Women and Birth 31 (2018) e20–e25

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Women and Birth

journal homepage: www.elsevier.com/locate/wombi

Maternal pre-pregnancy body mass index, gestational weight gain

influence birth weight
Zhao R.a , Xu L.a , Wu M.L.a , Huang S.H.b,* , Cao X.J.a,*
a
Department of Maternal and Child Health Care, Anhui Medical University, Hefei 230032, China
b
Department of Microbiology, Anhui Medical University, Hefei 230032, China

A R T I C L E I N F O A B S T R A C T

Article history: Background: Evidence suggests that pre-pregnancy body mass index and gestational weight gain have
Received 26 March 2017 impact on pregnancy and birth weight, yet whether maternal gestational weight gain has a differential
Received in revised form 4 June 2017 effect on the rates of adverse birth weight among women with different pre-pregnancy body mass index
Accepted 6 June 2017
categories are unknown.
Methods: We selected 1617 children matched with their mothers as study subjects. The subjects were
Keywords: divided into three categories: weight gain below the American Institute of Medicine guidelines, weight
Pre-pregnancy body mass index (BMI)
gain within the American Institute of Medicine guidelines and weight gain above the American Institute
Gestational weight gain (GWG)
Birth weight
of Medicine guidelines.
LGA Results: The prevalence of pre-pregnancy underweight and overweight/obese women was 16.3% and 12.3%.
SGA And nearly 15.2% of the women had gestational weight gain below American Institute of Medicine guideline,
52.1% of the women had gestational weight gain above American Institute of Medicine guideline. Maternal
overweight and obese was associated with increased risk for macrosomia and large-for-gestational age.
Women had gestational weight gain below American Institute of Medicine guideline were more likely to
have low birth weight and small-for-gestational age than women who had gestational weight gain within
American Institute of Medicine guideline. Furthermore, the risks for macrosomia and large-for-gestational
age were increased in women with above American Institute of Medicine guideline. And for women with a
normal weight before pregnancy, gestational weight gain above the American Institute of Medicine
guidelines were associated with higher rates of macrosomia and large-for-gestational age, compared with
the women of similar pre-pregnancy weight category but with gestational weight gain within the American
Institute of Medicine guidelines.
Conclusions: Women with abnormal pre-pregnancy body mass index and gestational weight gain are at risk
for adverse birth weight outcomes. Moreover, gestational weight gain has a differential effect on the rates
of adverse birth weight outcomes between women of different pre-pregnancy body mass index categories.
© 2017 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

What is already know

Statement of significance
Pre-pregnancy weight and gestational weight gain outside of
the normal range are associated with increased risks for
Problem or issue adverse birth weight.

Whether maternal gestational weight gain has a differential

effect on the rates of adverse birth weight among women
with different pre-pregnancy BMI categories are unknown.
* Corresponding authors.
E-mail addresses: huangshh68@aliyun.com (S.H. Huang), xiujingcao@yeah.net
(X.J. Cao).
What this paper adds
For women with a normal weight before pregnancy,
gestational weight gain above the American Institute of
Medicine guidelines were associated with higher rates of
macrosomia and large-for-gestational age, compared with
the women of similar pre-pregnancy weight category but
with gestational weight gain within the American Institute
of Medicine guidelines.

