Intern
ati
o
n
a
l
Jo
urn
a
l
o
f
P
u
b
lic Hea
l
th Science (IJ
P
HS)
V
o
l.5
,
No
.2
,
Jun
e
2
016
, pp
. 15
1
~ 1
57
I
S
SN
: 225
2-8
8
0
6
1
51
Jo
urn
a
l
h
o
me
pa
ge
: h
ttp
://iaesjo
u
r
na
l.com/
o
n
lin
e/ind
e
x.ph
p
/
IJPHS
Early Weight Gain during Preg
nancy: Which Women are the
Most
Af
f
ect
ed
?
Tebbani
Fouz
ia,
O
u
lam
a
r
a
Hayet, Agli Abden
a
cer
Institute of Nut
r
i
tion, Food and
Food
Technologi
es (INATAA), Laborator
y
of
Nutr
ition
and Food
T
echnolog
ies (
L
NTA),
Algeria
Article Info
A
B
STRAC
T
Article histo
r
y:
Received Feb 29, 2016
Rev
i
sed
Mar
27
, 20
16
Accepted Apr 29, 2016
Maternal weight gain during pregnancy
is a good prediction too
l
in short and
long term h
ealth
of pregn
a
nt wo
men and th
eir
ch
ildren
.
To
stud
y
the
effect of
earl
y
w
e
ight
gai
n
of pregnan
t
w
o
m
e
n until
the
end of th
e 2
nd
t
r
im
ester
of
pregnancy
,
dep
e
nding on th
eir p
r
e-pre
gnan
c
y
bo
d
y
mass index
.
116 health
y
pregnant wom
e
n were followe
d until the 2
nd
trimester of pregnancy
,
th
eir
weight and heig
ht before pr
egnancy
,
as
wel
l
as
t
h
e curren
t
weigh
t
at th
e end
of the 1
st
and
2
nd
trim
esters wer
e
col
l
e
c
ted
.
Da
ta
includ
ed ag
e,
p
a
rit
y
,
e
a
ting
habits and
ph
ysical
ac
tivi
t
y
l
e
vel.
Stat
istics
were perform
ed
using the
S
t
atview s
o
ftwa
re.
The m
ean
p
r
e-
pregnan
c
y
B
M
I was 27 ± 5.27 kg/m².
W
e
ight gain in the 2
nd
trimester is 6.33 ± 4.84 kg.
It decreas
es
with the
increasing ag
e o
f
the mother (25
%
of women between 20 and 24
.9
y
ears vs
12.5% of more
than 35). Also,
it decr
eases with the in
creasing
number of
childr
e
n (62.5%
in nullip
arous vs 25%
in m
u
ltiparous). Breakfast
is skipped
b
y
64.5 % of o
v
erweight pr
egn
a
nt women in th
e 1st trimester and 90 % in
the 2
nd
one. 80.17% and 69.83% of pregnant women do not
practice
an
y
ph
y
s
ical activ
ity. Overweight an
d obe
se pregnant women before pregnan
c
y
do not
take en
ough weight du
ring pregn
a
ncy
.
Prospects will to
analy
ze
behaviors r
e
lated to h
e
a
lth
and s
o
cial status.
Keyword:
First and
second
trim
ester
Pre
gna
ncy
pre
-
p
r
e
gna
ncy
B
M
I
Wei
g
ht
gai
n
Health a
n
d s
o
c
i
al status
Copyright ©
201
6 Institut
e
o
f
Ad
vanced
Engin
eer
ing and S
c
i
e
nce.
All rights re
se
rve
d
.
Co
rresp
ond
i
ng
Autho
r
:
Tebbani Fouzi
a
,
In
stitu
te
o
f
Nu
t
r
itio
n
,
Fo
od
and
Foo
d
Tech
nolo
g
i
es
(INATAA),
Lab
o
rat
o
ry
of Nut
r
i
t
i
on
a
n
d Fo
od
Tec
h
n
o
l
o
gi
es
(
L
NT
A
)
, Al
ge
ri
a.
