pregnancies and 23% of pregnant women had GWG less than IOM recommendations(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Despite the prevalence of IOM guideline, the recommendations cannot be applicable all over the world mainly due to different ethnicities and lifestyles(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe IOM guideline\u0026rsquo;s generalizability to Asian women was limited because it was originally designed based on the Caucasian population data(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). For example, the IOM recommended GWG range may be too great for Chinese pregnant women regarding each BMI category(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Thus it is necessary to study the correlation between GWG and pregnancy outcomes in Chinese pregnant women using GWG guidelines designed specific for Chinese population. What\u0026rsquo;s more, Studies exploring associations of second-trimester GWG with perinatal outcomes have been relatively few. In this study, we will study the effect of GWG during 24 gestational weeks on pregnancy outcomes based on the Standard of Recommendation for Weight Gain during Pregnancy Period published by Maternal and Child Health Standards Professional Committee of National Health Commission (NHC), China PR in 2022(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy population\u003c/h2\u003e \u003cp\u003eIn this retrospective study, the hospital records of a total of 1000 women giving birth at the Department of Obstetrics, Shanghai General Hospital between January 2021 and December 2021 were abstracted in a standardized fashion. Information about anthropological characteristics, obstetrical risk factors, delivery methods and maternal and neonatal outcomes were collected during prenatal visits, at time of delivery and at infant hospital discharge. Prenatal system at the Shanghai General Hospital includes scheduled appointments (eight prenatal visits and five ultrasounds on average) starting from 6 to 13 weeks of gestation. The typical schedule of routine antenatal visits are at weeks 11\u0026ndash;13, week 24, week 28, and weeks 31\u0026ndash;32 and, thereafter, every second week until birth.\u003c/p\u003e \u003cp\u003eAll women included in this study must be \u0026ge;\u0026thinsp;18 years old and have a live-birth singleton pregnancy. Besides, all fetuses need to be delivered at \u0026ge;\u0026thinsp;28 weeks of gestation and have a birth weight\u0026thinsp;\u0026gt;\u0026thinsp;1,000 g. Among the 1,000 women who met the inclusion criteria, 21 cases without pre-pregnancy body mass index (BMI; kg/m2) or no gestational weight gain measurement and 3 cases complicated by the congenital malformation of the fetus or stillbirth were excluded. Ultimately, 976 cases were included in the analysis.\u003c/p\u003e \u003cp\u003e This study was approved by the Ethics Committee of the Shanghai General Hospital. Informed consent was not required due to the retrospective nature of the study design.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eBMI and weight gain\u003c/h2\u003e \u003cp\u003eThe eligible data collected in this study were obtained from self-reported pre-pregnancy weight (kg) and height (cm), while weight at gestational week 24 was routinely measured using the available electronic weighing device with a calibrated scale of 0.1 kg in the hospital. Pre-pregnancy body mass index (BMI; kg/m\u003csup\u003e2\u003c/sup\u003e) was calculated as pre-pregnancy weight (kg) divided by height (m)\u003csup\u003e2\u003c/sup\u003e, while weight gain during 24 gestational weeks was calculated as weight at gestational week 24 minus pre-pregnancy weight.\u003c/p\u003e \u003cp\u003eConsidering our study is based on data of Chinese women, we use the Standard of Recommendation for Weight Gain during Pregnancy Period published by Maternal and Child Health Standards Professional Committee of National Health Commission (NHC), China PR in 2022, which specifies the recommended value of weight gain of natural singleton pregnancy in China(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). According to the 2022 Chinese guidelines, we stratified pre-pregnancy BMI into four categories: underweight (BMI\u0026thinsp;\u0026lt;\u0026thinsp;18.5), normal weight (BMI 18.5\u0026ndash;23.9), overweight (BMI 24\u0026ndash;27.9) and obese (BMI\u0026thinsp;\u0026ge;\u0026thinsp;28) (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). In addition, the 2022 recommendations suggest that range of gestational weight gain (GWG) in the first trimester (0\u0026ndash;13 weeks) is 0\u0026ndash;2.0 kg for all BMI categories, while range of recommended weekly weight gain for women in the second and third trimester is 0.37\u0026ndash;0.56 kg/week for the underweight group, 0.26\u0026ndash;0.48 kg/week for the normal weight group, 0.22\u0026ndash;0.37 kg/week for the overweight group, and 0.15\u0026ndash;0.30 kg/week for the obesity group(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Therefore, range of weight gain during 24 gestational weeks\u0026thinsp;=\u0026thinsp;range of gestational weight gain in first trimester\u0026thinsp;+\u0026thinsp;range of recommended weekly weight gain in the second trimester * (24\u0026thinsp;\u0026minus;\u0026thinsp;13) weeks. Accordingly, optimal weight gain during 24 gestational weeks is 4.07\u0026ndash;8.16 kg for the underweight group, 2.86\u0026ndash;7.28 kg for the normal weight group, 2.42\u0026ndash;6.07 kg for the overweight group, and 1.65\u0026ndash;5.3 kg for the obese group. In this study, women whose weight gain during 24 gestational weeks (G24WG) is among the recommended range were classified as \u0026ldquo;Average\u0026rdquo; group, while those below the recommended range were classified as \u0026ldquo;Below\u0026rdquo; group and those above the recommended range were classified as \u0026ldquo;Above\u0026rdquo; group.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eOutcome\u003c/h2\u003e \u003cp\u003eThe outcomes included gestational diabetes mellitus (GDM), gestational hypertension, preeclampsia (PE), caesarean section, postpartum hemorrhage (PPH), Large for Gestational Age (LGA), Small for Gestational Age (SGA), macrosomia (birth weight\u0026thinsp;\u0026gt;\u0026thinsp;4000 g) and low birth weight (birth weight\u0026thinsp;\u0026le;\u0026thinsp;2500 g).\u003c/p\u003e \u003cp\u003eLGA refers to infants who weigh more than 90% of newborns of the same gestational age (GA) at birth (above the 90th percentile)(\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Similarly, SGA is defined as newborns whose birth weight is below the 10th percentile for their GA(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). PPH is defined as blood loss in excess of 500 mL following vaginal delivery or more than 1000 mL following cesarean delivery(\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eGestational diabetes mellitus (GDM) is defined as a glucose tolerance disorder, where pregnant women\u0026rsquo;s glucose value fall at or above the following thresholds: fasting 5.1 mmol/L, 1 hour 10.0 mmol/L and 2 hour 8.5 mmol/L, with first recognition during pregnancy and has caused a tremendous healthy and economic burden in China(\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). All women included in this study received a 75 g Oral Glucose Tolerance Test (OGTT) during 24\u0026ndash;28 weeks of gestation. Gestational hypertension is defined as new onset hypertension (systolic blood pressure\u0026thinsp;\u0026ge;\u0026thinsp;140 mmHg or diastolic blood pressure\u0026thinsp;\u0026ge;\u0026thinsp;90 mmHg) on 2 occasions at least 4 hours apart after 20 weeks of gestation(\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). Preeclampsia (PE) is defined as hypertension (BP\u0026thinsp;\u0026ge;\u0026thinsp;140/90 mmHg) with proteinuria (excretion of 0.3 g protein or higher in the 24-hour urine collection) or other end-organ influence, including thrombocytopenia\u0026thinsp;\u0026lt;\u0026thinsp;100 \u0026times; 10\u003csup\u003e9\u003c/sup\u003e / L, renal insufficiency, impaired liver function, pulmonary edema, and new onset headache or visual symptoms(\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). The incidence of adverse pregnancy outcomes were examined among three WG24 groups.