Modeling Trajectories of Optimal Pregnancy Weight Gain for Overweight and Obese Women

Patricia Fontaine, M.D., M.S.
Department of Family Medicine and Community Health, University of Minnesota

As the U.S. population experiences an epidemic of obesity, more women than ever before are entering pregnancy overweight or obese. The Agency for Healthcare Research and Quality recently conducted a comprehensive meta-analysis of existing studies of weight gain in pregnancy and found strong evidence that pregravid weight status and gestational weight gain (GWG) are related to maternal and newborn outcomes. Yet recommendations for optimal GWG, particularly for overweight and obese women, are limited by major shortcomings in the body of research. The reviewers identified specific research needs, stating: “To understand fully the impact of gestational weight gain on short- and long-term outcomes for women and their offspring will require that researchers use consistent definitions of weight gain during pregnancy, better address confounders in their analyses, improve study designs and statistical models, and conduct studies with longer follow-up.” The work proposed in this pilot application represents the critical next step in our work to examine relationships between GWG trajectories and maternal and child health outcomes, using a rigorously constructed database, with the eventual goal of obtaining extramural funding to develop an effective intervention to promote healthy weight gain during pregnancy. In July 2007, our project team received pilot funding from UCare Minnesota and the HealthPartners Research Foundation to create a large and comprehensive data set using prenatal health information derived from the HealthPartners Electronic Medical Record (EMR) data and chart abstraction data from UMN Physician-affiliated community clinics. The product of this collaborative effort is the database including serial weight measurements, maternal pre-pregnancy and prenatal health status diagnosis information, demographic data, laboratory data, and delivery and birth outcomes for an ethnically diverse sample of 2,540 women. We have begun deriving analysis variables from the database; however, we are just at the beginning of the most productive analytic phase of our initiative. This pilot proposal would allow us to pursue additional analyses and manuscripts, capitalizing on the strengths of this unique data set and providing key supporting data for future extramural funding, including an R01 grant to develop and evaluate a primary care-based intervention as well as a maternal-child registry in the Twin Cities metropolitan area.