E-m
a
il
:
fouzi
a
t
e
bani
@y
afo
o
.
f
r
1.
INTRODUCTION
R
a
t
e
s of
obesi
t
y
have i
n
c
r
ea
sed si
g
n
i
f
i
c
a
n
t
l
y
over t
h
e pa
st
several
deca
des. T
o
day
o
v
e
r 3
5
%
o
f
rep
r
o
d
u
ct
i
v
e a
g
e
wom
e
n are
obe
se (B
o
d
y
M
a
ss I
nde
x
(B
M
I)
≥
30
k
g
/
m
2
), a
n
d 8 % a
r
e
extrem
ely obe
se (BMI
≥
40
kg
/m
2
) [1
]
.
The obe
si
t
y
epi
d
em
i
c
i
s
impact
i
ng
pre
g
na
ncy
.
O
v
er
hal
f
of al
l
wom
e
n ent
e
ri
n
g
p
r
eg
na
ncy
i
n
the United
States are either
over
w
ei
g
h
t
o
r
obese
[2
].
Num
e
ro
us st
ud
i
e
s have sh
o
w
n o
b
esi
t
y
and excessi
ve
gest
at
i
onal
wei
g
ht
gai
n
(GWG) are associate
d
with both m
a
ternal a
nd
fetal com
p
lications
includi
ng
gest
ational diabete
s
, hype
rt
ensi
on, preeclam
psia,
fetal
m
acrosom
i
a
, cesarean
del
i
ver
y
, an
d
po
st
part
um
wei
ght
ret
e
nt
i
o
n
[
3
]
,
[
4
]
.
Wei
g
ht
gai
n
d
u
ri
ng
pre
gna
n
c
y
i
s
att
r
i
but
abl
e
t
o
t
h
e ut
er
us an
d i
t
s
cont
ent
s
(f
oet
u
s
,
am
ni
ot
i
c
fl
ui
d
and
placenta
),
breasts, blood
and i
n
terstitial
fluid. A sm
alle
r fraction
of that weight
ga
in
is due to a
n
increase
in
cellu
lar water an
d
d
e
po
sitio
n
o
f
n
e
w fat an
d
p
r
o
t
ein
con
s
titu
tin
g
m
a
te
rn
al reserv
es [5
]. Tho
ugh
th
e ran
g
e
of
wei
g
ht
gai
n
con
s
i
d
ere
d
no
r
m
al
i
s
wi
de, i
t
depe
n
d
s
on t
h
e
pre
-
ge
st
at
i
ona
l
bo
dy
m
a
ss i
n
dex
(B
M
I
) [
6
]
.
The
m
o
st widely accepted rec
o
mmendations
re
garding
GWG ar
e t
hose
published
by the
Institute of Me
dicine
(IOM)
of the
United States
of
Am
erica [7].
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
SN
:
2
252
-88
06
IJP
H
S V
o
l
.
5, No
. 2,
J
u
ne 2
0
1
6
:
15
1 – 1
5
7
15
2
These guidelines
state
that he
althy
wom
e
n who ha
ve a
n
o
r
m
a
l
wei
ght
f
o
r t
h
ei
r
hei
g
ht
(
B
M
I
1
8
.
5
–
2
4
.9)
sho
u
l
d
gain
11
.5–1
6 kg du
r
i
n
g
pr
eg
n
a
n
c
y.
O
v
erw
e
igh
t
wo
m
e
n
(
B
MI
25–
29
.9)
sh
ou
ld g
a
i
n
7–1
1.5 kg
and
o
b
ese w
o
m
e
n (B
M
I
g
r
e
a
t
e
r t
h
an
3
0
) s
h
o
u
l
d
o
n
l
y
put
on
5
–9
kg
. It
i
s
al
so rec
o
m
m
ende
d t
o
gai
n
bet
w
ee
n
0.
5 a
n
d
2
kg
d
u
ri
ng
the
first
trim
ester [4]
.