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analyses\u003c/h2\u003e \u003cp\u003eMaternal demographic characteristics were compared among three WG24 groups. Categorical variables were described by frequencies (%), while continuous variables were described by mean with standard deviation (SD). Categorical data were analyzed by chi-square tests or Fisher\u0026rsquo;s exact tests, while continuous data were analyzed by one-way analysis of variance or Kruskal-Wallis H tests. Binary logistic regression was used to estimate the adjusted odds ratio (OR) and 95% confidence intervals (CIs) of SGA among three WG24 groups. P value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant. All analyses were performed using Statistical Package for the Social Sciences (SPSS 26).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eOverall, data of a total of 976 pregnant women following the inclusion criteria were analyzed in this study. According to the 2022 Chinese GWG recommendations, 123 (12.6%), 490 (50.2%), and 363 (37.2%) pregnant women had inadequate (Below group), adequate (Average group), and excessive G24WG (Above group), respectively. As shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, 8.6% of the pregnant women were underweight (BMI\u0026thinsp;\u0026lt;\u0026thinsp;18.5 kg/m\u003csup\u003e2\u003c/sup\u003e), 16.7% were overweight (BMI 24\u0026ndash;27.9 kg/m\u003csup\u003e2\u003c/sup\u003e), and 8.0% were obese (BMI\u0026thinsp;\u0026ge;\u0026thinsp;28 kg/m\u003csup\u003e2\u003c/sup\u003e). Women with inadequate G24WG and women with excessive G24WG were more likely to have a higher pre-pregnancy BMI compared with women with adequate G24WG. The proportion of women with G24WG below the 2022 Chinese GWG guidelines was similar in the underweight (10.7%) and normal weight (9.7%) categories, while the proportion was much higher in the overweight (16.6%) and obese (30.8%) categories. The proportion of women with G24WG within the 2022 Chinese GWG guidelines was highest in underweight (61.9%) category, followed by 53.1% in the normal weight category, 41.7% in the overweight category, and 30.8% in the obese category. The proportion of women with G24WG above the 2022 Chinese GWG guidelines was lowest in the underweight category and highest in the overweight category (27.4% and 41.7%, respectively). Maternal age, parity and fetal gender among the three groups did not have significant difference. Women with excessive G24WG tended to have more gravidity compared with two other groups. Baby's birth weight of women with inadequate G24WG was significantly less than that of women with adequate G24WG, while women with excessive G24WG tended to have heavier babies.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eStudy population baseline characteristics overall and by status of GWG during 24 gestational weeks\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e \u003cp\u003eGWG during 24 gestational weeks (2022 Chinese GWG guidelines)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBelow \u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;123, 12.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAverage\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;490, 50.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAbove\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;363, 37.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;976)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaternal age (year), mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31.42\u0026thinsp;\u0026plusmn;\u0026thinsp;4.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31.32\u0026thinsp;\u0026plusmn;\u0026thinsp;4.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31.58\u0026thinsp;\u0026plusmn;\u0026thinsp;4.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.699\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e31.43\u0026thinsp;\u0026plusmn;\u0026thinsp;4.40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGravidity, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.24\u0026thinsp;\u0026plusmn;\u0026thinsp;1.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.22\u0026thinsp;\u0026plusmn;\u0026thinsp;1.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.32\u0026thinsp;\u0026plusmn;\u0026thinsp;1.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.026\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.32\u0026thinsp;\u0026plusmn;\u0026thinsp;1.34\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.363\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimiparity, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60(11.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e273(51.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e193(36.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e526\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMultiparity, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e63(14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e217(48.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e170(37.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e450\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeight (cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e159.30\u0026thinsp;\u0026plusmn;\u0026thinsp;4.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e160.15\u0026thinsp;\u0026plusmn;\u0026thinsp;5.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e160.65\u0026thinsp;\u0026plusmn;\u0026thinsp;5.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.040\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e160.23\u0026thinsp;\u0026plusmn;\u0026thinsp;5.18\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeight (kg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e61.00\u0026thinsp;\u0026plusmn;\u0026thinsp;11.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56.03\u0026thinsp;\u0026plusmn;\u0026thinsp;8.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e57.96\u0026thinsp;\u0026plusmn;\u0026thinsp;9.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e57.38\u0026thinsp;\u0026plusmn;\u0026thinsp;9.70\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePre-pregnancy BMI(kg/m2),mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23.95\u0026thinsp;\u0026plusmn;\u0026thinsp;4.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.83\u0026thinsp;\u0026plusmn;\u0026thinsp;3.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22.60\u0026thinsp;\u0026plusmn;\u0026thinsp;3.