http://dx.doi.org/10.1016/j.wombi.2017.06.003
1871-5192/© 2017 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.
 R. Zhao et al. / Women and Birth 31 (2018) e20–e25
1. Introduction
Overweight and obesity is a worldwide epidemic problem and
the prevalence of obese women in childbearing age have shown
the trend of rising.1 From 1980 to 2013, the world prevalence of
overweight or obese women increased from 29.8% to 38.0%.2
Obesity among American women increased from 24.8% in 1999 to
28.3% in 2008,3 and almost 48% of the childbearing age women are
overweight or obese now.4 Almost 33% of pregnant women were
overweight or obese in the United Kingdom,5 and 10%–24% of
pregnant women were overweight or obese in China.6,7 On the
other hand, the phenomena of underweight is also common with
almost 11%–13% of women in China were underweight.6,7
Many studies have found that intrauterine environment
changes during pregnancy can cause a wide range of damage to
the offspring.8,9,11–15 Too little gestational weight gain increased
risks of low birth weight and preterm birth,8,9 and the latter
disorder was ranked the seventh in the leading causes of global
years of life lost.10 In contrast, excessive gestational weight gain is
associated with gestational diabetes, cesarean birth and postpar-
tum weight retention.11–13 Furthermore, excessive gestational
weight gain has been linked to childhood obesity in the offspring,14
which is associated with increased risk of chronic diseases in later
life.15 And accumulating evidence have shown that pre-pregnancy
women with overweight or obesity were at increased risk for
adverse maternal and neonatal outcomes.16 It included gestational
diabetes mellitus (GDM), preterm birth, large-for-gestational age
(LGA), macrosomia and neonatal death.17–22 In contrast, maternal
underweight was associated with small-for-gestational age (SGA)
and low birth weight.23,24 Nevertheless, the effect of maternal pre-
pregnancy body mass index, gestational weight gain on birth
weight are unknown, and it is unclear whether there is a
differential effect of gestational weight gain (GWG) on the rate
of adverse birth weight among women of different pre-pregnancy
BMI categories.
Therefore, the objectives of this study were: (1) to investigate
the prevalence of pregnancy underweight, normal weight,
overweight and obesity defined by body mass index (BMI), and
the prevalence of GWG below the American Institute of Medicine
(IOM) guideline, GWG within IOM guideline and GWG above IOM
guideline in China; (2) to study the associations between maternal
pre-pregnancy BMI, gestational weight gain and adverse birth
weight respectively; and (3) to evaluate the effect of GWG on the
rates of adverse birth weight between women of different pre-
pregnancy BMI categories.
2. Methods
2.1. Participants
Our team selected Xiaoxian, the most northern of Anhui
province, as study sites. With informed consent, we recruited
1733 children matched their mothers who received regular
physical examinations in the 13 XiaoXian Maternal and Child
HealthCare Hospitals from August 2014 to February 2015. After
excluding mothers who had pregnancy complications and infants
who had birth defects, 1617 normal birth outcomes and their
mothers were included in our final study. Confidential interviews
were conducted by trained research assistants to collect informa-
tion. The information obtained was: (1) maternal characteristics,
including age, height, weight before pregnancy, weight at birth,
education level, paternal education level, pregnancy history,
lifestyle before and during pregnancy (alcohol consumption and
smoking), anxiety trait, stress during pregnancy and bleeding,
vomiting in the first trimester. (2) offspring characteristics,
including delivery mode, gender, birth weight, and birth height.
e21
2.2. Measurements
Maternal self-reported pre-pregnancy weight and height were
used to calculate the pre-pregnancy BMI [calculated as weight
(kg)/height (m)2], which was further categorized into four groups:
underweight (<18.5 kg/m2), normal weight (18.5–24.0 kg/m2),
overweight (24.0–28.0 kg/m2), and obese (28.0 kg/m2 or higher).35
Gestational weight gain was calculated by subtracting each
woman's pre-pregnancy weight from her weight at delivery. The
2009 IOM GWG recommendation is for underweight, normal
weight, overweight, and obese women to gain 12.5–18 kg, 11.5–
16 kg, 7–11.5 kg, and 5–9 kg, respectively.1 Women were catego-
rized into three groups based on GWG relative to the 2009 IOM
recommendations: (1) weight gain below the IOM guidelines; (2)
weight gain within the IOM guidelines; and (3) weight gain above
the IOM guidelines.
We also considered the potential effect of maternal anxiety trait
as well as prenatal stress on birth weight. Maternal anxiety trait
was assessed using the State-trait Anxiety Inventory.25 The State-
trait Anxiety Inventory is a 40-item self-rating questionnaire, we
chose 21–40 items to assess maternal trait anxiety. The total score
was calculated by summing all of the items, and a score above the
cut-off score of 49 is used as an indication of trait anxiety. Maternal
stress during pregnancy was assessed using the Life Events Scale
for Pregnant Women.36 It is a 53-item self-rating questionnaire
and the participants were asked to indicate whether the events had
occurred during pregnancy using a dichotomous (yes–no) re-
sponse scale. The values in each event were summed and used to
assess the participant’s perception of stress, and a score above the
cut-off score of 375 is an indication.
We examined and categorized birth weight as following: low
birth weight (<2500 g), SGA (defined as birth weight below the
10th percentile of mean weight corrected or fetal sex and
gestational age), LGA (defined as birth weight above the 90th
percentile of mean weight corrected for fetal sex and gestational
age), macrosomia (>4000 g).26
2.3. Ethical considerations
All the investigators have had research ethics training.
Participation and their parents were voluntary, and informed
consent was sought from all the respondents. And the data were
collected and analyzed anonymously. Our study procedures were
approved by the ethics committee of Anhui Medical University,
Hefei, China.
2.4. Statistical analysis
Continuous variables were presented as the mean (SD), and
categorical variables were calculated as the number and rate (%).
Histograms and P–P plots were applied to evaluate the normality of
the distribution of the continuous variables. To test the research
hypothesis, multivariable logistic regression analysis was used to
control for potential confounders when assessing the associations
between pre-pregnancy BMI, gestational weight gain and adverse
birth weight, and evaluating the effect of GWG on the rates of
adverse birth weight among women of different pre-pregnancy
BMI category. Adjusted odds ratios (aOR) and 95% confidence
intervals (CI) were calculated to describe the relative risk. All
analyses were performed using SPSS, version 11.0 (SPSS Inc.).
P  0.05 (two-sided) was considered statistically significant.
3. Results
The means, standard deviations and other information of all
descriptive variables are listed in Table 1 and Fig. 1. Nearly 16.3% of
e22 R. Zhao et al. / Women and Birth 31 (2018) e20–e25