I
n
the
se
co
nd
t
r
i
m
ester
,
un
d
e
rw
eigh
t wo
m
e
n
shou
ld
g
a
in 0.5
kg
each wee
k
of
pre
g
nancy, norm
a
l wom
e
n 0.4 kg/wee
k, overweight women 0.3kg/we
e
k and obe
se wom
e
n
0.
2k
g/
wee
k
[
4
]
.
Despi
t
e
t
h
ese
gui
del
i
n
es,
o
v
e
r
55
%
of
obes
e
w
o
m
e
n gai
n
m
o
re t
h
an t
h
e
recom
m
ended
am
ount
[
2
]
.
GW
G
is no
t lin
ear
ov
er
th
e co
ur
se
o
f
p
r
egnan
c
y.
W
e
i
g
h
t
gain
starts slowly in
th
e first tri
m
ester an
d
in
creases
m
o
re co
n
s
istently in
th
e secon
d
and
t
h
ird
tri
m
esters
[8
]. Th
e ab
ility to
id
en
tify wo
m
e
n
at risk
for ex
cessiv
e
gest
at
i
onal
wei
ght
gai
n
al
l
o
ws
f
o
r
wei
g
ht
m
a
nagem
e
nt
i
n
t
e
r
v
ent
i
o
ns
.
The sec
o
nd
h
a
l
f
o
f
p
r
e
gna
ncy
i
s
cha
r
act
eri
zed
by
p
r
o
g
ressi
ve i
n
sul
i
n re
si
st
ance
[
9
]
,
[
10]
, a
n
d
maternal fat ac
cum
u
lation appears t
o
influe
nce s
ubse
q
ue
nt
m
a
ternal insul
i
n resistance
[
9
]
,
[1
1]
. Th
e pat
t
ern
of
GW
G
is
h
i
gh
er
in
th
e second tr
i
m
ester
at a r
a
te of
0.563
kg
p
e
r
w
eek and
b
i
r
t
h
w
e
igh
t
is str
o
n
g
l
y corr
elated
wi
t
h
wei
g
h gai
n
du
ri
n
g
t
h
at
p
e
ri
o
d
[
1
2]
.
Pre
v
i
o
us st
u
d
i
e
s ha
ve s
u
g
g
e
s
t
e
d t
h
at
e
x
ce
ssi
ve
early
GWG m
i
ght be associated
wi
th an ea
rly
in
crease i
n
in
su
lin
resistan
ce lead
in
g to
exh
a
ustio
n
o
f
t
h
e panc
reat
i
c
B
cel
l
.
Thi
s
B
cel
l
depl
et
i
on
coul
d
reduce the ca
pacity to co
m
p
ensate fo
r the i
n
creasi
ng i
n
s
u
lin resistance
of
pregna
ncy, a
nd t
h
ere
f
ore lead to
hy
pe
ri
ns
ul
i
n
e
m
i
a
,
m
a
t
e
rnal
hy
pe
rgl
y
cem
i
a
an
d e
x
cessi
ve
fet
a
l
gr
o
w
t
h
[
9
]
,
[1
3]
-
[
1
5
]
.
Howev
e
r it is i
m
p
o
r
tan
t
to
reme
m
b
er th
e p
r
o
p
o
s
ed
obj
ectiv
es b
y
th
e Swed
ish
stud
y of
2
007
wh
ich
allow dec
r
easi
ng t
h
e num
b
er of caesa
r
ean s
ections but als
o
of pe
rsistent
ove
rweight and obesity in 1
year of
ch
ild
b
i
rth
,
with
ou
t in
creasing
th
e
n
u
m
b
e
r of o
t
her co
m
p
lic
ations. T
h
ese
objectives are a
weight gain
of 10
kg
max
i
m
u
m
,
reg
a
rd
less
o
f
th
e
in
itial Bo
d
y
Mass Ind
e
x
o
f
th
e p
a
tien
t
. A weig
h
t
g
a
i
n
m
o
re th
an
1
0
k
g
at
6
m
ont
hs of
pre
g
nancy
i
s
de
em
ed exce
ssi
ve
(r
i
s
k fact
o
r
o
f
ge
st
at
i
onal
di
abet
es). It
i
s
t
o
be
m
odul
at
ed acc
or
di
n
g
t
o
t
h
e
p
r
e-
pre
g
nancy
B
M
I [
1
6]
.
