Objective: To establish suggested gestational weight gain (GWG) using several distinct methods in a Chinese population. Methods: This study analyzed data from the medical records of singleton pregnancy women during 2011–2017 in Beijing, China. Suggested GWG was calculated using four distinct methods. In method 1, suggested GWG was identified by the interquartile method. Subsequently, risk models for small for gestational age (SGA) and large for gestational age (LGA) with respect to GWG were constructed. GWG was treated as a continuous variable in method 2, and as a categorized variable in methods 3 and 4. Results: An average GWG of 15.78 kg with a prevalence of LGA at 19.34% and SGA at 2.12% was observed among the 34,470 participants. Methods 1 and 2 did not yield clinically applicable results. The suggested GWGs were 11–17/11–16 kg, 9–19/9–15 kg, 4–12/4–10 kg, and 0–12/0–6 kg by method 3/method 4 for underweight, normal-weight, overweight, and obese women, respectively. The GWG range suggested by method 3 resulted in a larger proportion of participants (62.03%) within range, while the suggested GWG range by method 4 was associated with a lower risk of LGA compared to that conferred by the Institute of Medicine (IOM) criteria. Conclusion: This study suggests a modest GWG goal compared to IOM recommendations based on a large Chinese cohort.

Inappropriate gestational weight gain (GWG) increases both short-term and long-term health risks of mothers and offspring [1, 2]. Excessive GWG is associated with increased risk of cesarean delivery [3], postpartum weight retention [4], and large for gestational age (LGA) [3], all of which increase the long-term risk of obesity in both mothers and offspring [5]. In contrast, insufficient GWG increases the risk of small for gestational age (SGA) [3]. Nonetheless, there is no global consensus on the recommended GWG [6]. The Institute of Medicine (IOM) guideline provides the most widely used criteria for GWG [7]. However, it was developed based on Caucasian populations and was not intended for use in women who are thinner and shorter than US women [7].

There is a lack of evidence-based guidelines for “optimal” GWG in Asian populations. Recent studies in Japan, Singapore, and Taiwan have indicated that optimal GWG in Asian women may be substantially lower than that recommended by the IOM, especially in overweight and obese women [8-10]. We aimed to establish suggested GWG in a large Chinese population by applying different risk models for GWG-associated perinatal outcomes.

We used data from singleton pregnancy women having delivered between January 2011 and December 2017 in Beijing Obstetrics and Gynecology Hospital in China. We included women who had received standard prenatal care to ensure they had credible information about prepregnancy weight and predelivery weight. Women with chronic medical conditions including hypertension, type 2 diabetes mellitus, heart disease, or kidney disease were excluded. Women without data regarding baseline characteristics, GWG, or neonatal birthweight were also excluded. The number of participants included is shown in a flowchart (Fig. 1).

Fig. 1.

Flowchart of the participants included in the analysis.

Fig. 1.

Flowchart of the participants included in the analysis.

Close modal

Clinical information was collected through medical record review. The collected information included maternal date of birth, height, self-reported prepregnancy weight, predelivery weight, gestational age, and neonatal birth weight in the form of continuous variables, as well as parity, gestational diabetes mellitus (GDM), pregnancy-induced hypertension (PIH), delivery mode (cesarean section or vaginal delivery), and neonatal gender in the form of categorical variables. Prepregnancy body weight was self-reported at the first prenatal visit around the 5th–6th gestational week. Prepregnancy body mass index (PPBMI) was calculated as prepregnancy weight/height squared (kg/m2). The participants were defined as underweight (PPBMI <18.5 kg/m2), normal weight (18.5 ≤ PPBMI < 25 kg/m2), overweight (25 ≤ PPBMI < 30 kg/m2), or obese (PPBMI ≥30 kg/m2). GDM was diagnosed by using the National Diabetes Data Group (NDDG) 2-step criteria [11] and the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria in women who delivered before 2012 and since 2012 [12]. PIH was defined as the development of new hypertension after a gestational age of 20 weeks in a previously normotensive woman [13]. Birth weight was classified as low birth weight (LBW; <2,500 g), normal weight (2,500–4,000 g), and macrosomia (>4,000 g). LGA and SGA (birthweights greater than or below the 10th percentile for the gestational age) were defined according to an international standard set by Villar et al. [14]. Gestational age <37 weeks is defined as preterm.