Table 1
Characteristics of the studied sample of mothers and their offspring (n = 1617).

Value
Maternal characteristics
Maternal age (years) 25.1 (16.0–46.0)
Gestational weight gain (GWG) (kg) 16.7 ( 10.0 to 41)
Maternal education, n (%)
Middle school or below 1155 (71.4)
Above high school level of education 462 (28.6)
Paternal education, n (%)
Middle school or below 1104 (68.3)
Above high school level of education 513 (31.7)
Maternal alcohol consumption before pregnancy, n (%) 36 (2.2)
Maternal smoking before pregnancy, n (%) 56 (3.5)
Maternal alcohol consumption during pregnancy, n (%) 20 (1.2)
Maternal smoking during pregnancy, n (%) 32 (2.0)
Parity, n (%)
Once 876 (54.2)
Twice or more 741 (45.8)
Gravity, n (%)
Once 975 (60.3) Fig. 1. Percentage of women in each BMI class by IOM GWG category.
Twice or more 642 (39.7) Percentage of women in each BMI class (underweight, normal, overweight/obese)
Anxiety trait, n (%) 256 (15.8) by their gestational weight change category is shown.
Stress, n (%) 123 (7.6)
Bleeding in the first trimester, n (%) 204 (12.6)
Vomiting in the first trimester, n (%) 1086 (67.2)
The associations between pre-pregnancy BMI, maternal gesta-
Maternal BMI before pregnancy, n (%) tional weight gain according to IOM guidelines and adverse birth
Underweight 263 (16.3) weight are demonstrated in Table 2. Overweight and obese women
Normal 1155 (71.4) were at increased risk for macrosomia (OR 1.7, 95% CI 1.2–2.6) and
Overweight/obese 199 (12.3)
LGA (OR 1.7, 95% CI 1.1–2.5) compared with the women of normal
Weight gain during pregnancy, n (%)
Below IOM guideline 246 (15.2) weight. Women had GWG below IOM guideline were more likely to
Within IOM guideline 529 (32.7) have low birth weight (OR 2.2, 95% CI 1.1–4.4) and SGA (OR 2.0, 95%
Above IOM guideline 842 (52.1) CI 1.2–3.4) than women had GWG within IOM guideline.
Offspring characteristics Furthermore, the risks for macrosomia (OR 1.7, 95% CI 1.2–2.5)
Males, n (%) 970 (60.0)
Birth weight (kg) 3.4 (1.2–6.9)
and LGA (OR 1.7, 95% CI 1.1–2.4) were increased in women with
Birth height (cm) 50.2 (20.0–67.0) above IOM guideline.
Cesarean birth, n (%) 582 (36.0) To investigate whether GWG has a differential effect on the
Data are presented as absolute and relative frequencies or mean (range). BMI, body rates of adverse birth weight among women with different pre-
mass index; IOM, Institute of Medicine. pregnancy BMI categories, the associations between birth weight
and GWG with respect to the 2009 IOM guidelines were studied
the women were categorized as underweight. In contrast, the separately in underweight women (Table 3), normal weight
proportion of overweight and obese women was 12.3%. And nearly (Table 4) women, and overweight/obese women (Table 5). For
15.2% of the women had GWG below IOM guideline, 52.1% of the women with a normal weight before pregnancy, GWG above the
women had GWG above IOM guideline. Noticeably, normal weight IOM guidelines were associated with higher rates of macrosomia
women were more likely to have GWG below the 2009 IOM (aOR 1.79, 95% CI 1.15–2.78) and LGA (aOR 1.70, 95% CI 1.13–2.57),
guidelines while overweight and obese women were more likely to compared with the women of similar pre-pregnancy weight
have GWG above the guidelines. In total, 36.0% of the participants category but with GWG within the IOM guidelines.
delivered by Cesarean section, and 60.0% of the offspring were
male. And 3.5%, 2.2% of the participants smoked and consumed 4. Discussion
alcohol before pregnancy respectively, and 2.0%, 1.2% of the
participants smoked and consumed alcohol during pregnancy In our study, 16.3% of the women were underweight, 12.3% were
respectively. categorized as overweight before pregnancy. The prevalence of