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e22.39\u0026thinsp;\u0026plusmn;\u0026thinsp;3.47\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePre-pregnancy BMI categories, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnderweight (\u0026lt;\u0026thinsp;18.5 kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9(10.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52(61.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23(27.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e84 (8.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNormal weight (18.5\u0026ndash;23.9 kg/m2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e63(9.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e346(53.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e242(37.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e651 (66.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOverweight (24-27.9 kg/m2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27(16.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68(41.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e68(41.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e163 (16.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eobese (\u0026ge;\u0026thinsp;28 kg/m2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24(30.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24(30.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30(38.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e78 (8.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eGWG at gestational week 24 by BMI categories (kg), mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAll women\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.58\u0026thinsp;\u0026plusmn;\u0026thinsp;2.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.06\u0026thinsp;\u0026plusmn;\u0026thinsp;1.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.80\u0026thinsp;\u0026plusmn;\u0026thinsp;5.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6.15\u0026thinsp;\u0026plusmn;\u0026thinsp;3.62\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnderweight (\u0026lt;\u0026thinsp;18.5 kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.50\u0026thinsp;\u0026plusmn;\u0026thinsp;3.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.37\u0026thinsp;\u0026plusmn;\u0026thinsp;1.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.07\u0026thinsp;\u0026plusmn;\u0026thinsp;1.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6.86\u0026thinsp;\u0026plusmn;\u0026thinsp;2.98\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNormal weight (18.5\u0026ndash;23.9 kg/m2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.22\u0026thinsp;\u0026plusmn;\u0026thinsp;1.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.13\u0026thinsp;\u0026plusmn;\u0026thinsp;1.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.58\u0026thinsp;\u0026plusmn;\u0026thinsp;1.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6.41\u0026thinsp;\u0026plusmn;\u0026thinsp;3.12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOverweight (24-27.9 kg/m2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(-0.06)\u0026thinsp;\u0026plusmn;\u0026thinsp;3.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.28\u0026thinsp;\u0026plusmn;\u0026thinsp;1.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.57\u0026thinsp;\u0026plusmn;\u0026thinsp;3.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5.77\u0026thinsp;\u0026plusmn;\u0026thinsp;4.33\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eObese (\u0026ge;\u0026thinsp;28 kg/m2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(-0.71)\u0026thinsp;\u0026plusmn;\u0026thinsp;2.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.31\u0026thinsp;\u0026plusmn;\u0026thinsp;1.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.35\u0026thinsp;\u0026plusmn;\u0026thinsp;5.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.01\u0026thinsp;\u0026plusmn;\u0026thinsp;5.33\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBaby's birth weight (kg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.14\u0026thinsp;\u0026plusmn;\u0026thinsp;0.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.26\u0026thinsp;\u0026plusmn;\u0026thinsp;0.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.32\u0026thinsp;\u0026plusmn;\u0026thinsp;0.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.27\u0026thinsp;\u0026plusmn;\u0026thinsp;0.47\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.610\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65(13.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e246(50.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e174(35.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e485\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e58(11.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e244(49.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e189(38.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e491\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eOGTT level\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOGTT (0 h)(mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.70\u0026thinsp;\u0026plusmn;\u0026thinsp;0.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.59\u0026thinsp;\u0026plusmn;\u0026thinsp;0.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.59\u0026thinsp;\u0026plusmn;\u0026thinsp;0.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.197\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.60\u0026thinsp;\u0026plusmn;\u0026thinsp;0.64\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOGTT (1 h)(mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.50\u0026thinsp;\u0026plusmn;\u0026thinsp;2.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.03\u0026thinsp;\u0026plusmn;\u0026thinsp;2.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.78\u0026thinsp;\u0026plusmn;\u0026thinsp;1.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.002\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8.00\u0026thinsp;\u0026plusmn;\u0026thinsp;1.99\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOGTT (2 h)(mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.29\u0026thinsp;\u0026plusmn;\u0026thinsp;1.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.94\u0026thinsp;\u0026plusmn;\u0026thinsp;1.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.89\u0026thinsp;\u0026plusmn;\u0026thinsp;1.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6.96\u0026thinsp;\u0026plusmn;\u0026thinsp;1.83\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e*, P value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant. The data are presented as the mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation, the number and frequency, or the number and percentage. GWG: gestational weight gain, SD: standard deviation, BMI: body mass index, OGTT: oral glucose tolerance test. The 2022 Chinese GWG guidelines provided recommended ranges of weekly GWG rate during the 2nd and 3rd trimesters (kg/week) by pre-pregnancy BMI status: 0.37\u0026ndash;\u0026ndash;0.56 kg/week for underweight (BMI\u0026thinsp;\u0026lt;\u0026thinsp;18.5 kg/m\u003csup\u003e2\u003c/sup\u003e), 0.26\u0026ndash;0.48 kg/week for normal body weight (18.5 kg/m\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;\u0026le;\u0026thinsp;BMI\u0026thinsp;\u0026lt;\u0026thinsp;24.0 kg/m\u003csup\u003e2\u003c/sup\u003e), 0.22\u0026ndash;0.37 kg/week for overweight (24.0 kg/m\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;\u0026le;\u0026thinsp;BMI\u0026thinsp;\u0026lt;\u0026thinsp;28.0 kg/m\u003csup\u003e2\u003c/sup\u003e), and 0.15\u0026ndash;0.30 kg/week for obesity (BMI\u0026thinsp;\u0026ge;\u0026thinsp;28.0 kg/m\u003csup\u003e2\u003c/sup\u003e). The recommended ranges of gestational weight gain in the first trimester were 0\u0026ndash;2.0 kg for all BMI categories. BMI categories were defined based on Chinese women characteristics.