The data were analyzed using SAS 9.3. Associations between GWG and perinatal outcomes, including LGA, SGA, macrosomia, LBW, preterm delivery, and cesarean section, were evaluated using a logistic regression model adjusted for maternal age, parity, PPBMI, height, GDM, and PIH. Gestational age was also adjusted for when using macrosomia, LBW, and cesarean section as outcomes. GWG within the IOM-recommended range was used as a reference. Subsequently, suggested GWG was calculated using four distinct methods. In method 1, GWG data from subjects with optimal perinatal outcomes (vaginal delivery of a term appropriate-for-gestational-age infant without macrosomia, LBW, GDM, or PIH) were used to generate an interquartile (25–75%) GWG range as the suggested GWG. In method 2, a similar method to the one reported by Beyerlein et al. [15] was used to develop a logistic regression model in order to assess the relationship between GWG and the risk of SGA and LGA, with GWG being a continuous variable which was adjusted for maternal age, parity, PPBMI, height, GDM, and PIH. Suggested GWG is defined by a joint predicted risk of 20% for SGA and LGA. In method 3, a logistic regression model was used to evaluate the association of the risk of SGA and LGA with categorized GWG intervals, adjusted for the covariates mentioned for method 2. GWG was categorized in 1- and 2-kg intervals into underweight/normal-weight women and overweight/obese women, due to the limited sample sizes of the latter groups. IOM-recommended lower and upper limits of GWG for each weight group were set as the reference levels to calculate adjusted odd ratios (ORs) for LGA and SGA, respectively, in each categorized GWG interval. Accordingly, in the determination of adjusted ORs for LGA, 12.0–12.9 kg, 11.0–11.9 kg, 6.0–7.9 kg, and 4.0–5.9 kg were the reference GWG ranges for the underweight, normal-weight, overweight, and obese groups, respectively, whereas the ORs for SGA were calculated using 17.0–17.9 kg, 15.0–15.9 kg, 10.0–11.9 kg, and 8–9.9 kg as the reference ranges for the respective PPBMI groups. Suggested GWG was determined using an OR of 2.0 or above as the cut-off for risk of LGA/SGA compared to the corresponding reference in the group. Method 4 was similar to method 3, except that an OR cut-off of 1.5 for LGA, instead of 2.0, was used to calculate the upper/lower range of suggested GWG. This difference in OR cut-off value between method 3 and method 4 was made due to the high prevalence of LGA in our cohort. After having established the suggested GWG ranges using the aforementioned methods, we calculated the percentage of participants in each PPBMI group who were within the suggested GWG range as determined by each method. We also compared rates of prevalence of LGA and SGA among women who met the suggested GWG ranges according to the IOM criteria or the proposed GWG ranges by χ2 test.

A total of 34,470 participants were included (Fig. 1). As shown in Table 1, the average GWG was 15.78 kg, with a high prevalence of LGA (19.34%) and a low prevalence of SGA (2.12%).

Table 1.

Characteristics of the participants

Characteristics of the participants
Characteristics of the participants

The majority of pregnant women in our cohort did not gain weight during gestation as recommended by the IOM guideline (Table 2). To be more specific, only 52.56% of the underweight, 39.63% of the normal-weight, 26.82% of the overweight, and 30.55% of the obese women achieved GWGs that were within the IOM-recommended ranges. Using the women with IOM-recommended GWG as the reference group, perinatal outcomes were compared between the reference group and those who did not achieve the recommended GWG. Excessive GWG was associated with higher risk of LGA and cesarean section in all weight groups, as well as with higher risk of macrosomia in all weight groups except for obese women, while insufficient GWG was associated with elevated risk of SGA and preterm delivery only for underweight and normal-weight women and elevated risk of LBW for normal-weight women (Table 2).

