Trends in gestational weight gain from 2007-2019: A prospective cohort study

Trends in gestational weight gain from 2007-2019: A prospective cohort study | Authorea try { document.documentElement.classList.add('js'); } catch (e) { } var _gaq = _gaq || []; _gaq.push(['_setAccount', 'G-8VDV14Y67G']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })(); Skip to main content Preprints Collections Wiley Open Research IET Open Research Ecological Society of Japan All Collections About About Authorea FAQs Contact Us Quick Search anywhere Search for preprint articles, keywords, etc. Search Search ADVANCED SEARCH SCROLL This is a preprint and has not been peer reviewed. Data may be preliminary. 12 March 2025 V1 Latest version Share on Trends in gestational weight gain from 2007-2019: A prospective cohort study Authors : Belle Martin , David E. Cantonwine , Lyndsey Darrow , Kelly K. Ferguson , Thomas F McElrath , and Barrett Welch [email protected] Authors Info & Affiliations https://doi.org/10.22541/au.174176127.76499008/v1 Published Paediatric and Perinatal Epidemiology Version of record Peer review timeline 310 views 137 downloads Contents Abstract Abstract Introduction Methods Results Discussion Conclusion Information & Authors Metrics & Citations View Options References Figures Tables Media Share Abstract Objective: To evaluate temporal trends in total gestational weight gain (GWG) from 2007 to 2019 in a large pregnancy cohort. Design: Prospective cohort study. Setting: LIFECODES study, Brigham and Women’s Hospital, Boston, MA. Sample: 3,675 pregnant participants, with 29,037 weight measures. Methods: Using self-reported pre-pregnancy weight and serial weight measurements, we applied a mixed effects model to predict maternal weight at delivery. Total GWG (kg) was defined as the difference between predicted delivery weight and pre-pregnancy weight, classified based on the 2009 guidelines by pre-pregnancy BMI. Main Outcome Measures: Trends in proportions of GWG categories, both overall and stratified by maternal characteristics; Trends in covariate-adjusted geometric means (GMs) of GWG. Results: The proportion of participants with total GWG within the guidelines decreased from 46% in 2007-2008 to 24% in 2018-2019, which was driven by an increase in those gaining above the guidelines (40% to 73%). Trends were consistent across maternal characteristics, though the largest relative increases of proportions above the guidelines were observed among those of normal pre-pregnancy BMI (19% to 62%) and of non-Hispanic Black (48% to 85%) or non-Hispanic White (37% to 74%) race/ethnicity. Adjusted GMs increased from 8.3 kg (95% confidence interval [CI]: 6.3, 10.8) in 2007-2008 to 10.9 kg (95% CI: 7.9, 14.9) in 2018-2019. Conclusions: Over time, fewer women have been meeting the revised 2009 GWG guidelines, and this trend is driven by increasing proportions of pregnant individuals gaining weight above the recommendations. Trends in gestational weight gain from 2007-2019: A prospective cohort study Belle Martin a , David E. Cantonwine b , Lyndsey A. Darrow a , Kelly K. Ferguson c , Thomas F. McElrath b , Barrett M. Welch a* a School of Public Health, University of Nevada, Reno, Reno, NV b Division of Maternal-Fetal Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA c Epidemiology Branch, Division of Intramural Research, National Institute of Environmental Health Sciences, Research Triangle Park, NC *CORRESPONDING AUTHOR: Barrett M Welch ( [email protected] ) SHORT TITLE: Trends in gestational weight gain from 2007-2019 Abstract Objective: To evaluate temporal trends in total gestational weight gain (GWG) from 2007 to 2019 in a large pregnancy cohort. Design: Prospective cohort study. Setting: LIFECODES study, Brigham and Women’s Hospital, Boston, MA. Sample: 3,675 pregnant participants, with 29,037 weight measures. Methods: Using self-reported pre-pregnancy weight and serial weight measurements, we applied a mixed effects model to predict maternal weight at delivery. Total GWG (kg) was defined as the difference between predicted delivery weight and pre-pregnancy weight, classified based on the 2009 guidelines by pre-pregnancy BMI. Main Outcome Measures: Trends in proportions of GWG categories, both overall and stratified by maternal characteristics; Trends in covariate-adjusted geometric