Ou
r st
udy
assessed
t
h
e e
f
fect
o
f
ea
rl
y
w
e
i
ght
gai
n
o
f
p
r
eg
na
nt
w
o
m
e
n
unt
i
l
the end
of the
2
nd
t
r
i
m
est
e
r of
p
r
eg
na
ncy
,
de
pen
d
i
n
g
o
n
t
h
e
i
r p
r
e-
pre
g
nanc
y
bo
dy
m
a
ss i
ndex
.
2.
R
E
SEARC
H M
ETHOD
We c
o
n
d
u
ct
ed
a pr
os
pect
i
v
e a
nd
a l
o
ngi
t
u
di
n
a
l
coh
o
rt
st
udy
near
by
11
6
pr
egna
nt
wom
e
n du
ri
n
g
t
h
e
first an
d secon
d
trim
esters o
f
pregn
a
n
c
y
in
m
a
tern
ities, an
ten
a
tal centers and
priv
ate g
y
n
e
co
log
i
sts in
C
onst
a
nt
i
n
e,
A
l
geri
a f
r
om
Decem
b
er 2
0
13 t
o
A
u
gu
st
2
0
1
5
.
The
part
i
c
i
p
a
n
t
s
we
re rec
r
ui
t
e
d an
d f
o
l
l
o
w
e
d-
u
p
lo
ng
itu
d
i
n
a
lly, as
d
e
scri
b
e
d
p
r
ev
iou
s
ly. The trim
esters we
re
defin
e
d
as
first (less
tha
n
1
6
c
o
m
p
lete week
s),
secon
d
(15
–28 co
m
p
lete
w
eek
s).
W
o
m
e
n
w
e
r
e
r
e
cru
ited b
e
f
o
r
e
16
w
e
ek
s of
am
en
o
r
r
h
ea.
W
o
m
e
n
w
e
r
e
elig
ib
le for p
a
rticip
atio
n
if they en
tered
p
r
en
atal care
be
fore the 16s
wee
k
of am
enorrhea, age
d
18 ye
ars ol
d
and m
o
re a
nd
were
heal
t
h
y
a
nd m
e
nt
al
l
y
com
p
et
ent
.
W
e
ex
clud
ed wo
m
e
n
refusing
to
particip
ate in
the stu
d
y
,
m
i
ssi
ng i
n
f
o
r
m
at
i
on on
pre
-
pre
g
nancy
wei
ght
,
kn
o
w
n
di
a
b
et
es, hy
pert
e
n
si
on a
nd a
n
em
i
a
befo
re p
r
eg
nancy
.
Po
ten
tially eli
g
ib
le wo
m
e
n
were sen
t
an
in
fo
rm
atio
n
a
l l
e
tter ex
p
l
ain
i
ng
th
e stu
d
y
an
d
its o
b
j
ectives and
requ
esting
th
ei
r p
a
rticip
atio
n.
W
r
itten
co
nsen
t was
ob
tain
ed
fro
m
th
e m
o
th
er at in
clusion
.
At enro
llm
e
n
t, a
stan
d
a
rd
ized
qu
estion
n
a
ire
was co
m
p
leted
.