Table 2.

Association between perinatal outcomes and GWG according to IOM criteria

Association between perinatal outcomes and GWG according to IOM criteria
Association between perinatal outcomes and GWG according to IOM criteria

The suggested GWG ranges according to the different methods are presented in Table 3. In method 1, 16,058 women with optimal perinatal outcomes (46.59%) were included in calculating the suggested GWG. The interquartile (25–75%) range of GWG in each PPBMI group was proposed as the suggested GWG. The suggested GWGs calculated using this method overall were higher than the corresponding IOM-recommended GWGs, especially in the overweight and obese groups. Figure 2 shows the estimated isolated risk of SGA and LGA, as well as the total risk of SGA and LGA by GWG, according to method 2. Interestingly, in the underweight group, the curve for total risk of LGA and SGA against GWG appears to assume a U-shaped form. In all the other PPBMI groups, due to the much higher prevalence of LGA than of SGA, the curves for total risk of LGA and SGA were significantly skewed to the left, resulting in either no nadir or negative GWG being the nadir. The suggested GWG ranges determined by methods 3 and 4 were the same for the underweight group, while method 3 yielded a wider range for the other groups (Table 3; online suppl. Tables 1, 2; see www.karger.com/doi/10.1159/000509134 for all online suppl. material). Compared to the GWG according to the IOM guideline, the suggested GWG range according to methods 3 and 4 generally was wider and lower in all groups.

Table 3.

Suggested GWG range (kg) by different strategies

Suggested GWG range (kg) by different strategies
Suggested GWG range (kg) by different strategies
Fig. 2.

A–D Predicted joint risk of LGA and SGA in the four prepregnancy body mass index groups by gestational weight gain. LGA, large for gestational age; SGA, small for gestational age; GWG, gestational weight gain.

Fig. 2.

A–D Predicted joint risk of LGA and SGA in the four prepregnancy body mass index groups by gestational weight gain. LGA, large for gestational age; SGA, small for gestational age; GWG, gestational weight gain.

Close modal

The percentages of women who met the IOM recommendation or the four suggested GWG ranges, as well as the corresponding prevalence rates for LGA and SGA, are presented in Table 4 and Figure 3. In summary, 38.4% of the total number of participants met the IOM criteria. Approximately 51.73, 62.03, 65.74, and 39.75% of the participants met the suggested GWG ranges determined by methods 1–4, respectively.

Table 4.

Comparison of prevalence of LGA and SGA (%) among women who met suggested GWG by different strategies and IOM criteria

Comparison of prevalence of LGA and SGA (%) among women who met suggested GWG by different strategies and IOM criteria
Comparison of prevalence of LGA and SGA (%) among women who met suggested GWG by different strategies and IOM criteria
Fig. 3.

A–D Four suggested GWG ranges and the corresponding prevalence rates of LGA and SGA. LGA, large for gestational age; SGA, small for gestational age; GWG, gestational weight gain.

Fig. 3.

A–D Four suggested GWG ranges and the corresponding prevalence rates of LGA and SGA. LGA, large for gestational age; SGA, small for gestational age; GWG, gestational weight gain.

Close modal

Method 1 resulted in more women within range compared to the IOM guideline in all PPBMI groups. There was no difference in risk of SGA between the groups. However, in the normal-weight and overweight groups, using method 1 led to a higher prevalence of LGA among women within the suggested GWG range than among those within the IOM-recommended range. Method 2 yielded far more women within the GWG range in the underweight and normal-weight groups, but far fewer women within the GWG range in the overweight group, when comparing the numbers of women to those based on the corresponding IOM-recommended range. No difference in SGA or LGA was observed when comparing method 2 and the IOM criteria. Using method 3, our study identified more women within range in all groups. Except that method 4 detected fewer cases of LGA in the normal-weight group compared to the IOM criteria, the prevalence rates of LGA and SGA as revealed by method 3 or 4 were generally similar to those revealed by the IOM criteria in all PPBMI groups.

