Associations between gestational weight gain and adverse pregnancy outcomes: a prospective cohort study.

Authors

Xueyin Wang, Xiaosong Zhang, Meihua Zhang, Xu Chen, Xietong Wang, Yuyan Ma, Yue Teng, Haixia Meng, Xiaoqing Wang, Qiuhong Yang, Lin Xu, Shufan Shan, Juan Juan, Di Gao, Huixia Yang

Published in

Journal of global health. Volume 16. Pages 04375. Nov 13, 2026. Epub Nov 13, 2026.

Abstract

Most studies on gestational weight gain (GWG) and pregnancy outcomes have focused on Western populations, leaving a gap in knowledge about the applicability of their findings to Asian women. Similarly, most investigations have utilised recommendations created by the US Institute of Medicine, with few using the Chinese GWG recommendations. We aimed to assess the associations between GWG, evaluated according to the Chinese recommendations, and adverse pregnancy outcomes, as well as to explore whether prepregnancy body mass index (BMI) or maternal age modified these associations.
In this prospective cohort study, we recruited pregnant women at 11-13 weeks of gestation from 13 hospitals in northern China between October 2020 and June 2024. We categorised GWG as insufficient, adequate, or excessive when it fell below, within, or above the Chinese recommendations, with the recommended GWG ranges being 11.0-16.0 kg (BMI < 18.5 kg/m²), 8.0-14.0 kg (18.5-23.9 kg/m²), 7.0-11.0 kg (24.0-27.9 kg/m²), and 5.0-9.0 kg (BMI ≥ 28.0 kg/m²). We used logistic regression models to estimate odds ratios (ORs) for adverse pregnancy outcomes.
Among 10,638 pregnant women, 13.3%, 54.3%, and 32.4% had insufficient, adequate, and excessive GWG, respectively. After adjusting for confounders, excessive GWG was associated with higher odds for caesarean delivery (OR = 1.38; 95% confidence interval (CI) = 1.26-1.53), macrosomia (OR = 1.77; 95% CI = 1.44-2.17), being large for gestational age (OR = 1.66; 95% CI = 1.38-1.99), and neonatal ward admission (OR = 1.35; 95% CI = 1.09-1.67), while insufficient GWG was associated with increased odds of being small for gestational age (OR = 1.48; 95% CI = 1.17-1.88). There was a significant interaction between GWG and maternal age in relation to the odds of caesarean delivery (P-value for interaction = 0.034). Women aged ≥ 35 years with excessive GWG had the highest odds of caesarean delivery (OR = 2.72; 95% CI = 2.27-3.24), compared with women aged <35 years with adequate GWG.
Excessive GWG was associated with higher odds of caesarean delivery, macrosomia, large for gestational age, and neonatal ward admission, while insufficient GWG was associated to higher odds of small for gestational age.

PMID:
43023568
Bibliographic data and abstract were imported from PubMed on 13 Nov 2026.

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