Data co
llect
ed include m
a
ternal c
h
aracte
r
istics (age,
parity),
m
a
t
e
rnal
pre
-
p
r
eg
na
ncy
wei
g
ht
, hei
ght
,
p
r
e-
pre
g
nancy
B
M
I, wei
ght
gai
n
at
t
h
e end
of t
h
e fi
rst
a
nd
se
con
d
t
r
im
est
e
rs of
pre
g
nancy
,
eat
i
ng
habi
t
s
(
s
u
c
h as eat
i
n
g
bet
w
ee
n m
eals, t
a
ki
n
g
or
n
o
t
o
f
b
r
eak
fas
t
and
consum
ing m
o
re fried foods
)
and the
practice of
physical
activ
ity (at least walk
i
n
g). Th
ese in
form
at
io
ns were
obtaine
d by fa
ce to face interview with eac
h pregna
nt
woman. W
e
ight
and height
were
m
easured acc
ordi
ng
t
o
a st
an
dar
d
p
r
ot
ocol
.
Wei
g
h
t
s of
pre
g
na
nt
wom
e
n we
re s
e
l
f
re
po
rt
ed
or
reco
rde
d
at
t
h
e
earl
y
fi
rst
t
r
i
m
est
e
r
du
ri
n
g
t
h
ei
r
fi
r
s
t
vi
si
t
and c
o
nt
i
nue
d i
n
e
v
e
r
y
t
r
im
est
e
r by
usi
n
g a
n
el
ect
ro
ni
c wei
ghi
ng
bal
a
nce Se
ca
t
o
t
h
e
nearest
0.
1
kg
.
Hei
g
ht
was
m
easure
d
i
n
cm
usi
n
g a l
o
c
a
l
l
y
m
a
de ant
h
r
o
p
o
m
e
t
e
r. The p
r
egna
nt
wom
e
n were
aske
d t
o
m
a
i
n
tai
n
an u
p
ri
ght
and e
r
ect
p
o
st
ure
wi
t
h
he
r fe
et
t
oget
h
er a
n
d
t
h
e back
of
he
r heel
s t
o
uchi
n
g
t
h
e
pole of the ant
h
ropom
eter. The height
was
measured
whe
n
the horiz
ont
al headpiece
was lowere
d onto the
w
o
m
e
n
’
s
h
ead.
W
e
calcu
lated
pr
e-pr
egn
a
ncy BMI
u
s
ing
either a doc
u
mented first trim
ester weight
and
hei
g
ht
or a sel
f
rep
o
r
t
e
d wei
ght
. P
r
e-
p
r
eg
n
a
ncy
bo
dy
m
a
ss i
nde
x (B
M
I
) was com
put
e
d
as re
po
rt
ed
wei
g
ht
(k
g)
di
vi
ded
b
y
squa
re o
f
m
easure
d
hei
g
ht
(m
) and cat
ego
r
i
zed i
n
t
o
f
o
u
r
g
r
ou
ps as
un
der
w
ei
g
h
t
(<1
8
.
5
kg/
m
2
), n
o
rm
al (
≥
18
.5
an
d
<25
k
g
/
m
2
), o
v
er
weig
ht (
≥
25
an
d <30
kg
/ m
2
) and
obe
s
e
(
≥
3
0
kg/
m
2
). P
r
e
-
p
r
egn
a
n
c
y BMI and
g
e
stational weig
h
t
g
a
i
n
were categor
ized
b
a
sed
on
Institu
te o
f
Med
i
cin
e
BMI g
r
o
u
p
s
and
gestational wei
ght gain guide
lines
[4]. W
e
i
ght (in kg)
at
each
pre
n
atal visit (at the e
n
d
of t
h
e fi
rst a
n
d the
second trim
esters)
were c
o
llected. T
h
e wei
ght
gain
va
ri
at
e was cat
eg
ori
cal
and
had
3
val
u
es:
wei
g
ht
gai
n
abo
v
e,
bel
o
w
,
or
wi
t
h
i
n
I
O
M
recom
m
endat
i
ons
.
At
t
h
e e
n
d
of t
h
e fi
r
s
t
t
r
i
m
est
e
r of
p
r
e
gna
ncy
,
al
l
w
o
m
e
n
sho
u
l
d
gai
n
be
t
w
een 0
.
5 an
d
2 k
g
[4]
.