The current recommendation on GWG based on the IOM criteria appears to be less representative in Asian populations, as shown in recent studies in which only a small proportion of pregnant women were able to achieve GWG within the IOM-recommended ranges [10, 16]. The current study identifies “optimal” GWG using four distinct methods by weighing the risks of adverse pregnancy outcomes (LGA and SGA) in different PPBMI groups in a large cohort of Chinese women. We also compared the risks of LGA and SGA among women within optimal GWG as determined by different criteria.

A study by Kim et al. [17] discovered that among all modifiable risk factors, preventing excessive GWG has the greatest potential of reducing the incidence of LGA. Consistent with previous findings, our study found that GWG is positively associated with the risk of SGA, LBW, and preterm delivery, but negatively associated with the risk of LGA, macrosomia, and cesarean delivery. Therefore, determining optimal GWG is mainly to balance the risks of these contrasting pregnancy outcomes, especially LGA and SGA in the current study.

In this study, the different analytical methods resulted in distinct suggested GWG ranges. Among mothers who have optimal pregnancy outcomes, the interquartile method is a common strategy for calculating “optimal” GWG [18]. Indeed, the IOM Committee used this strategy to calculate “optimal” GWG for twin pregnancies [7]. The suggested GWG according to this method was substantially higher than the IOM-recommended ranges, especially in the overweight and obese groups, which was similar to the findings by Wang et al. [19]. A possible explanation is that we did not exclude women with long-term weight retention or offspring obesity due to lack of related information [20, 21]. Possibly owing to the high “optimal” GWG determined by the interquartile method, the prevalence of LGA was higher among women who met the suggested GWG by this method compared to those who met the IOM criteria.

Predicted joint risk of 20% for SGA and LGA delivery is another generally used strategy for calculating “optimal” GWG [15, 22, 23]. However, due to the high prevalence of LGA and the low prevalence of SGA in this study, the linear fitting model did not identify clinically applicable cut-off values for the lower GWG limit in all weight groups. Therefore, it appears that method 2, which uses GWG as a continuous variable and a 20% risk tolerance, may not be applicable to this population. Consequently, we developed models using GWG as a categorized variable (methods 3 and 4). The suggested GWG range according to method 3 appears to cover the largest proportion of participants of all the four methods. In all, 62.03% of the participating subjects were considered to have appropriate GWG by method 3, which was higher than the proportion determined by IOM criteria (51.73%), but without a significantly increased risk of LGA or SGA. A high prevalence of LGA and macrosomia was observed in this study, which was similar to a national survey result for 101,723 neonates [24]. LGA is associated with both perinatal complications and long-term risks of obesity and metabolic diseases of offspring later in life [25]. We thus placed a relatively higher value on reducing LGA prevalence than on reducing SGA prevalence in our study population by applying method 4.

We used four different methods to calculate suggested GWG and made comparisons to IOM-recommended GWG. Recent evidence has suggested that IOM GWG targets may be overly generous for obese Asian women. A study of Singaporean women suggested a total GWG of ≤1.8 kg for obese women [9]. A Japanese guideline suggested a GWG of 5–7 kg for women with a PPBMI >24.0 kg/m2 [26]. Similarly, a systematic review by Faucher and Barger [27] recommended a GWG of 1–5 kg for class II obesity and no GWG for class III obesity. Therefore, a lower GWG than recommended by the IOM guideline may be appropriate for overweight and obese Chinese women. Additionally, the high birth weight according to the national survey [24], as well as the high LGA prevalence even in the low-GWG group in this study, suggest that overweight and obese Chinese women should probably be allowed to gain less weight to limit the risk of LGA. Conversely, another systematic review reported that even though GWG below the IOM guideline in obese women was accompanied by decreased odds of LGA, it was also associated with increased odds of SGA and preterm delivery [28]. We did not observe any increased risk of SGA when applying the suggested GWG ranges according to methods 3 and 4 to the overweight and obese groups. However, the statistical power to determine risk of SGA may have been limited for overweight and obese women.