Table 2
Adverse birth weight associated with maternal gestational weight gain according to Institute of Medicine (IOM) guidelines and pre-pregnancy BMI.

Variable Macrosomia Low birth weight SGA LGA

OR (95% CI) P OR (95% CI) P OR (95% CI) P OR (95% CI) P

Maternal BMI before pregnancy
Normal 1.00 1.00 1.00 1.00
Underweight 0.7 (0.4–1.2) 0.238 1.6 (0.8–3.0) 0.147 1.5 (0.9–2.5) 0.100 0.6 (0.4–1.0) 0.059
Overweight/obese 1.7 (1.2–2.6) 0.007 1.0 (0.4–2.4) 0.959 1.0 (0.5–2.0) 0.931 1.7 (1.1–2.5) 0.008

Weight gain during pregnancy

Within IOM guideline 1.00 1.00 1.00 1.00
Below IOM guideline 1.2 (0.7–2.0) 0.528 2.2 (1.1–4.4) 0.027 2.0 (1.2–3.4) 0.011 1.1 (0.7–1.8) 0.657
Above IOM guideline 1.7 (1.2–2.5) 0.005 0.9 (0.5–1.8) 0.846 0.9 (0.6–1.4) 0.580 1.7 (1.1–2.4) 0.004

Adjusted for maternal age, education, paternal education, parity, gravity, maternal alcohol consumption before pregnancy, maternal smoking before pregnancy, maternal
alcohol consumption during pregnancy, maternal smoking during pregnancy, maternal stress during pregnancy, anxiety trait, bleeding or vomiting in the first trimester,
delivery mode and infant gender.
CI = confidence interval; LGA = large-for-gestational age; OR = odds ratio; SGA = small-for-gestational age.
 R. Zhao et al. / Women and Birth 31 (2018) e20–e25 e23

Table 3
Adverse birth weight associated with gestational weight gain according to Institute of Medicine (IOM) guidelines in women with pre-pregnancy underweight.

Outcome Below IOM guidelines Within IOM guidelines Above IOM guidelines Below vs. Within Above vs. within
(n = 38) (n = 112) (n = 113) Adjusted OR (95% CI) Adjusted OR (95% CI)
Low birth weight 6 (5.4) 4 (10.5) 4 (3.5) 2.70 (0.61–11.99) 1.13 (0.27–4.80)
Macrosomia 4 (3.6) 5 (13.2) 8 (7.1) 4.09 (0.98–17.08) 2.26 (0.64–7.93)
SGA 8 (7.1) 6 (15.8) 11 (9.7) 2.56 (0.79–8.35) 1.58 (0.59–4.24)
LGA 5 (4.5) 4 (10.5) 8 (7.1) 2.31 (0.54–9.94) 1.80 (0.55–5.93)

Data presented as n (%). Adjusted for maternal age, education, paternal education, parity, gravity, maternal alcohol consumption before pregnancy, maternal smoking before
pregnancy, maternal alcohol consumption during pregnancy, maternal smoking during pregnancy, maternal stress during pregnancy, anxiety trait, bleeding or vomiting in
the first trimester, delivery mode and infant gender.
CI = confidence interval; LGA = large-for-gestational age; OR = odds ratio; SGA = small-for-gestational age.

Table 4
Adverse birth weight associated with gestational weight gain according to Institute of Medicine (IOM) guidelines in women with pre-pregnancy normal weight.