I
n
t
h
e secon
d
t
r
i
m
est
e
r, u
nde
rwei
ght
w
o
m
e
n shoul
d gai
n
0
.
5
kg eac
h
week
o
f
pre
g
nancy
,
n
o
r
m
a
l w
o
m
e
n 0.
4
kg/
week
,
ove
r
w
ei
g
h
t
w
o
m
e
n
0.
3k
g/
wee
k
an
d
obe
se
wom
e
n
0.
2k
g/
wee
k
[
4
]
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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S I
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225
2-8
8
0
6
Early Wei
ght
Gai
n
Duri
ng P
r
egnancy: W
h
ich W
o
men are
the M
o
st Affected? (Tebbani
Fouzia)
15
3
Statistical an
al
ysis was p
e
rform
e
d
u
s
in
g St
at View so
ftware.
Qu
an
titati
v
e
v
a
riab
les
were an
alyzed
by
st
u
d
ent
’
s t
-
t
e
st
and
one
way
-
AN
OV
A
.
B
i
nary
l
o
gi
st
i
c
regre
ssi
o
n
anal
y
s
i
s
was
do
ne t
o
fi
n
d
out
t
h
e
associ
at
i
on am
on
g b
o
d
y
m
a
ss i
ndex
,
gest
at
i
onal
w
e
i
g
ht
ga
i
n
, som
e
m
a
t
e
r
n
al
fact
o
r
s suc
h
as age,
hei
g
h
t
and
pari
t
y
. P
val
u
e
s
< 0
.
0
5
we
re
considere
d
sign
ifican
t. Th
e
χ
2
test was
use
d
in com
p
aris
on analyses, whereas
correlations
we
re e
v
aluated by
Pears
o
n a
n
d Spearm
a
n tests.
3.
R
E
SU
LTS AN
D ANA
LY
SIS
The
dat
a
base
c
ont
ai
ne
d
2
4
5
wom
e
n, a
n
d
,
o
f
t
h
ese
,
11
6
w
o
m
e
n
m
e
t
al
l
incl
usi
o
n
cri
t
e
ri
a an
d
were
i
n
cl
ude
d i
n
t
h
e
st
udy
.
We e
x
c
l
ude
d w
o
m
e
n wi
t
h
m
i
ssi
ng o
r
i
m
pl
ausi
bl
e i
n
f
o
rm
at
i
on o
n
pre
-
p
r
e
gna
ncy
B
M
I,
pre
-
p
r
e
gna
ncy
wei
g
ht
, kn
o
w
n
di
abet
es
, hy
pe
rt
ensi
o
n
a
n
d
a
n
em
i
a
befo
re pr
egna
ncy
.
We ide
n
tified
116 patie
nts who recei
ved
care thro
ugh
maternities, antenatal centers and
private
gynecologists i
n
C
onstantin
e,
Algeria from
Decem
ber 2013 to
August
2015.
All wom
e
n in
itiated care
at less
than 16 weeks of
am
enorrhea and
ha
d
a do
cumen
t
ed
first tri
m
ester weigh
t
.
The soci
o-
dem
o
g
r
a
phi
c an
d
ot
he
r cha
r
act
er
i
s
t
i
c
s (age, pa
r
i
t
y
, pre-
pre
gna
ncy
bo
dy
wei
ght
,
hei
g
ht
,
bo
dy
m
a
ss i
n
d
e
x a
n
d
gest
at
i
o
nal
a
g
e)
o
f
t
h
e
1
1
6
wom
e
n i
n
t
h
e a
n
al
y
s
i
s
c
o
h
o
r
t
are
sh
o
w
n i
n
Ta
bl
e
02
.
M
ean
wei
g
ht
bef
o
re
pre
g
nancy
was
7
1
± 1
3
.
9
9
k
g
,
t
h
e
o
v
eral
l
m
ean pre
-
pre
gna
ncy
B
M
I was
27
.2
9 ± 5.
2
7
k
g
/
m
2
.
GWG in
th
e fi
rst tri
m
ester was 1
.