means (GMs) of GWG. Results: The proportion of participants with total GWG within the guidelines decreased from 46% in 2007-2008 to 24% in 2018-2019, which was driven by an increase in those gaining above the guidelines (40% to 73%). Trends were consistent across maternal characteristics, though the largest relative increases of proportions above the guidelines were observed among those of normal pre-pregnancy BMI (19% to 62%) and of non-Hispanic Black (48% to 85%) or non-Hispanic White (37% to 74%) race/ethnicity. Adjusted GMs increased from 8.3 kg (95% confidence interval [CI]: 6.3, 10.8) in 2007-2008 to 10.9 kg (95% CI: 7.9, 14.9) in 2018-2019. Conclusions: Over time, fewer women have been meeting the revised 2009 GWG guidelines, and this trend is driven by increasing proportions of pregnant individuals gaining weight above the recommendations. Keywords : gestational weight gain; pregnancy cohort; maternal health; trends Introduction Total gestational weight gain (GWG), defined as the amount of weight gained during pregnancy, is recognized to be a potentially modifiable risk factor for adverse pregnancy (e.g., cesarean delivery, preeclampsia, gestational diabetes) and postpartum (e.g., maternal weight retention, childhood obesity) outcomes. 1-4 In 1990, the National Academy of Medicine (NAM), formerly the Institute of Medicine, released clinical guidelines, which categorized total GWG as below, within, or above the guidelines, based on pre-pregnancy body mass index (BMI). 5 In 2009, revisions to guidelines included adjusted definitions of BMI categories, a new upper weight gain limit for those with obesity, new ranges for rates of weight gain in trimesters 2-3, and removal of prior recommendations for height, adolescence, or race/ethnicity. 5 Since the implementation of the 2009 guidelines, relatively few US studies have described longitudinal trends in total GWG (i.e., a decade or longer). 6-9 Further, the limited existing evidence is mixed. While both US and international studies have found modest increasing trends in the average weight gain and proportions of women gaining weight above the guidelines, 6,7,10-18 others have shown either no major changes, 19-23 or possible decreases in weight gain and higher proportions gaining below the guidelines. 8,24,25 Separately, the existing literature has key methodological limitations. Total GWG is typically calculated by subtracting self-reported pre-pregnancy weight from maternal weight at some point prior to delivery. 26 However, the method to define or measure weight at delivery varies widely and can produce measurement bias. 27 For example, existing studies often rely on self-reported weight at delivery using follow-up questionnaires, 8,24 perinatal interviews, 11 or birth certificate data, 7,14,19,22 which are prone to bias. 28 Alternatively, the last recorded weight is often used in place of measurement at delivery, 13,16,18 which can avoid recall bias but lack accuracy if taken days to weeks prior delivery. 29 In this study, we characterize trends in maternal GWG from 2007-2019 among participants of LIFECODES, a large US prospective cohort study. We address prior methodological gaps in total GWG measures by leveraging repeated weight measures to predict weight at delivery. Our primary aims are to evaluate trends in: a) total GWG categories (i.e., below, within, above) using the 2009 guidelines; and b) average weight gain. Our secondary aim examines trends by characteristics related to GWG disparities, 26 including maternal pre-pregnancy BMI, race and ethnicity, and educational levels. Methods Study design and participant selection Participants in the ongoing LIFECODES cohort are pregnant women from the Boston area who attend Brigham and Women’s Hospital (BWH) for prenatal care. Eligibility criteria include: being ≥ 18 years of age, no higher order pregnancies beyond twins, and planning to deliver at BWH. 30 At the initial study visit, participants complete a questionnaire to determine their sociodemographic and background health information. Gestational age at each visit is established using first-trimester ultrasound. Participants are followed through delivery to gather anthropometric measurements and ascertain complications. All participants provide written informed consent and the Institutional Review Board at BWH