Beyond Obesity: Excessive Gestational Weight Gain and Perinatal Outcomes in Belgium

Background

Maternal obesity has risen significantly affecting up to 20% of pregnant women in Belgium. Whilst the link between obesity and adverse pregnancy outcomes is well established, the impact of gestational weight gain (GWG) on perinatal outcomes remains less clear, particularly within the Belgian population. The aim was to assess this association among women giving birth at term in Belgium.

Methods

This population-based study included 1,338,106 women who delivered a single live-born term baby between 2010 and 2022. Women were categorized according to pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) based on established guidelines. Perinatal outcomes studied were induction of labor, cesarean delivery, instrumental vaginal delivery, episiotomy, macrosomia, low Apgar score, and neonatal admission. Multivariable logistic regression analyses were performed to assess the association between GWG and perinatal outcomes. Models were adjusted for sociodemographic factors (maternal age, parity, education, income, single status, and nationality) and comorbidities, hypertension and diabetes.

Results

In obese women, excessive GWG was associated with significantly increased odds of adverse outcomes compared with non-obese women with recommended GWG, including induction (aOR 1.52, 95% CI 1.49–1.54), cesarean (aOR 2.08, 95% CI 2.05–2.12), macrosomia (aOR 2.26, 95% CI 2.21–2.31), low Apgar score (aOR 1.44, 95% CI 1.36–1.53), and neonatal admission (aOR 1.35, 95% CI 1.31–1.38). Similarly, excessive GWG in non-obese women was associated with increased odds of adverse perinatal outcomes compared with those with recommended GWG. In contrast, obese women with less GWG had lower rates of perinatal complications compared with those with recommended GWG.

Conclusions

Excessive GWG is associated with adverse perinatal outcomes regardless of BMI and socio demographic factors. These findings highlight the importance of appropriate weight management during pregnancy.

Key messages

• Excessive GWG is associated with higher rates of induction, caesarean, macrosomia, low Apgar score, and neonatal admission, independent of BMI and sociodemographic factors.

• GWG should be managed to reduce adverse perinatal outcomes.