There is a lack of data on recommended GWG in Chinese women. Tsai et al. [8] suggested a GWG of 10–14 kg for women with an appropriate PPBMI in Taiwan, which is similar to the results from method 4 in this study. Wang et al. [19] proposed a modest GWG (10–15 kg) in normal-weight women, but a higher GWG for overweight (8–14 kg) and obese Chinese women (5–11.5 kg), compared to the IOM guideline using P25–P75 of GWG for women in China. However, the proposed GWGs for overweight and obese women may not be accurate due to the limited numbers of participants. Additionally, recall bias is a concern due to the cross-sectional study design.

Our study has certain limitations. First, no long-term risks of obesity and cardiometabolic health parameters were evaluated in the mothers and offspring in our study, due to lack of information. Second, our study was completed in Northern China and may not be representative of a broader Chinese population. Third, the sample size of the overweight and obese groups is rather small in this study.

In conclusion, this study suggests a modest GWG goal compared to IOM recommendations based on a large, prospective cohort of Chinese women. Conventional methods may be unsuitable for calculating “optimal” GWG in a population with notably high LGA prevalence rates. Our suggested GWG will need to be confirmed in a larger and more diverse population.

We thank the participants for their participation and the medical staff for their work on information collection.

The study was conducted ethically in accordance with the World Medical Association Declaration of Helsinki. The study protocol was approved by the Ethics Committee of Beijing Obstetrics and Gynecology Hospital (2018-KY-009-01) and written informed consent was obtained from every participant.

The authors declare no conflict of interest.

This study was funded by the National Key Research and Development Program (2016YFC1000304), the National Natural Science Foundation of China (grant No. 81671477), and the Capital’s Funds for Health Improvement and Research (CFH 2018-2-2112).

W. Zheng conducted the population study, analyzed and interpreted the data, and drafted the manuscript. W.H. participated in data analysis and interpretation, and draft revision. L.Z. and Z.T. participated in data collection and interpretation of the results. Q.Y. and T.W. assisted with data collection and analysis. G.L. and W. Zhang designed the study and critically revised the manuscript. All authors read and approved the final manuscript.

The data set used in this study is accessible upon reasonable request to the corresponding author via liguanghui@ccmu.edu.cn.