has approved the study. We restricted our analysis to participants with a singleton gestation, an initial prenatal visit at ≤15 weeks of gestation, and a live birth delivery at ≥22 weeks of gestation. We also restricted to participants with a delivery between 2007 to 2019, which represented the time span from the cohort’s initiation to the most recent year in which all obstetric data was available. Among the initial 3,675 participants with 29,037 weight measures meeting these criteria, we excluded 152 (4.1%) participants and 1,060 (3.7%) weight measures using the additional a priori criteria described in Figure S1. Our final analytic sample included n = 3,523 participants with 27,977 weight measures. Assessment of GWG We used self-reported pre-pregnancy weight as the baseline weight. Using serial weight measurements from each prenatal visit (median = 7/participant, interquartile range [IQR] = 4-11), we applied a linear mixed effects model to predict participant weight at their respective gestational age at delivery. A previous study in LIFECODES compared methodologies to predict maternal weight values and found this modeling approach was highly accurate. 29 Our model specified maternal weight as the dependent variable, gestational age (weeks) as the independent variable, a random intercept for participant, an unstructured variance-covariance matrix, and robust standard errors. We fit restricted cubic splines for gestational age to account for the expected non-linear patterns in weight gain, 29,30 and we compared models with 3-6 knots using AIC values. Our final model specified 5 knots based on the observed gestational age distribution (knot locations = 5.0, 27.5, 50.0, 72.5, and 95.0 percentiles), 31 which produced participant-specific slopes and intercepts used to create model-predicted weights. Total GWG (kg) was calculated by subtracting the self-reported pre-pregnancy weight from the model-predicted weight at delivery. For weight gain in trimesters 2-3, 30 we subtracted a model-predicted weight at 14 weeks of gestation from the model-predicted weight at delivery and expressed it as a rate (kg/week) using completed gestational weeks. We generated weight-gain-for-gestational-age z-scores using BMI-specific reference charts and standard formulas. 32-34 For both pre- and post-2009 periods, we categorized adequacy of each GWG metric (kg, 2-3 trimester rate, z-score) as below, within, or above the 2009 guidelines based on pre-pregnancy BMI (underweight [BMI < 18.5 kg/m 2 ], normal weight [18.5–24.9 kg/m 2 ], overweight [25.0–29.9 kg/m 2 ], or obesity [BMI ≥ 30 kg/m 2 ]). 5 Values for each metric are provided in Table S1. Statistical methods Our primary aim was to evaluate trends in kilogram-based measures of total GWG, defined using clinical categories and averages, in the study population over calendar year of delivery (Table S1). Due to limited sample size, we grouped years as 2007-2008, 2009-2011, 2012-2014, 2015-2017, and 2018-2019. To assess trends in clinical categories of GWG (below, within, above), we examined proportions of category membership by year of delivery. We conducted sensitivity analyses of trends using alternative measures, including: a) trimester 2-3 rates; and b) z-scores. We used linear regression models to calculate unadjusted and adjusted geometric means (GMs) over years, which accounted for the potential influence of outliers and demographic changes over the study period. For unadjusted GMs, the model specified the dependent variable as log-transformed total GWG and the independent variable as the categorical year. The GM of the referent category (2007-2008) was estimated by exponentiating the beta coefficient for the intercept. The GMs of the remaining categories were estimated by exponentiating their beta coefficient and multiplying by the referent category GM. Statistically significant differences were defined by p -value<0.05. For adjusted GMs, the model included covariates that may have changed over time, including maternal age, gestational age at delivery, parity, educational attainment, and pre-pregnancy BMI. Our secondary aim was to evaluate trends in the proportions of GWG categories by maternal pre-pregnancy BMI, race/ethnicity, and educational level. We selected these characteristics as they may drive underlying disparities in GWG. 26,35,36 