Outcome Below IOM guidelines Within IOM guidelines Above IOM guidelines Below vs. within Above vs. within
(n = 182) (n = 372) (n = 602) Adjusted OR (95% CI) Adjusted OR (95% CI)
Low birth weight 11 (3.0) 12 (6.6) 17 (2.8) 2.33 (1.00–5.44) 0.95 (0.44–2.08)
Macrosomia 33 (8.9) 15 (8.2) 81 (13.5) 0.92 (0.48–1.76) 1.79 (1.15–2.78)
SGA 24 (6.5) 19 (10.4) 30 (5.0) 1.72 (0.90–3.27) 0.77 (0.44–1.36)
LGA 40 (10.8) 19 (10.4) 91 (15.1) 0.97 (0.54–1.74) 1.70 (1.13–2.57)

Data presented as n (%). Adjusted for maternal age, education, paternal education, parity, gravity, maternal alcohol consumption before pregnancy, maternal smoking before
pregnancy, maternal alcohol consumption during pregnancy, maternal smoking during pregnancy, maternal stress during pregnancy, anxiety trait, bleeding or vomiting in
the first trimester, delivery mode and infant gender.
CI = confidence interval; LGA = large-for-gestational age; OR = odds ratio; SGA = small-for-gestational age.

Table 5
Adverse birth weight associated with gestational weight gain according to Institute of Medicine (IOM) guidelines in women with pre-pregnancy overweight and obesity.

Outcome Below IOM guidelines Within IOM guidelines Above IOM guidelines Below vs. within Above vs. within
(n = 26) (n = 45) (n = 128) Adjusted OR (95% CI) Adjusted OR (95% CI)
Low birth weight 1 (2.2) 1 (3.8) 4 (3.1) 2.59 (0.12–53.86) 1.64 (0.16–16.62)
Macrosomia 8 (17.8) 5 (19.2) 32 (25.0) 0.98 (0.26–3.72) 1.37 (0.55–3.42)
SGA 2 (4.4) 3 (11.5) 6 (4.7) 3.14 (0.44–22.69) 1.19 (0.22–6.59)
LGA 8 (17.8) 5 (19.2) 37 (28.9) 0.88 (0.23–3.35) 1.63 (0.67–3.99)

Data presented as n (%). Adjusted for maternal age, education, paternal education, parity, gravity, maternal alcohol consumption before pregnancy, maternal smoking before
pregnancy, maternal alcohol consumption during pregnancy, maternal smoking during pregnancy, maternal stress during pregnancy, anxiety trait, bleeding or vomiting in
the first trimester, delivery mode and infant gender.
CI = confidence interval; LGA = large-for-gestational age; OR = odds ratio; SGA = small-for-gestational age.

