Sarah D McDonald8, Zhen Han2, Sohail Mulla3, Olha Lutsiv3, Tiffany Lee3, Joseph Beyene14, Prakesh Shah5, Arne Ohlsson6, Vibhuti Shah5, Kellie E Murphy7, Sarah D McDonald8, Eileen Hutton9, Christine Newburn-Cook10, Corine Frick11, Fran Scott12, Victoria Allen13, Joseph Beyene14, John D Cameron14. 1. Division of Maternal-Fetal Medicine, McMaster University, Hamilton, ON; Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON; Department of Radiology, McMaster University, Hamilton, ON; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON. 2. Department of Obstetrics and Gynecology, First Affiliated Hospital of Xi'an Jiao Tong University, Shaanxi Province, People's Republic of China. 3. Faculty of Health Sciences, McMaster University, Hamilton, ON. 4. Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON. 5. Department of Paediatrics, Mount Sinai Hospital and Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON. 6. Department of Paediatrics, Mount Sinai Hospital and Departments of Paediatrics, Obstetrics and Gynaecology, and Health Policy, Management and Evaluation, University of Toronto, ON. 7. Department of Obstetrics and Gynecology, Mount Sinai Hospital and University of Toronto, Toronto, ON. 8. Division of Maternal-Fetal Medicine, Departments of Obstetrics & Gynecology, Clinical Epidemiology & Biostatistics, and Diagnostic Imaging, McMaster University, Hamilton, ON. 9. Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON. 10. Faculty of Nursing, University of Alberta, Edmonton, AB. 11. Faculty of Nursing, University of Calgary, Calgary, AB. 12. Dalla Lana School of Public Health, University of Toronto and Toronto Public Health, Toronto, ON. 13. Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, NS. 14. McMaster University, Hamilton, ON.
Abstract
OBJECTIVE: Many women have high gestational weight gain (GWG), but potential neonatal consequences are not yet well quantified. We sought to determine the relationship between high GWG and preterm birth (PTB) and low birth weight (LBW) in singleton births. DATA SOURCES: We searched Medline and Embase and reference lists. STUDY SELECTION: Two assessors independently performed all steps. We selected studies assessing high total or weekly GWG on PTB (< 37 weeks) and LBW (< 2500 grams). DATA EXTRACTION AND SYNTHESIS: Thirty-eight studies, 24 cohort and 14 case-control, were included involving 2 124 907 women. Most contained unadjusted data. Women with high total GWG had a decreased risk overall of PTB < 37 weeks (relative risk [RR] 0.75; 95% CI 0.60 to 0.96), PTB 32 to 36 weeks (RR 0.70; 95% CI 0.70 to 0.71), and < 32 weeks (RR 0.87; 95% CI 0.85 to 0.90). High GWG was associated with lower risk of LBW (RR 0.64; 95% CI 0.53 to 0.78). Women with the highest GWG had lower risks of LBW (RR 0.55; 95% CI 0.32 to 0.94) than women with moderately high GWG (RR 0.73; 95% CI 0.60 to 0.89). Women with the highest weekly GWG had greater risks of PTB (RR 1.51; 95% CI 1.47 to 1.55) than women with moderately high weekly GWG (RR 1.09; 95% CI 1.05 to 1.13). Women with high weekly GWG were at increased risk of PTB 32 to 36 weeks (RR 1.14; 95% CI 1.10 to 1.17 and < 32 weeks (RR 1.81; 95% CI 1.73 to 1.90). CONCLUSION: Although women with high total GWG have lower unadjusted risks of PTB and LBW, high weekly GWG is associated with increased PTB, and more adjusted studies are needed, as are more studies in obese women. Potential benefits of high GWG for the infant must be balanced against maternal risks and other known infant risks such as high birth weight.
OBJECTIVE: Many women have high gestational weight gain (GWG), but potential neonatal consequences are not yet well quantified. We sought to determine the relationship between high GWG and preterm birth (PTB) and low birth weight (LBW) in singleton births. DATA SOURCES: We searched Medline and Embase and reference lists. STUDY SELECTION: Two assessors independently performed all steps. We selected studies assessing high total or weekly GWG on PTB (< 37 weeks) and LBW (< 2500 grams). DATA EXTRACTION AND SYNTHESIS: Thirty-eight studies, 24 cohort and 14 case-control, were included involving 2 124 907 women. Most contained unadjusted data. Women with high total GWG had a decreased risk overall of PTB < 37 weeks (relative risk [RR] 0.75; 95% CI 0.60 to 0.96), PTB 32 to 36 weeks (RR 0.70; 95% CI 0.70 to 0.71), and < 32 weeks (RR 0.87; 95% CI 0.85 to 0.90). High GWG was associated with lower risk of LBW (RR 0.64; 95% CI 0.53 to 0.78). Women with the highest GWG had lower risks of LBW (RR 0.55; 95% CI 0.32 to 0.94) than women with moderately high GWG (RR 0.73; 95% CI 0.60 to 0.89). Women with the highest weekly GWG had greater risks of PTB (RR 1.51; 95% CI 1.47 to 1.55) than women with moderately high weekly GWG (RR 1.09; 95% CI 1.05 to 1.13). Women with high weekly GWG were at increased risk of PTB 32 to 36 weeks (RR 1.14; 95% CI 1.10 to 1.17 and < 32 weeks (RR 1.81; 95% CI 1.73 to 1.90). CONCLUSION: Although women with high total GWG have lower unadjusted risks of PTB and LBW, high weekly GWG is associated with increased PTB, and more adjusted studies are needed, as are more studies in obese women. Potential benefits of high GWG for the infant must be balanced against maternal risks and other known infant risks such as high birth weight.
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