For pre-pregnancy BMI, we excluded those with underweight BMI due to limited sample size. We summarized race and ethnicity as non-Hispanic White (White), non-Hispanic Black (Black), Hispanic, Asian (Far East or Near East Asian), and Multiracial/Other (Native American, Mixed, Other). Participants were categorized as Hispanic if they reported that ethnicity, regardless of racial identity. Educational level was based on highest level reported. Results Most of the 3,523 participants were of White race/ethnicity (58%), over 30 years of age (68%), graduated college (67%), parous (59%), and had private health insurance (74%) (Table 1, Table S2). Compared to women in the overall US population during this period, our study had lower proportions of White race/ethnicity and higher levels of education. 37,38 The rates of pregnancy complications in the cohort, including for preterm birth (13%), preeclampsia (7%), and gestational diabetes (6%), were slightly higher than those among the US population. 39,40 Approximately half of participants had a normal pre-pregnancy BMI (51%), and the other half predominantly had BMIs of overweight (24%) or obesity (22%). Although national data shows slightly greater proportions of women with pre-pregnancy overweight or obesity during this period, 41 our distribution closely matches that from larger cohorts in California and Pennsylvania. 34 Distributions of participant characteristics remained relatively consistent over time (Table 1, Table S2). However, the cohort had more participants recruited in earlier phases of the study period than later, resulting in more participants with a delivery in 2007-2008 (33%) compared to 2018-2019 (8%). The proportion of participants entering pregnancy with a normal weight BMI decreased over the study period from 57% in 2007-2008 to 46% in 2018-2019, which matched national trends. 41 Over half (56%) of participants gained weight above the clinical GWG guidelines (Figure 1). The highest proportion of GWG above guidelines was among those with overweight (75%) BMI, followed by those with an obesity (65%). Over time, the proportion of participants with GWG above the guidelines trended higher while the proportion gaining within or below the guidelines trended lower (Figure 2). For example, the proportion of participants with weight gain above the guidelines increased from 40% in 2007-2008 to 73% in 2018-2019, while the proportion within the guidelines decreased from 46% in 2007-2008 to 24% in 2018-2019. Despite a slight increase in the proportion of participants gaining within the guidelines from 2009-2011 to 2012-2014 (32% to 34%), the overall trend remained. The trends were consistent when total GWG was categorized using trimester 2-3 rates (Figure S2) and z-scores (Figure S3). However, the overall trend was attenuated when examining trimester 2-3 rates. Trends were generally consistent across maternal characteristics. For pre-pregnancy BMI, the proportions with GWG gain above guidelines increased across categories (Figure S4, Table S3). Although those with normal BMI had relatively lower proportions above the guidelines, they also had the largest temporal increase, going from 19% in 2007-2008 to 62% in 2018-2019. Alternatively, participants with overweight or obesity BMI had stable to modest decreases in proportions of weight gain above the guidelines from 2007-2008 to 2012-2014, followed by increases in the later years. Participants of Black and White race/ethnicity had the largest proportional increases of GWG above guidelines, increasing from 48% and 37% in 2007-2008 to 85% and 74% in 2018-2019, respectively (Figure S5, Table S3). Separately, each maternal education group showed increasing proportions of participants with weight gain above the guidelines (Figure S6, Table S3). Continuous measures of total GWG also increased over time when visually inspected (Figure S7). The same upward trend was confirmed by unadjusted and adjusted GMs (Table 2), as both measures were significantly higher in 2015-2017 and 2018-2019 compared to 2007-2008. The consistency in trends between GM measures indicated that overall trends were unlikely due to changes in participant characteristics. Discussion Main Findings We leveraged a large prospective cohort with over a decade of recruitment to assess trends in maternal weight gain during