25
±
3
.
8
kg
and
in
second
trim
es
ter was 6
.
34
± 4.84
k
g
(0
.53
kg
/week
)
. A
m
a
jori
t
y
o
f
t
h
e
wom
e
n 4
3
(
3
7.
07
%) st
art
e
d
pre
g
nancy
wi
t
h
a
no
rm
al
body
m
a
ss i
ndex
(B
M
I
)
.
Th
e s
econ
d
lar
g
est BMI
gr
oup
w
a
s
ov
erw
e
igh
t
36
(31.03
%)
and
o
b
ese 35
(3
0.1
7
%)
. Th
e m
a
j
o
r
ity o
f
wo
m
e
n
in
th
e
sam
p
le w
e
r
e
betw
een
20
an
d
3
4
year
s
of
ag
e (8
1.03
%)
.
Tabl
e
2.
Di
st
ri
but
i
o
n
o
f
part
i
c
i
p
ant
s
acc
o
r
di
ng
t
o
cl
i
n
i
cal
c
h
aract
eri
s
t
i
c
s a
n
d
wei
ght
gai
n
(
n
=
11
6)
Cat
e
gory
M ± SD
Minim
u
m
Maxim
u
m
Age (
y
ears
)
20-
34.
9
≥
35
30 ± 5.
00
81.
03%
18.
96%
20
42
Parity
Nulliparity
Pri
m
ipa
r
ity
Multiparity
1 ± 0.
99
47 (
40.
52%)
36 (
31.
03%)
33 (
28.
48%)
0 4
Pr
egnancy
term
27 ± 1.
13 weeks of
am
enorr
h
ea
23
28
Initial weight (kg)
71 ± 13.99
45
114
Height (m
)
1.
61 ± 0.
06
1.
46
1.
72
Pr
e-
pr
egnancy BMI
(
kg/m
2
)
27.
29 ± 5.
27
16.
52
46.
84
W
e
ight gain (
1
st
tr
im
ester)
1.
25 ± 3.
8
-
15
9
W
e
ight gain (
2
nd
trim
ester)
6.
34 ± 4.
84
-
4
,
1
17.
2
Data a
r
e mean
± SD
or n (%)
unless
ot
he
rwise s
p
ecifie
d
In
gene
ral
,
as
pre-
p
r
eg
na
nc
y
B
M
I i
n
creased, t
h
e am
ou
nt
of
wei
g
ht
gai
n
e
d
d
u
ri
ng
pre
gna
ncy
decrease
d
(
7
.
9
6 ± 4.
86
k
g
i
n
no
rm
al
wei
ght
wom
e
n
v
s
4.
58
± 4.
1
4
kg
i
n
o
b
ese o
n
es, p=
0
.
0
0
1
7
)
(
T
abl
e
03
).
Th
e
rate
o
f
matern
al weigh
t
g
a
i
n
fro
m
th
e fi
rst to the second
trimester of
pregnan
c
y was a
si
gni
fi
ca
nt
pre
d
i
c
t
o
r
o
f
e
x
ces
si
ve
wei
g
ht
gai
n
.
Tabl
e 3. Di
st
ri
but
i
o
n o
f
part
i
c
i
p
ant
s
acc
o
r
di
ng
t
o
wei
g
ht
g
a
i
n
i
n
t
h
e 1
st
and
2
nd
t
r
i
m
est
e
rs o
f
pre
gna
ncy
by
pre
-
p
r
e
gna
ncy
st
at
e
wei
g
ht
Pre-p
regnancy st
ate w
e
ight
Weight gain (M
±
SD)
1
st
Tri
m
ester
2
nd
Tri
m
ester
Under
w
eight
2.
59 ± 0.
18
7.
55 ± 0.
78
Norm
al
1.
66 ± 3.
22
7.
96 ± 4.
86
Over
weight
1.
1 ± 3.
47
6.
04 ± 5.
06 (
P
=0.
09)
Obese
0.
83 ± 4.
81
4.
58
4.