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eG24WG-related characteristics and adverse pregnancy outcomes were summarized in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. With respect to the pregnancy outcomes, a total of 271 cases of GDM, 70 cases of PE, 99 cases of gestational hypertension, 46 cases of LBW, 50 cases of macrosomia, 159 cases of LGA, and 60 cases of SGA, were observed (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The proportion of PE patients (50%) was highest in the G24WG group above the 2022 Chinese guidelines, which was similar for gestational hypertension (45.5%). However, the proportion of SGA, LGA, GDM and LBW were highest in the G24WG group within the 2022 Chinese guidelines (48.3%, 49.1%, 49.1%, and 52.2%, respectively). The proportion of macrosomia (44%) was highest in the G24WG group above the 2022 Chinese guidelines.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSummary characteristics of pregnancy outcomes in the study population overall and by G24WG status\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAdverse pregnancy outcome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003eGWG at gestational week 24 (G24WG)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;976\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBelow, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAverage, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAbove, n (%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGDM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44 (16.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e133 (49.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e94 (34.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e271\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e79 (11.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e357 (50.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e269 (38.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e705\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (11.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27 (38.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e35 (50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e115 (12.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e463 (51.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e328 (36.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e907\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGestational hypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (13.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e41 (41.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e45 (45.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e99\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e110 (12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e449 (51.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e318 (36.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e877\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMacrosomia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (6.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22 (44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25 (50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e120 (13.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e468 (50.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e338 (36.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e726\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eLow birth weight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (13.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24 (52.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e16 (34.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e117 (12.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e466 (50.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e347 (37.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e930\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSGA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (23.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29 (48.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17 (28.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e109 (11.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e461 (50.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e346 (37.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e916\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eLGA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (8.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e78 (49.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e67 (42.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e159\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e109 (13.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e412 (50.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e296 (36.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e817\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eP: positive, N: negative, G24WG: gestational weight gain during 24 gestational weeks, GDM: gestational diabetes mellitus, PE: preeclampsia, SGA: small for gestational age, LGA: large for gestational age\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAs shown at Table \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, the result of univariate logistic regression showed that excessive G24WG significantly increased the risk of PE compared with the average group (crude OR\u0026thinsp;=\u0026thinsp;1.830, 95% CI: 1.086\u0026ndash;3.083, P\u0026thinsp;=\u0026thinsp;0.023), which is consistent with a previous study(\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). However, after adjusting pre-pregnancy BMI, maternal age, primiparity and gravidity, there was no statistical significance in the risk of PE between the excessive group and the average group (Adjusted OR\u0026thinsp;=\u0026thinsp;1.566, 95% CI: 0.908\u0026ndash;2.702, P\u0026thinsp;=\u0026thinsp;0.107). The reason for this contradiction might be that parity is a strong confounding factor for the occurrence of PE because PE status in a woman\u0026rsquo;s first pregnancy strongly predicts her risks of PE in subsequent pregnancies(\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAssociations between G24WG and adverse pregnancy outcomes\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003ePregnancy outcomes, odds ratio (95% CI), P value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroups\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGDM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGestational hypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMacrosomia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eLBW\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSGA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eLGA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBelow (Crude ORs)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.495\u003c/p\u003e \u003cp\u003e(0.983\u0026ndash;2.273)\u003c/p\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.060\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.193\u003c/p\u003e \u003cp\u003e(0.528\u0026ndash;2.695)\u003c/p\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.671\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.294\u003c/p\u003e \u003cp\u003e(0.670\u0026ndash;2.499)\u003c/p\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.442\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.532\u003c/p\u003e \u003cp\u003e(0.157\u0026ndash;1.806)\u003c/p\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.311\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.996\u003c/p\u003e \u003cp\u003e(0.398\u0026ndash;2.492)\u003c/p\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.993\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.042\u003c/p\u003e \u003cp\u003e(1.044\u0026ndash;3.995)\u003c/p\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.037\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.678\u003c/p\u003e \u003cp\u003e(0.370\u0026ndash;1.245)\u003c/p\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.210\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAverage (Crude ORs)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRef (OR\u0026thinsp;=\u0026thinsp;1.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRef (OR\u0026thinsp;=\u0026thinsp;1.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRef (OR\u0026thinsp;=\u0026thinsp;1.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRef (OR\u0026thinsp;=\u0026thinsp;1.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRef (OR\u0026thinsp;=\u0026thinsp;1.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eRef (OR\u0026thinsp;=\u0026thinsp;1.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eRef (OR\u0026thinsp;=\u0026thinsp;1.00)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbove (Crude ORs)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.938\u003c/p\u003e \u003cp\u003e(0.689\u0026ndash;1.276)\u003c/p\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.684\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.830\u003c/p\u003e \u003cp\u003e(1.086\u0026ndash;3.083)\u003c/p\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.023\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.550\u003c/p\u003e \u003cp\u003e(0.991\u0026ndash;2.423)\u003c/p\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.055\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.573\u003c/p\u003e \u003cp\u003e(0.872\u0026ndash;2.838)\u003c/p\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.132\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.895\u003c/p\u003e \u003cp\u003e(0.468\u0026ndash;1.711)\u003c/p\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.828\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.781\u003c/p\u003e \u003cp\u003e(0.422\u0026ndash;1.444)\u003c/p\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.431\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.196\u003c/p\u003e \u003cp\u003e(0.835\u0026ndash;1.712)\u003c/p\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.329\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBelow (Adjusted ORs)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.939\u003c/p\u003e \u003cp\u003e(0.594\u0026ndash;1.485)\u003c/p\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.788\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.663\u003c/p\u003e \u003cp\u003e(0.277\u0026ndash;1.583)\u003c/p\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.354\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.747\u003c/p\u003e \u003cp\u003e(0.366\u0026ndash;1.523)\u003c/p\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.422\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.333\u003c/p\u003e \u003cp\u003e(0.094\u0026ndash;1.173)\u003c/p\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.087\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.125\u003c/p\u003e \u003cp\u003e(0.441\u0026ndash;2.868)\u003c/p\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.805\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.690\u003c/p\u003e \u003cp\u003e1.334\u0026ndash;5.427\u003c/p\u003e \u003cp\u003e0.006\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.435\u003c/p\u003e \u003cp\u003e(0.228\u0026ndash;0.829)\u003c/p\u003e \u003cp\u003e0.011\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAverage (Adjusted ORs)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRef (OR\u0026thinsp;=\u0026thinsp;1.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRef (OR\u0026thinsp;=\u0026thinsp;1.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRef (OR\u0026thinsp;=\u0026thinsp;1.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRef (OR\u0026thinsp;=\u0026thinsp;1.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRef (OR\u0026thinsp;=\u0026thinsp;1.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eRef (OR\u0026thinsp;=\u0026thinsp;1.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eRef (OR\u0026thinsp;=\u0026thinsp;1.00)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbove (Adjusted ORs)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.301\u003c/p\u003e \u003cp\u003e(0.7938\u0026ndash;1.804)\u003c/p\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.115\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.566\u003c/p\u003e \u003cp\u003e(0.908\u0026ndash;2.702)\u003c/p\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.107\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.344\u003c/p\u003e \u003cp\u003e(0.840\u0026ndash;2.150)\u003c/p\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.218\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.404\u003c/p\u003e \u003cp\u003e(0.765\u0026ndash;2.574)\u003c/p\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.273\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.936\u003c/p\u003e \u003cp\u003e(0.486\u0026ndash;1.801)\u003c/p\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.843\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.885\u003c/p\u003e \u003cp\u003e(0.473\u0026ndash;1.653)\u003c/p\u003e \u003cp\u003e0.701\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.062\u003c/p\u003e \u003cp\u003e(0.732\u0026ndash;1.541)\u003c/p\u003e \u003cp\u003e0.751\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e*, P value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant. G24WG: gestational weight gain during 24 gestational weeks, OR: odds ratio, CI: confidence interval, Ref: reference, GDM: gestational diabetes mellitus, PE: preeclampsia, SGA: small for gestational age, LGA: large for gestational age, LBW: low birth weight\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eCompared to the reference group with average G24WG, women with inadequate G24WG had a significantly higher risk of SGA (Adjusted OR\u0026thinsp;=\u0026thinsp;2.690, 95% CI: 1.334\u0026ndash;5.427, P\u0026thinsp;=\u0026thinsp;0.006) and a a significantly lower risk of LGA (Adjusted OR\u0026thinsp;=\u0026thinsp;0.435, 95% CI: 0.228\u0026ndash;0.829, P\u0026thinsp;=\u0026thinsp;0.011), which was consistent with a previous study demonstrating that inadequate second-trimester GWG might be associated with increased risk of SGA in underweight women(\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). There was also a higher risk of LBW and a lower risk of macrosomia in the group below the 2022 Chinese guideline without statistical significance. For the group of excessive G24WG, no significant difference in risks was observed across the outcomes including GDM, LBW, macrosomia, PE, gestational hypertension, SGA or LGA compared to the reference group (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e), which was inconsistent with previous studies demonstrating that excessive total GWG significantly increased the risk of LGA and GDM (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). It was possible that the amount of GWG difference between excessive vs. average GWG groups in our study may not be sufficient enough to detect a significant difference in outcome risks due to a relatively small sample size.