1.
Voerman
E
,
Santos
S
,
Inskip
H
,
Amiano
P
,
Barros
H
,
Charles
MA
, et al;
LifeCycle Project-Maternal Obesity and Childhood Outcomes Study Group
.
Association of Gestational Weight Gain With Adverse Maternal and Infant Outcomes
.
JAMA
.
2019
May
;
321
(
17
):
1702
15
.
[PubMed]
0098-7484
2.
Widen
EM
,
Whyatt
RM
,
Hoepner
LA
,
Ramirez-Carvey
J
,
Oberfield
SE
,
Hassoun
A
, et al
Excessive gestational weight gain is associated with long-term body fat and weight retention at 7 y postpartum in African American and Dominican mothers with underweight, normal, and overweight prepregnancy BMI
.
Am J Clin Nutr
.
2015
Dec
;
102
(
6
):
1460
7
.
[PubMed]
0002-9165
3.
Goldstein
RF
,
Abell
SK
,
Ranasinha
S
,
Misso
M
,
Boyle
JA
,
Black
MH
, et al
Association of Gestational Weight Gain With Maternal and Infant Outcomes: A Systematic Review and Meta-analysis
.
JAMA
.
2017
Jun
;
317
(
21
):
2207
25
.
[PubMed]
0098-7484
4.
Rong
K
,
Yu
K
,
Han
X
,
Szeto
IM
,
Qin
X
,
Wang
J
, et al
Pre-pregnancy BMI, gestational weight gain and postpartum weight retention: a meta-analysis of observational studies
.
Public Health Nutr
.
2015
Aug
;
18
(
12
):
2172
82
.
[PubMed]
1368-9800
5.
Oken
E
,
Taveras
EM
,
Kleinman
KP
,
Rich-Edwards
JW
,
Gillman
MW
.
Gestational weight gain and child adiposity at age 3 years
.
Am J Obstet Gynecol
.
2007
Apr
;
196
(
4
):
322.e1
8
.
[PubMed]
0002-9378
6.
Scott
C
,
Andersen
CT
,
Valdez
N
,
Mardones
F
,
Nohr
EA
,
Poston
L
, et al
No global consensus: a cross-sectional survey of maternal weight policies
.
BMC Pregnancy Childbirth
.
2014
May
;
14
(
1
):
167
.
[PubMed]
1471-2393
7.
Rasmussen
KM
,
Yaktine
AK
,
Rasmussen
KM
,
Yaktine
AK
.
Weight gain during pregnancy: reexamining the guidelines
.
National Academies Press
;
2009
.
8.
Tsai
IH
,
Chen
CP
,
Sun
FJ
,
Wu
CH
,
Yeh
SL
.
Associations of the pre-pregnancy body mass index and gestational weight gain with pregnancy outcomes in Taiwanese women
.
Asia Pac J Clin Nutr
.
2012
;
21
(
1
):
82
7
.
[PubMed]
0964-7058
9.
Ee
TX
,
Allen
JC
 Jr
,
Malhotra
R
,
Koh
H
,
Østbye
T
,
Tan
TC
.
Determining optimal gestational weight gain in a multiethnic Asian population
.
J Obstet Gynaecol Res
.
2014
Apr
;
40
(
4
):
1002
8
.
[PubMed]
1341-8076
10.
Morisaki
N
,
Nagata
C
,
Jwa
SC
,
Sago
H
,
Saito
S
,
Oken
E
, et al
Pre-pregnancy BMI-specific optimal gestational weight gain for women in Japan
.
J Epidemiol
.
2017
Oct
;
27
(
10
):
492
8
.
[PubMed]
0917-5040
11.
Group
ND
;
National Diabetes Data Group
.
Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance
.
Diabetes
.
1979
Dec
;
28
(
12
):
1039
57
.
[PubMed]
0012-1797
12.
Metzger
BE
,
Gabbe
SG
,
Persson
B
,
Buchanan
TA
,
Catalano
PA
,
Damm
P
, et al;
International Association of Diabetes and Pregnancy Study Groups Consensus Panel
.
International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy
.
Diabetes Care
.
2010
Mar
;
33
(
3
):
676
82
.
[PubMed]
0149-5992
13.
Arulkumaran
N
,
Lightstone
L
.
Severe pre-eclampsia and hypertensive crises
.
Best Pract Res Clin Obstet Gynaecol
.
2013
Dec
;
27
(
6
):
877
84
.
[PubMed]
1521-6934
14.
Villar
J
,
Cheikh Ismail
L
,
Victora
CG
,
Ohuma
EO
,
Bertino
E
,
Altman
DG
, et al;
International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH-21st)
.
International standards for newborn weight, length, and head circumference by gestational age and sex: the Newborn Cross-Sectional Study of the INTERGROWTH-21st Project
.
Lancet
.
2014
Sep
;
384
(
9946
):
857
68
.
[PubMed]
