Jodie M. Dodd, Andrea R. Deussen, Megan Mitchell, Jennie Louise
<p>The practice of regularly weighing women during pregnancy dates to the 1940s in a strategy introduced by the government of the UK to monitor the effect of post-World War II food rationing on the maintenance of a healthy pregnancy [<span>(1)</span>]. This practice continued throughout the 1970s and into the 1990s to aid detection of both preeclampsia and infants who are born small for gestational age (SGA), although it was recognized to have a low positive predictive value [<span>(2)</span>]. There has since been a move in some countries [<span>(3)</span>] to recommend that a woman be weighed only at the time of the booking obstetric visit in the first trimester and then again at 36 weeks' gestation. However, this practice is not universal, with other countries adopting a more intensive approach with regular weighing at each antenatal appointment and adherence to the Institute of Medicine (now National Academy of Medicine) recommendations to limit gestational weight gain (GWG), with the expectation of improved pregnancy and birth outcomes [<span>(4)</span>].</p><p>In this edition, Boone-Heinonen and colleagues [<span>(5)</span>] report a cohort study using electronic health record data from 77,599 pregnancies between 2004 and 2020 from women whose body mass index (BMI) was greater than 18.5 kg/m<sup>2</sup>. GWG was measured in each trimester of pregnancy to evaluate relationships between rate of gain and the occurrence of infant size at birth, defined as large for gestational age (LGA; >90th percentile) and SGA (<10th percentile). The authors identified the risk of birth of an infant with LGA to be greatest among women with a higher prepregnancy BMI and among those whose GWG was higher. Conversely, birth of an infant with SGA was seen in women with a lower prepregnancy BMI and lower GWG. The authors suggest that first-trimester GWG may influence birth size via an effect on second- and third-trimester weight gain and that targeting first-trimester weight gain may be a strategy for intervention.</p><p>We would like to propose an alternate view that challenges some of the widely held assumptions around GWG and its relationship, often presumed to be causal, with pregnancy and birth outcomes. Recent reports [<span>(6-8)</span>] have identified the lack of evidence to suggest that the effect of maternal BMI on pregnancy outcomes is mediated via an effect on GWG. That is, GWG is not on a causal pathway between maternal BMI and adverse pregnancy outcomes [<span>(6)</span>], with limited predictive value in the identification of women who experience a range of pregnancy and birth complications [<span>(7, 8)</span>].</p><p>The validity of the purported relationships between total or trimester-specific GWG and fetal size is problematic for reasons that should be immediately apparent in considering the nature of GWG as an outcome. Although GWG is a clinically simple measure to obtain, it represents a composite of maternal fat deposition; pregnancy-r
{"title":"Regular weighing of pregnant women: a relic from a bygone era","authors":"Jodie M. Dodd, Andrea R. Deussen, Megan Mitchell, Jennie Louise","doi":"10.1002/oby.24117","DOIUrl":"10.1002/oby.24117","url":null,"abstract":"<p>The practice of regularly weighing women during pregnancy dates to the 1940s in a strategy introduced by the government of the UK to monitor the effect of post-World War II food rationing on the maintenance of a healthy pregnancy [<span>(1)</span>]. This practice continued throughout the 1970s and into the 1990s to aid detection of both preeclampsia and infants who are born small for gestational age (SGA), although it was recognized to have a low positive predictive value [<span>(2)</span>]. There has since been a move in some countries [<span>(3)</span>] to recommend that a woman be weighed only at the time of the booking obstetric visit in the first trimester and then again at 36 weeks' gestation. However, this practice is not universal, with other countries adopting a more intensive approach with regular weighing at each antenatal appointment and adherence to the Institute of Medicine (now National Academy of Medicine) recommendations to limit gestational weight gain (GWG), with the expectation of improved pregnancy and birth outcomes [<span>(4)</span>].</p><p>In this edition, Boone-Heinonen and colleagues [<span>(5)</span>] report a cohort study using electronic health record data from 77,599 pregnancies between 2004 and 2020 from women whose body mass index (BMI) was greater than 18.5 kg/m<sup>2</sup>. GWG was measured in each trimester of pregnancy to evaluate relationships between rate of gain and the occurrence of infant size at birth, defined as large for gestational age (LGA; >90th percentile) and SGA (<10th percentile). The authors identified the risk of birth of an infant with LGA to be greatest among women with a higher prepregnancy BMI and among those whose GWG was higher. Conversely, birth of an infant with SGA was seen in women with a lower prepregnancy BMI and lower GWG. The authors suggest that first-trimester GWG may influence birth size via an effect on second- and third-trimester weight gain and that targeting first-trimester weight gain may be a strategy for intervention.</p><p>We would like to propose an alternate view that challenges some of the widely held assumptions around GWG and its relationship, often presumed to be causal, with pregnancy and birth outcomes. Recent reports [<span>(6-8)</span>] have identified the lack of evidence to suggest that the effect of maternal BMI on pregnancy outcomes is mediated via an effect on GWG. That is, GWG is not on a causal pathway between maternal BMI and adverse pregnancy outcomes [<span>(6)</span>], with limited predictive value in the identification of women who experience a range of pregnancy and birth complications [<span>(7, 8)</span>].</p><p>The validity of the purported relationships between total or trimester-specific GWG and fetal size is problematic for reasons that should be immediately apparent in considering the nature of GWG as an outcome. Although GWG is a clinically simple measure to obtain, it represents a composite of maternal fat deposition; pregnancy-r","PeriodicalId":215,"journal":{"name":"Obesity","volume":"32 9","pages":"1611-1612"},"PeriodicalIF":4.2,"publicationDate":"2024-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/oby.24117","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141790711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}