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this study, we found that women with inadequate weight gain during 24 gestational weeks (G24WG) had a significantly higher risk of SGA and a significantly lower risk of LGA. The significant effect of excessive G24WG on the increased risk of PE was counteracted after considering the influence of maternal age, primiparity, gravidity and pre-pregnancy BMI.\u003c/p\u003e \u003cp\u003eNo significant difference in risks of adverse pregnancy outcomes between excessive and average G24WG group was observed, which may be due to the limited sample in this study.\u003c/p\u003e \u003cp\u003eAssociations between inadequate or excessive weight gain during the whole pregnancy and outcomes for mothers and infants have been well described(\u003cspan additionalcitationids=\"CR32 CR33\" citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). A systemic review demonstrated that GWG was below or above the IOM guidelines in 23% and 47% of pregnancies, respectively. The 23% of women who gained inadequate weight had an increased risk of SGA compared with those whose gestational weight gain was within the IOM guidelines(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). However, the IOM recommendations are based on population information from North America, which restricts its use among populations from different countries and different ethnicities (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). Asian women usually have a lower pre-pregnancy BMI compared with those in Western countries, so the BMI criteria in the IOM guidelines are not appropriate for Asian populations, which might result in error of classification. Previous studies have shown that Asians have increased risk of diabetes or cardiovascular diseases, which are all obesity-related, at lower BMI levels than Caucasians(\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). Therefore, lower BMI cut-off and lower recommended GWG should be more suitable for Asian populations. Many Asian countries including Singapore(\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e), Japan(\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e), and Korea(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e) have proposed their own recommendations of GWG, which implies that the optimal GWG may vary due to different population characteristics and each country should consider its own optimal GWG range. Thus in this study, we use the Standard of Recommendation for Weight Gain during Pregnancy Period published by Maternal and Child Health Standards Professional Committee of National Health Commission (NHC), China PR in 2022(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). According to the IOM guideline, pre-pregnancy BMI is classified as: underweight (BMI\u0026thinsp;\u0026lt;\u0026thinsp;18.5 kg/m\u003csup\u003e2\u003c/sup\u003e), normal weight (BMI 18.5\u0026ndash;24.9 kg/m\u003csup\u003e2\u003c/sup\u003e), overweight (BMI 25.0-29.9 kg/m\u003csup\u003e2\u003c/sup\u003e), and obese (BMI\u0026thinsp;\u0026ge;\u0026thinsp;30 kg/m\u003csup\u003e2\u003c/sup\u003e), which might be too big for Chinese women. In the 2022 Chinese standard, pre-pregnancy BMI is stratified into four categories: underweight (BMI\u0026thinsp;\u0026lt;\u0026thinsp;18.5 kg/m\u003csup\u003e2\u003c/sup\u003e), normal weight (BMI 18.5\u0026ndash;23.9 kg/m\u003csup\u003e2\u003c/sup\u003e), overweight (BMI 24\u0026ndash;27.9 kg/m\u003csup\u003e2\u003c/sup\u003e) and obese (BMI\u0026thinsp;\u0026ge;\u0026thinsp;28 kg/m\u003csup\u003e2\u003c/sup\u003e).\u003c/p\u003e \u003cp\u003eThis study has some strengths compared with other studies reported in the literature. First, we applied the Standard of Recommendation for Weight Gain during Pregnancy Period designed specific for Chinese pregnant women instead of the 2009 IOM guidelines more suitable for Caucasian people. Second, the study contains detailed clinical data including pre-pregnancy weight and weight measurements during 24 gestational weeks, which made it possible to study GWG in the second trimester. In addition, it is difficult to disentangle the\u003c/p\u003e \u003cp\u003eeffect caused by GWG from the effect caused by duration of pregnancy due to the strong correlation between GWG and gestational duration. However, the use of gestational weight gain during 24 gestational weeks (G24WG) in our study can overcome this limitation, ensuring that the weight gain of women who experience adverse pregnancy outcomes would be\u003c/p\u003e \u003cp\u003ecompared with the weight gain of women without adverse outcomes at the same point in pregnancy. Besides, studies exploring the effect of GWG during the second trimester on adverse pregnancy outcomes are relatively few. Our study fill this gap.\u003c/p\u003e \u003cp\u003eThere are also limitations in our study. First, the pre-pregnancy weight data in this study was self-reported at the first prenatal visit within the first 13 weeks of pregnancy, which may lead to recalling bias. Second, we only investigated the short-term perinatal outcomes, without considering long-term complications such as cardiometabolic diseases and obesity in later life. Third, the nature of our study is a single-centered retrospective study. In the future, more powered randomized trials are needed.\u003c/p\u003e \u003cp\u003eOur findings may have clinical implications. We have demonstrated that inadequate GWG during 24 gestational weeks (in the mid-pregnancy period) may affect subsequent maternal and neonatal outcomes. To mitigate the harms of inadequate weight gain, doctors need to take measures to increase the proportion of women who adhere to the 2022 Chinese guidelines for weight gain during pregnancy, including appropriate nutritional supplement, exercise, counseling and a variety of mobile technology interventions. Maintaining the appropriate amount of weight gain during the second trimester may be a driver to prevent pregnancy complications and should be integrated into routine prenatal care.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003e In this investigation, we found that women with inadequate weight gain during 24 gestational weeks (G24WG) had a significantly higher risk of SGA and a significantly lower risk of LGA using the Standard of Recommendation for Weight Gain during Pregnancy Period published by Maternal and Child Health Standards Professional Committee of National Health Commission (NHC), China PR in 2022, which is more suitable for Chinese women. Our study is the first study to demonstrate the association between weight gain during 24 gestational weeks and pregnancy outcomes using the 2022 Chinese guidelines based on Chinese population and help doctors provide appropriate nutritional counseling. In the future, more multi-centered, randomized controlled trials are needed to make appropriate gestational weight gain guidelines for Chinese people.