underweight, overweight, and obesity in our study is different
from Brazil,2 American,3,4 Mexico,28 and other Chinese popula-
tions.6,7 And nearly 15.2% of the women had GWG below IOM
guideline, up to 52.1% of the women had GWG above IOM
guideline. Noticeably, normal weight women were more likely to
have GWG below the 2009 IOM guidelines while overweight and
obese women were more likely to have GWG above the guidelines.
It demonstrated the public still do not fully realize the importance
of pregnancy weight control in China.
Our study confirmed most prior reports that pre-pregnancy
weight outside of the normal range is associated with increased
risks for adverse birth weight. Overweight and obese women were
at increased risk for macrosomia (OR 1.7, 95% CI 1.2–2.6) and LGA
(OR 1.7, 95% CI 1.1–2.5) compared with the women of normal
weight. Relevant study also demonstrated that women with pre-
pregnancy overweight carried a 1.68-fold increased risk for LGA,
and obesity women carried a 2.10-fold increased risk for LGA in
Uruguay.29 And in China overweight and obese women carried a
2.56-fold increased risk for LGA.30 Moreover, maternal obese is
associated with 3.23-fold increased risk for macrosomia than
normal weight women.31 Our study also found women had GWG
below IOM guideline were more likely to have low birth weight
(OR 2.2, 95% CI 1.1–4.4) and SGA (OR 2.0, 95% CI 1.2–3.4) than
women had GWG within IOM guideline. Furthermore, the risks for
macrosomia (OR 1.7, 95% CI 1.2–2.5) and LGA (OR 1.7, 95% CI
1.1–2.4) were increased in women with above IOM guideline. Costa
had also demonstrated that excessive weight gain during
pregnancy was associated with birth weight of offspring and
macrosomia.32
The mechanism may be related to insulin resistance which is
often present in women with obesity or excessive weight gain
during pregnancy. Insulin resistance causes metabolic disorders,
resulting in the increased availability of nutrients to the fetus,
which receives large amounts of glucose through the placenta,
resulting in hyperinsulinemia and fetal growth acceleration.
Pregnant women with insulin resistance have higher
concentrations of triglycerides, which are fragmented into
smaller molecules by placental lipases and are transferred to
the fetal circulation, resulting in greater energy input to the
fetus.37,38 Additionally, insulin resistance increases the metabo-
lism of leucine, resulting in the increased crossing of the amino
acids to the fetus, and hyperinsulinemia with an increase in the
speed of growth of the fetu, leading to the occurrence of
macrosomia and LGA.33 Animal experiments found that
up-regulation of specific placental nutrient transporter isoforms,
including protein expression of glucose transporter (GLUT) 1 and
3, sodium-coupled neutral amino acid transporter (SNAT) 2,
and large neutral amino acid transporter 1 (LAT1) may
constitute a mechanism underlying fetal overgrowth in maternal
obesity.34
e24 R. Zhao et al. / Women and Birth 31 (2018) e20–e25
Another important finding of this study is that we found GWG
relative to the IOM guidelines has a differential effect on the rates
of adverse birth weight outcomes among women of different
pre-pregnancy weight categories. For women with a normal
weight before pregnancy, GWG above the IOM guidelines were
associated with higher rates of macrosomia (aOR 1.79, 95% CI
1.15–2.78) and LGA (aOR 1.70, 95% CI 1.13–2.57), compared with
the women of similar pre-pregnancy weight category but with
GWG within the IOM guidelines. These findings imply that
adverse birth weight such as macrosomia and LGA are generally
related to excessive weight gain during pregnancy rather than
pre-pregnancy overweight, obesity or underweight. These results
indicate that nutritional plan should be personalized according to
pre-pregnancy BMI and the importance of adherence to the
IOM recommendations to optimize fetal growth should be
highlighted.
Several limitations of our study merit attention. First, the
sample size in the present study is relative small, the findings need
to be replicated in other prospective cohort studies with larger
samples, and our results were only derived from data of women
living in Xiaoxian. Second, we focused only on the effect of
maternal weight gain during pregnancy and pre-pregnancy BMI on
birth weight. The effect of maternal weight gain in each trimester,
however, especially the first trimester, which is in itself critical
window in the progress of development, has been neglected in the
present study. Third, the pre-pregnancy weight was self-reported,
which is easy to produce recall error and can lead to underestima-
tion or overestimation of GWG.
In summary, the current study demonstrated that excessive
weight gain might be an independent predictor of macrosomia and
LGA, which may hamper the subsequent development of the child
and affect their health. Interventions of providing more assistance
of weight gain control may be recommended as a part of antenatal
care for mothers and children, and nutritional plan should be
individualized according to pre-pregnancy BMI. Further follow-up
study is needed to explore the effect of maternal weight gain in
each trimester on birth weight and the potential biological
pathways.
5. Conclusion
The current study demonstrated that overweight and obese
women before pregnancy were at increased risk for macrosomia
and LGA compared with the women of normal weight. Women
with GWG below IOM guideline were more likely to have low birth
weight and SGA than women with GWG within IOM guideline.
Furthermore, the risks for macrosomia and LGA were increased in
women with above IOM guideline. And for women with a normal
weight before pregnancy, GWG above the IOM guidelines were
associated with higher rates of macrosomia and LGA, compared
with the women of similar pre-pregnancy weight category but
with GWG within the IOM guidelines. These indicated excessive
gestational weight gain might be an independent predictor of
adverse birth weight. Thus, more assistance of controlling weight
gain may be recommended as a part of antenatal care for mothers
and children, and nutritional plan should be personalized
according to pre-pregnancy BMI.
Ethical statement
The authors confirm that there are no known conflicts of
interest associated with this publication and there has been no
significant financial support for this work that could have
influenced its outcome.
Funding
This study were supported by grants from Major Program of
Provincial University Natural Science Research Project of Anhui
Province (KJ2014ZD18), National Natural Science Foundation of
China (NO.30970906) and National Natural Science Foundation of
China (NO.81371797).
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