Analysis of Excessive Gestational Weight Gain and Neonatal Outcomes in Women Undergoing Trial of Labor after a Previous Cesarean Using Propensity Scores
Open AccessBackground: Gestational weight gain is crucial to support the functions of growth and maturity in the fetus. The Institute of Medicine (IOM) released updated guidelines in 2009 for the weight that women should gain during pregnancy. In spite of these recommendations, about one-fifth of women in the United States (US) do not gain enough weight while almost half of women gain excessive weight. Excessive gestational weight gain is associated with detrimental neonatal outcomes. Understanding this association among women attempting a trial of labor after cesarean delivery (TOLAC) is particularly important because excessive fetal growth can lead to morbidity and a lower TOLAC success rate. However, excessive gestational weight gain is a condition that is potentially modifiable with appropriate interventions. Objective: To evaluate, among women undergoing TOLAC, the association between excessive gestational weight gain and neonatal outcomes.Methods: A multicenter observational study of cesarean section and vaginal birth after cesarean section conducted from 1999 through 2002 in the US was used for analysis. Among women undergoing TOLAC, gestational weight gain was categorized as below, within, or above the IOM guidelines. The neonatal outcomes of excessive fetal growth, hypoglycemia requiring treatment, and a composite of perinatal death or neonatal morbidity related to birth trauma were compared in women who gained gestational weight above the recommended guidelines versus women who gained weight within the guidelines. Inverse probability of treatment weighting using propensity scores estimated via generalized boosted model were used to estimate odds ratios (OR) and 95% confidence intervals (CI) adjusted for several potentially confounding factors (age, race and ethnicity, marital status, insurance type, pre-pregnancy BMI, diabetes, asthma, thyroid disease, seizure disorder, pre-gestational choric hypertension treated with medications, renal disease, heart disease, cigarette use, alcohol use, street drug use, and medical center).Results: In adjusted analysis among women undergoing TOLAC, women who gained excessive weight had 77% higher odds to deliver an infant with excessive fetal growth (OR 1.77, 95% CI 1.53–2.06) compared with women who gained weight within the IOM goals. The composite neonatal outcome and hypoglycemia requiring treatment were not associated with excessive gestational weight gain.Conclusion: This study demonstrated an association between excessive gestational weight gain and excessive fetal growth among women attempting TOLAC. An intervention targeting excessive weight could potentially lower excessive fetal growth.
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