\u003c/p\u003e"},{"header":"List Of Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eGWG\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003egestational weight gain\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eG24WG\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eweight gain during 24 gestational weeks\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eOR\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eodds ratio\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eCI\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003econfidence interval\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eSD\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003estandard deviation\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eGDM\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003egestational diabetes mellitus\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eSGA\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003esmall for gestational age\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eLGA\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003elarge for gestational age\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eBMI\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ebody mass index\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003ePE\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003epreeclampsia\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eOGTT\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eoral glucose tolerance test\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eNHC\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNational Health Commission\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eIOM\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInstitute of Medicine\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003ePPH\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003epostpartum hemorrhage\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Ethics Committee of the Shanghai General Hospital. All methods were carried out in accordance with the Declaration of Helsinki. Written informed consent was waived by Shanghai General Hospital Ethic committee due to the retrospective nature of this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eShanghai Jiao Tong University Trans-Med Awards Research (STAR) (Major Project) (20210201)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eXian-Ming Xu and Jie Ma designed the study; De-Cui Cheng and Jie Ma provided study materials; Dong-Mei Zhou, Shi-Tong Zhan, Hao-Yi Jia collected and assembled data; Xue-Qing Liu and Yi Lin performed data analysis and interpretation; Xiao-Wei Wei and Chuan-Mei Qin wrote the manuscript; All authors reviewed the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eJin D, Rich-Edwards JW, Chen C, Huang Y, Wang Y, Xu X, et al. Gestational Diabetes Mellitus: Predictive Value of Fetal Growth Measurements by Ultrasonography at 22-24 Weeks: A Retrospective Cohort Study of Medical Records. Nutrients. 2020;12(12).\u003c/li\u003e\n\u003cli\u003eHutcheon JA, Stephansson O, Cnattingius S, Bodnar LM, Wikstr\u0026ouml;m AK, Johansson K. Pregnancy Weight Gain Before Diagnosis and Risk of Preeclampsia: A Population-Based Cohort Study in Nulliparous Women. Hypertension. 2018;72(2):433-41.\u003c/li\u003e\n\u003cli\u003ePitkin RM. Nutritional support in obstetrics and gynecology. Clin Obstet Gynecol. 1976;19(3):489-513.\u003c/li\u003e\n\u003cli\u003eKominiarek MA, Peaceman AM. Gestational weight gain. Am J Obstet Gynecol. 2017;217(6):642-51.\u003c/li\u003e\n\u003cli\u003eInstitute of M, National Research Council Committee to Reexamine IOMPWG. The National Academies Collection: Reports funded by National Institutes of Health. In: Rasmussen KM, Yaktine AL, editors. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington (DC): National Academies Press (US) Copyright \u0026copy; 2009, National Academy of Sciences.; 2009.\u003c/li\u003e\n\u003cli\u003eMamun AA, Callaway LK, O\u0026apos;Callaghan MJ, Williams GM, Najman JM, Alati R, et al. Associations of maternal pre-pregnancy obesity and excess pregnancy weight gains with adverse pregnancy outcomes and length of hospital stay. BMC Pregnancy Childbirth. 2011;11:62.\u003c/li\u003e\n\u003cli\u003eXu Z, Wen Z, Zhou Y, Li D, Luo Z. Inadequate weight gain in obese women and the risk of small for gestational age (SGA): a systematic review and meta-analysis. J Matern Fetal Neonatal Med. 2017;30(3):357-67.\u003c/li\u003e\n\u003cli\u003eGoldstein RF, Abell SK, Ranasinha S, Misso M, Boyle JA, Black MH, et al. Association of Gestational Weight Gain With Maternal and Infant Outcomes: A Systematic Review and Meta-analysis. Jama. 2017;317(21):2207-25.\u003c/li\u003e\n\u003cli\u003eHedderson MM, Gunderson EP, Ferrara A. Gestational weight gain and risk of gestational diabetes mellitus. Obstet Gynecol. 2010;115(3):597-604.\u003c/li\u003e\n\u003cli\u003ePremru-Srsen T, Kocic Z, Fabjan Vodusek V, Ger\u0026scaron;ak K, Verdenik I. Total gestational weight gain and the risk of preeclampsia by pre-pregnancy body mass index categories: a population-based cohort study from 2013 to 2017. J Perinat Med. 2019;47(6):585-91.\u003c/li\u003e\n\u003cli\u003eSantos S, Voerman E, Amiano P, Barros H, Beilin LJ, Bergstr\u0026ouml;m A, et al. Impact of maternal body mass index and gestational weight gain on pregnancy complications: an individual participant data meta-analysis of European, North American and Australian cohorts. Bjog. 2019;126(8):984-95.\u003c/li\u003e\n\u003cli\u003eWu Y, Wan S, Gu S, Mou Z, Dong L, Luo Z, et al. Gestational weight gain and adverse pregnancy outcomes: a prospective cohort study. BMJ Open. 2020;10(9):e038187.\u003c/li\u003e\n\u003cli\u003eChen D, Zhou X, Yan S, Li W, Yang X, Lv C, et al. Optimal Gestational Weight Gain for Tibetans Based on Prepregnancy Body Mass Index. Scientific Reports. 2020;10(1):10690.\u003c/li\u003e\n\u003cli\u003eMorisaki N, Nagata C, Jwa SC, Sago H, Saito S, Oken E, et al. Pre-pregnancy BMI-specific optimal gestational weight gain for women in Japan. Journal of Epidemiology. 2017;27(10):492-8.\u003c/li\u003e\n\u003cli\u003eChoi SK, Lee G, Kim YH, Park IY, Ko HS, Shin JC. Determining optimal gestational weight gain in the Korean population: a retrospective cohort study. Reproductive Biology and Endocrinology. 2017;15(1):67.\u003c/li\u003e\n\u003cli\u003eJiang X, Liu M, Song Y, Mao J, Zhou M, Ma Z, et al. The Institute of Medicine recommendation for gestational weight gain is probably not optimal among non-American pregnant women: a retrospective study from China. J Matern Fetal Neonatal Med. 2019;32(8):1353-8.\u003c/li\u003e\n\u003cli\u003eStandard of Recommendation for Weight Gain during Pregnancy Period. Biomed Environ Sci. 2022;35(10):875-7.\u003c/li\u003e\n\u003cli\u003eStandard of Recommendation for Weight Gain during Pregnancy Period. - Biomedical and Environmental Sciences. 2022;- 35(- 10):- 875.\u003c/li\u003e\n\u003cli\u003eZhao Y, Li DZ. Born large for gestational age: not just bigger. Am J Obstet Gynecol. 2023;228(3):366-7.\u003c/li\u003e\n\u003cli\u003eBattaglia FC, Lubchenco LO. A practical classification of newborn infants by weight and gestational age. J Pediatr. 1967;71(2):159-63.\u003c/li\u003e\n\u003cli\u003eChandraharan E, Krishna A. Diagnosis and management of postpartum haemorrhage. Bmj. 2017;358:j3875.