0140-6736
15.
Beyerlein
A
,
Schiessl
B
,
Lack
N
,
von Kries
R
.
Optimal gestational weight gain ranges for the avoidance of adverse birth weight outcomes: a novel approach
.
Am J Clin Nutr
.
2009
Dec
;
90
(
6
):
1552
8
.
[PubMed]
0002-9165
16.
Li
C
,
Liu
Y
,
Zhang
W
.
Joint and Independent Associations of Gestational Weight Gain and Pre-Pregnancy Body Mass Index with Outcomes of Pregnancy in Chinese Women: A Retrospective Cohort Study
.
PLoS One
.
2015
Aug
;
10
(
8
):
e0136850
.
[PubMed]
1932-6203
17.
Kim
SY
,
Sharma
AJ
,
Sappenfield
W
,
Wilson
HG
,
Salihu
HM
.
Association of maternal body mass index, excessive weight gain, and gestational diabetes mellitus with large-for-gestational-age births
.
Obstet Gynecol
.
2014
Apr
;
123
(
4
):
737
44
.
[PubMed]
0029-7844
18.
Wong
W
,
Tang
NL
,
Lau
TK
,
Wong
TW
.
A new recommendation for maternal weight gain in Chinese women
.
J Am Diet Assoc
.
2000
Jul
;
100
(
7
):
791
6
.
[PubMed]
0002-8223
19.
Wang
J
,
Duan
Y
,
Pang
X
,
Jiang
S
,
Yin
S
,
Yang
Z
, et al
Gestational weight gain and optimal ranges in Chinese mothers giving singleton and full-term births in 2013. Chin J Prev Med.
2018
(1).
20.
Nehring
I
,
Schmoll
S
,
Beyerlein
A
,
Hauner
H
,
von Kries
R
.
Gestational weight gain and long-term postpartum weight retention: a meta-analysis
.
Am J Clin Nutr
.
2011
Nov
;
94
(
5
):
1225
31
.
[PubMed]
0002-9165
21.
Sridhar
SB
,
Darbinian
J
,
Ehrlich
SF
,
Markman
MA
,
Gunderson
EP
,
Ferrara
A
, et al
Maternal gestational weight gain and offspring risk for childhood overweight or obesity
.
Am J Obstet Gynecol
.
2014
Sep
;
211
(
3
):
259.e1
8
.
[PubMed]
0002-9378
22.
Choi
SK
,
Lee
G
,
Kim
YH
,
Park
IY
,
Ko
HS
,
Shin
JC
.
Determining optimal gestational weight gain in the Korean population: a retrospective cohort study
.
Reprod Biol Endocrinol
.
2017
Aug
;
15
(
1
):
67
.
[PubMed]
1477-7827
23.
Hirooka-Nakama
J
,
Enomoto
K
,
Sakamaki
K
,
Kurasawa
K
,
Miyagi
E
,
Aoki
S
.
Optimal weight gain in obese and overweight pregnant Japanese women
.
Endocr J
.
2018
May
;
65
(
5
):
557
67
.
[PubMed]
0918-8959
24.
Li
G
,
Kong
L
,
Li
Z
,
Zhang
L
,
Fan
L
,
Zou
L
, et al
Prevalence of macrosomia and its risk factors in china: a multicentre survey based on birth data involving 101,723 singleton term infants
.
Paediatr Perinat Epidemiol
.
2014
Jul
;
28
(
4
):
345
50
.
[PubMed]
0269-5022
25.
Skilton
MR
,
Siitonen
N
,
Würtz
P
,
Viikari
JS
,
Juonala
M
,
Seppälä
I
, et al
High birth weight is associated with obesity and increased carotid wall thickness in young adults: the cardiovascular risk in young Finns study
.
Arterioscler Thromb Vasc Biol
.
2014
May
;
34
(
5
):
1064
8
.
[PubMed]
1079-5642
26.
Tsukamoto
H
,
Fukuoka
H
,
Inoue
K
,
Koyasu
M
,
Nagai
Y
,
Takimoto
H
.
Restricting weight gain during pregnancy in Japan: a controversial factor in reducing perinatal complications
.
Eur J Obstet Gynecol Reprod Biol
.
2007
Jul
;
133
(
1
):
53
9
.
[PubMed]
0301-2115
27.
Faucher
MA
,
Barger
MK
.
Gestational weight gain in obese women by class of obesity and select maternal/newborn outcomes: A systematic review
.
Women Birth
.
2015
Sep
;
28
(
3
):
e70
9
.
[PubMed]
1871-5192
28.
Kapadia
MZ
,
Park
CK
,
Beyene
J
,
Giglia
L
,
Maxwell
C
,
McDonald
SD
.
Can we safely recommend gestational weight gain below the 2009 guidelines in obese women? A systematic review and meta-analysis
.
Obes Rev
.
2015
Mar
;
16
(
3
):
189
206
.
[PubMed]
1467-7881
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