pregnancy. Overall, our results support an increasing trend in women gaining weight above clinical guidelines between 2007 to 2019. Importantly, we observed consistency in GWG trends across key maternal characteristics, indicating the overall trends were not driven by specific subgroups of pre-pregnancy BMI, race/ethnicity, or educational attainment. Our results provide new evidence that the revised 2009 guidelines for GWG are increasingly not being met by most patients. Strengths and Limitations Our study has several key strengths. We leveraged 13 years of prospective data with extensive repeated measures to characterize GWG trends in a large cohort. The use of serial pregnancy measures to calculate GWG allowed us to avoid common measurement biases in other studies. Further, we demonstrated our results were consistent across different GWG metrics (i.e., trimester rates and z-scores), though we noted an attenuation of trends when using trimester rates. Although our study population was drawn from one geographic region and single provider network, the cohort had demographic characteristics (pre-pregnancy BMI, race/ethnicity) that paralleled the distributions in larger cohorts and the overall US population. 34,42 We also had several key limitations. First, we had limited sample size in individual years, which required us to create grouped categories across years. These sample sizes changed over the study period and may have limited the precision of observed trends. However, we found trends were consistent across GWG methods, including covariate-adjusted GMs. Second, limited sample size prevented us from assessing trends in key BMI subgroups, including underweight or obesity subclasses (I, II, or III). These groups may be particularly vulnerable to the adverse effects of GWG outside of the guidelines and may also be experiencing differential trends. 3,43 Third, while we assessed trends over a key time period before and after the implementation of revised GWG guidelines, we did not assess trends after 2019. Recent studies provide mixed evidence about the potential impact of the COVID-19 pandemic on GWG, 15,16,44 though there may be an upward trend. 16 Interpretation (in light of other evidence) Since clinical guidelines were revised, limited evidence has been published to determine how the guidelines have impacted GWG. However, in the US, there have been investigations of trends in GWG that occurred mostly during, 7,9,14,19,44 before, 6,8,45,46 or after 15,16,22,23 our 2007-2019 period. The contemporaneous studies showed similar increasing trends in pre-pregnancy BMI, but found null to modest changes in GWG over time. 7,9,14,19,44 For example, two large studies of birth certificate data in South Carolina separately evaluated GWG trends during 2004-2015 7 and 2015-2021. 44 Similar to our results, albeit with lower magnitude, the 2004-2015 study found GWG increased, but only among people of overweight or obesity BMI. 7 This study also observed relatively stable trends in GWG across race/ethnicity. 7 In the 2015-2021 study, the authors similarly found that GWG remained relatively stable over time. 44 In another study of birth certificate data from 2012-2019 in Minnesota, authors found relatively stable rates of GWG above guidelines, but with slight increases among those living in rural areas. 14 Separately, a large study of rural Pennsylvania found GWG in the 3 rd trimester was relatively stable between 2006-2015. 9 However, the study had potential issues with the precision of GWG measures between time periods and limited heterogeneity in participant characteristics compared to the general population. 9 The inconsistencies between our findings and others may be attributable to a combination of differential measurement error between methods used to define total GWG and distinct trends between geographic areas. Almost all contemporaneous studies have relied on birth certificate data to calculate total GWG from weight at pre-pregnancy and delivery. 7,14,19,44 Determining both values from birth certificates increases susceptibility to systematic measurement error, 5,28,47-49 particularly increasing the likelihood of under-estimating pre-pregnancy weight and overestimating delivery weight. 