\u003c/li\u003e\n\u003cli\u003eMierzyński R, Poniedziałek-Czajkowska E, Sotowski M, Szydełko-Gorzkowicz M. Nutrition as Prevention Factor of Gestational Diabetes Mellitus: A Narrative Review. Nutrients. 2021;13(11).\u003c/li\u003e\n\u003cli\u003eJuan J, Yang H. Prevalence, Prevention, and Lifestyle Intervention of Gestational Diabetes Mellitus in China. Int J Environ Res Public Health. 2020;17(24).\u003c/li\u003e\n\u003cli\u003eSinkey RG, Battarbee AN, Bello NA, Ives CW, Oparil S, Tita ATN. Prevention, Diagnosis, and Management of Hypertensive Disorders of Pregnancy: a Comparison of International Guidelines. Curr Hypertens Rep. 2020;22(9):66.\u003c/li\u003e\n\u003cli\u003eRana S, Lemoine E, Granger JP, Karumanchi SA. Preeclampsia: Pathophysiology, Challenges, and Perspectives. Circ Res. 2019;124(7):1094-112.\u003c/li\u003e\n\u003cli\u003eRen M, Li H, Cai W, Niu X, Ji W, Zhang Z, et al. Excessive gestational weight gain in accordance with the IOM criteria and the risk of hypertensive disorders of pregnancy: a meta-analysis. BMC Pregnancy and Childbirth. 2018;18(1):281.\u003c/li\u003e\n\u003cli\u003eHern\u0026aacute;ndez-D\u0026iacute;az S, Toh S, Cnattingius S. Risk of pre-eclampsia in first and subsequent pregnancies: prospective cohort study. Bmj. 2009;338:b2255.\u003c/li\u003e\n\u003cli\u003eWei X, Shen S, Huang P, Xiao X, Lin S, Zhang L, et al. Gestational weight gain rates in the first and second trimesters are associated with small for gestational age among underweight women: a prospective birth cohort study. BMC Pregnancy Childbirth. 2022;22(1):106.\u003c/li\u003e\n\u003cli\u003eShi P, Liu A, Yin X. Association between gestational weight gain in women with gestational diabetes mellitus and adverse pregnancy outcomes: a retrospective cohort study. BMC Pregnancy and Childbirth. 2021;21(1):508.\u003c/li\u003e\n\u003cli\u003eLautredou M, Pan-Petesch B, Dupr\u0026eacute; P-F, Drugmanne G, Nowak E, Anouilh F, et al. Excessive gestational weight gain is an independent risk factor for gestational diabetes mellitus in singleton pregnancies: Results from a French cohort study. European Journal of Obstetrics \u0026amp; Gynecology and Reproductive Biology. 2022;275:31-6.\u003c/li\u003e\n\u003cli\u003eCheikh Ismail L, Bishop DC, Pang R, Ohuma EO, Kac G, Abrams B, et al. Gestational weight gain standards based on women enrolled in the Fetal Growth Longitudinal Study of the INTERGROWTH-21st Project: a prospective longitudinal cohort study. Bmj. 2016;352:i555.\u003c/li\u003e\n\u003cli\u003eCaughey AB. Gestational Weight Gain and Outcomes for Mothers and Infants. Jama. 2017;317(21):2175-6.\u003c/li\u003e\n\u003cli\u003eUkah UV, Bayrampour H, Sabr Y, Razaz N, Chan WS, Lim KI, et al. Association between gestational weight gain and severe adverse birth outcomes in Washington State, US: A population-based retrospective cohort study, 2004-2013. PLoS Med. 2019;16(12):e1003009.\u003c/li\u003e\n\u003cli\u003eBadon SE, Dublin S, Nance N, Hedderson MM, Neugebauer R, Easterling T, et al. Gestational weight gain and adverse pregnancy outcomes by pre-pregnancy BMI category in women with chronic hypertension: A cohort study. Pregnancy Hypertension. 2021;23:27-33.\u003c/li\u003e\n\u003cli\u003eGoldstein RF, Abell SK, Ranasinha S, Misso ML, Boyle JA, Harrison CL, et al. Gestational weight gain across continents and ethnicity: systematic review and meta-analysis of maternal and infant outcomes in more than one million women. BMC Medicine. 2018;16(1):153.\u003c/li\u003e\n\u003cli\u003eDeurenberg-Yap M, Deurenberg P. Is a re-evaluation of WHO body mass index cut-off values needed? The case of Asians in Singapore. Nutr Rev. 2003;61(5 Pt 2):S80-7.\u003c/li\u003e\n\u003cli\u003eChiu M, Austin PC, Manuel DG, Shah BR, Tu JV. Deriving ethnic-specific BMI cutoff points for assessing diabetes risk. Diabetes Care. 2011;34(8):1741-8.\u003c/li\u003e\n\u003cli\u003eEe TX, Allen JC, Jr., Malhotra R, Koh H, \u0026Oslash;stbye T, Tan TC. Determining optimal gestational weight gain in a multiethnic Asian population. J Obstet Gynaecol Res. 2014;40(4):1002-8.\u003c/li\u003e\n\u003cli\u003eMorisaki N, Nagata C, Jwa SC, Sago H, Saito S, Oken E, et al. Pre-pregnancy BMI-specific optimal gestational weight gain for women in Japan. J Epidemiol. 2017;27(10):492-8.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"gestational weight gain, small for gestational age, large for gestational age, preeclampsia","lastPublishedDoi":"10.21203/rs.3.rs-2954352/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2954352/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003e Although the association between inadequate or excessive gestational weight gain (GWG) and adverse pregnancy outcomes has been investigated in China, most studies use the Institute of Medicine (IOM) guidelines, which might not be suitable for Chinese women characteristics. Besides, studies exploring association between GWG in the second trimester and pregnancy outcomes are relatively few.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA total of 976 cases of live-birth singleton pregnancies at the Shanghai General Hospital were included in this retrospective observational study. Patients were classified into three groups including GWG during 24 gestational weeks (G24WG) within, below and above the Standard of Recommendation for Weight Gain during Pregnancy Period published by Maternal and Child Health Standards Professional Committee of National Health Commission (NHC), China PR in 2022 (2022 Chinese GWG guidelines), which specifies the recommended value of weight gain of natural singleton pregnancy in China. Binary logistic regression was used to estimate the adjusted odds ratio (OR) and 95% confidence intervals (CIs) of adverse pregnancy outcomes among three G24WG groups.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003e Of the 976 women analyzed, 12.6% had G24WG below the 2022 Chinese GWG guidelines, while 37.2% had G24WG above the 2022 Chinese GWG guidelines. Women with G24WG below the 2022 Chinese GWG guidelines had a higher risk of Small for Gestational Age (SGA, Adjusted OR\u0026thinsp;=\u0026thinsp;2.690, 95% CI: 1.334\u0026ndash;5.427, P\u0026thinsp;=\u0026thinsp;0.006) and a lower risk of Large for Gestational Age (LGA, Adjusted OR\u0026thinsp;=\u0026thinsp;0.435, 95% CI: 0.228\u0026ndash;0.829, P\u0026thinsp;=\u0026thinsp;0.011) than women who had G24WG within the 2022 Chinese GWG guidelines.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eG24WG is a strong predictor of newborn anthropometric outcomes and help doctors provide appropriate nutritional counseling for pregnant women in China.\u003c/p\u003e","manuscriptTitle":"Association between weight gain during 24 gestational weeks and pregnancy outcomes: A retrospective study in Chinese population","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-05-29 11:24:49","doi":"10.21203/rs.3.rs-2954352/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d6f064e9-abb0-4c56-b2d5-2d2840e9a8eb","owner":[],"postedDate":"May 29th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2023-06-13T09:44:15+00:00","versionOfRecord":[],"versionCreatedAt":"2023-05-29 11:24:49","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-2954352","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2954352","identity":"rs-2954352","version":["v1"]},"buildId":"-HB7Z8yhvgn0wM9Nzuekk","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}