28 Although we relied on self-reported pre-pregnancy weight, our participants reported their pre-pregnancy at enrollment (median = 8.74 weeks gestation, IQR = 6-11) and self-reported weight before 14 weeks gestation can accurately capture pre-pregnancy weight. 50 For weight at delivery, our predictive approach leveraged the large number of available repeated measures, thereby reducing concerns of recall bias, increasing the accuracy of weight estimates to fit participant-specific trajectories, 29 and better capturing population time trends. Conclusion Although the NAM revised GWG guidelines in 2009, widespread efforts (workshops, consensus statements) to inform obstetric providers were mostly delayed until 2013. 51,52 Nonetheless, even after 2013, our results provide evidence that GWG among patients has moved further away from guidelines. Although the other contemporaneous studies did not find the same increases, they also found no notable decreases or changes in GWG. 7,14,19,44 Thus, the results from our study and others suggest significant barriers still exist to prevent patients from meeting GWG guidelines. For obstetric providers, there are a myriad of logistical and sociological barriers that could inhibit successful implementation of GWG guidelines, including time constraints, stigma in conversations of weight gain, and perceived doubt on the relative importance of GWG. 51,53-56 On the patient side, barriers include the lack of knowledge of the guidelines, perceived risks of physical activity and nutrition during pregnancy, and lack of communication from providers about GWG. 51,54-57 Evidence suggests there are discrepancies between the perceptions of providers and patients on weight-related discussions, 56 which would inevitably reduce the efficacy of any GWG guidelines. While there are legitimate concerns about the trends in the health of women before pregnancy that could increase their risk of cardiometabolic complications (e.g., increased rates of pre-pregnancy obesity and physical inactivity), 58-60 our results show that temporal trends in such factors are unlikely to explain the increased GWG in our population, as women across pre-pregnancy BMI classes had similar trends. Future efforts should aim to better identify effective approaches to help patients achieve GWG within the recommendations. This includes more focus on the effectiveness of standardized prenatal care counseling, discussions surrounding lifestyle recommendations, and methods to assist women to monitor and interpret their weight gain throughout pregnancy. Given the evidence of disparities in adverse pregnancy and postpartum outcomes associated with GWG, 26,61 future studies may increase their impact by better characterizing GWG among women with higher pre-pregnancy BMI, lower socioeconomic status, multiple gestation, or living in rural areas. Although large-sample studies of birth certificates can provide exceptional statistical power, our results show it is important to pair such studies with prospective cohorts, particularly those that leverage serial measurements. Another key area for future research is to determine how GWG trends may be impacting trends in postpartum weight retention, an important risk factor for long-term maternal health. 62 To conclude, in a large prospective cohort in Boston, MA, the proportion of women gaining weight within the 2009 guidelines steadily declined over time, which was largely driven by an increasing proportion of women gaining weight above the recommendations. The minimal differences observed between maternal characteristics suggest that the impact of the guidelines has been limited across all groups, including pre-pregnancy BMI, race and ethnicity, and educational levels. These findings underscore the urgent need for investigation into strategies employed by physicians to help women achieve pregnancy gain within the recommended ranges. Acknowledgements: The authors have nothing to report. Disclosure of interests: The authors report no conflict of interest. Contribution to authorship: B.M. contributed to formal analysis, investigation, visualization, and writing – original draft preparation. D.E.C. and T.F.M. contributed to data curation and resources. L.A.D. contributed to conceptualization. K.K.F. contributed to funding acquisition. B.M.W. contributed to conceptualization, formal analysis, methodology, project administration, supervision, and validation. All authors critically reviewed and edited the manuscript. 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Sample size N = 3523 n = 1162 (33.0) n = 575 (16.3) n = 954 (27.1) n = 565 (16.0) n = 267 (7.6) Race/ethnicity Non-Hispanic White 2041 (57.9) 717 (61.7) 314 (54.6) 492 (51.6) 349 (61.8) 169 (63.3) Non-Hispanic Black 492 (14.0) 164 (14.1) 102 (17.7) 154 (16.1) 52 (9.2) 20 (7.5) Hispanic 575 (16.3) 143 (12.3) 100 (17.4) 191 (20.0) 95 (16.8) 46 (17.2) Asian 251 (7.1) 81 (7.0) 34 (5.9) 64 (6.7) 52 (9.2) 20 (7.5) Multiracial/Other 164 (4.7) 57 (4.9) 25 (4.3) 53 (5.6) 17 (3.0) 12 (4.5) Pre-pregnancy BMI a Underweight 95 (2.7) 34 (2.9) 10 (1.7) 30 (3.1) 13 (2.3) 8 (3.0) Normal weight 1792 (50.9) 657 (56.5) 284 (49.4) 450 (47.2) 279 (49.4) 122 (45.7) Overweight 856 (24.3) 278 (23.9) 153 (26.6) 239 (25.1) 116 (20.5) 70 (26.2) Obesity 780 (22.2) 193 (16.7) 128 (22.3) 235 (24.6) 157 (27.7) 67 (25.1) Age < 25 400 (11.4) 155 (13.3) 61 (10.6) 128 (13.4) 42 (7.4) 14 (5.2) 25-29 724 (20.6) 228 (19.6) 129 (22.4) 221 (23.2) 92 (16.3) 54 (20.2) 30-34 1256 (35.7) 426 (36.7) 209 (36.3) 310 (32.5) 217 (38.4) 94 (35.2) 35-39 847 (24.0) 286 (24.6) 121 (21.0) 213 (22.3) 151 (26.7) 76 (28.5) ≥ 40 296 (8.4) 67 (5.8) 55 (9.6) 82 (8.6) 63 (11.2) 29 (10.9) Educational Level High school or less 472 (13.4) 159 (13.7) 95 (16.5) 147 (15.4) 53 (9.4) 18 (6.7) Some college or technical school 620 (17.6) 186 (16.0) 109 (19.0) 221 (23.2) 68 (12.0) 36 (13.5) College or greater 2376 (67.4) 798 (68.7) 368 (64.0) 581 (60.9) 418 (74.0) 211 (79.0) Missing 55 (1.6) 19 (1.6) 3 (0.5) 5 (0.5) 26 (4.6) 2 (0.7) a Pre-pregnancy body mass index (BMI) in kilograms (kg) per squared height in meters (m 2 ), with categories defined as underweight (< 18.5), normal weight (18.5–24.9), overweight (25.0–29.9), and obesity (≥ 30). Figure 1. Distributions of weight gain measures by gestational weight gain (GWG) category and pre-pregnancy BMI in the LIFECODES pregnancy cohort. Abbreviation: BMI, body mass index. A total of 27,977 serial weight measurements from 3,523 participants are shown. GWG categories were defined as below, within, or above the 2009 guidelines. Distributions (n [%]) of GWG categories are shown by pre-pregnancy BMI. Figure 2. Overall trends in categories of total gestational weight gain (GWG) across the study period. Trends are within-year proportions of GWG categories, defined as below, within, or above the 2009 guidelines. Table 2. Unadjusted and adjusted geometric means (95% CI) of total GWG (kg) by year of delivery. 2007-2008 12.5 (12.2, 12.8) ref 8.3 (6.3, 10.8) ref 2009-2011 12.5 (11.7, 13.4) 0.98 8.6 (6.3, 11.6) 0.08 2012-2014 12.9 (12.2, 13.8) 0.08 8.9 (6.6, 12) <.001 2015-2017 15.2 (14.2, 16.3) <.001 10.6 (7.8, 14.4) <.001 2018-2019 15.6 (14.3, 16.9) <.001 10.9 (7.9, 14.9) <.001 Abbreviations: CI, confidence interval, GWG, gestational weight gain, kg, kilograms; GM, geometric mean, ref, reference group. a p -values for difference compared to reference group (2007–2008); b Full adjustment model included maternal age, parity, educational level, gestational age at delivery, and pre-pregnancy BMI. Information & Authors Information Version history V1 Version 1 12 March 2025 Peer review timeline Published Paediatric and Perinatal Epidemiology Version of Record 5 Dec 2025 Published Copyright This work is licensed under a Non Exclusive No Reuse License. Keywords epidemiology epidemiology: general obstetric epidemiology: perinatal Authors Affiliations Belle Martin University of Nevada Reno View all articles by this author David E. Cantonwine Brigham and Women's Hospital View all articles by this author Lyndsey Darrow University of Nevada Reno View all articles by this author Kelly K. Ferguson National Institute of Environmental Health Sciences Epidemiology Branch View all articles by this author Thomas F McElrath Brigham and Women's Hospital View all articles by this author Barrett Welch [email protected] University of Nevada Reno View all articles by this author Metrics & Citations Metrics Article Usage 310 views 137 downloads .FvxKWukQNSOunydq8rnd { width: 100px; } Citations Download citation Belle Martin, David E. Cantonwine, Lyndsey Darrow, et al. Trends in gestational weight gain from 2007-2019: A prospective cohort study. Authorea . 12 March 2025. 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