14 (
P
= 0.
0017)
Seco
nd
- G
W
G
rat
e
vari
e
d
wi
t
h
m
a
ny
soci
o
d
em
ogra
phic c
h
aracteristics, including m
a
ternal a
g
e
a
nd
p
a
rity. In
con
t
rast, first-trim
ester GWG rate d
i
d
n
o
t
v
a
ry
with these cha
r
a
c
teristics, but
was ass
o
ciated with
beha
vi
o
r
s i
n
cl
udi
ng
,
pre
g
nan
c
y
phy
si
cal
ac
t
i
v
i
t
y
, and
di
et
pat
t
e
r
n
.
G
W
G
rat
e
va
ri
ed
acros
s
pre
-
p
r
e
gna
ncy
BM
I categ
orie
s f
o
r
seco
n
d
tri
m
ester gain
b
u
t
not
f
o
r
first-t
r
im
ester gain.
Am
ong t
h
e
1
1
6
w
o
m
e
n anal
y
zed, 6
2
.
5
%
o
f
w
o
m
e
n wi
t
h
a no
rm
al
pre-p
r
eg
na
ncy
B
M
I, 2
5
%
of
ove
r
w
ei
g
h
t
an
d 12
,5
% of o
b
e
s
e
w
o
m
e
n
ha
d an
e
x
cessi
ve
e
a
rl
y
gest
at
i
o
nal
wei
g
ht
gai
n
(
p
=0.
0
2
)
(Fi
g
u
r
e 1)
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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:
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252
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06
IJP
H
S V
o
l
.
5, No
. 2,
J
u
ne 2
0
1
6
:
15
1 – 1
5
7
15
4
Fi
gu
re
1.
Pre
-
p
r
eg
na
ncy
st
at
e
wei
g
ht
an
d
2
nd
tri
m
ester weigh
t
g
a
i
n
Gest
at
i
onal
we
i
ght
gai
n
decre
a
sed wi
t
h
t
h
e i
n
creasi
ng a
g
e of t
h
e m
o
t
h
er (2
5% o
f
w
o
m
e
n bet
w
e
e
n
20
an
d
2
4
.
9
y
e
ars
vs
12
.5
% i
n
wom
e
n o
f
m
o
re
t
h
a
n
35
y
ears
ol
d,
p=
0.
0
7
)
(Fi
g
u
r
e
3)
.
Fi
gu
re 2.
Di
st
ri
but
i
o
n o
f
pre
g
nant
w
o
m
e
n
w
e
i
ght
gai
n
(
2
nd
trim
ester) accordi
n
g to a
g
e
As sh
own
in
Fig
u
re 3, 62
.5
% o
f
n
u
llip
arou
s, 12
.5
% of
p
r
i
m
ip
arou
s and
2
5
% of m
u
ltip
arou
s
wo
m
e
n
had e
x
cessi
ve wei
g
ht
gai
n
i
n
t
h
e 2
nd t
r
i
m
ester.
W
e
i
ght
gain dec
r
eases wit
h
the inc
r
easing num
b
er of c
h
ildre
n
(62
.
5
%
i
n
n
u
llip
arou
s wo
m
e
n
v
s
2
5
%
in
m
u
lt
ip
aro
u
s
, p
=
0.02
).
Fi
gu
re 3.
Di
st
ri
but
i
o
n o
f
pre
g
nant
w
o
m
e
n
w
e
i
ght
gai
n
(
2
nd
trim
ester) accordi
n
g to
parity
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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PH
S I
S
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:
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2-8
8
0
6
Early Wei
ght
Gai
n
Duri
ng P
r
egnancy: W
h
ich W
o
men are
the M
o
st Affected? (Tebbani
Fouzia)
15
5
GWG was sign
ifican
tly
lower
in
o
l
d
e
r,
mo
re p
a
rou
s
women
,
with ag
e and
p
a
rity stro
ng
ly related
(p=
0
.
0
1, p=
0.
0
7
) (
F
i
g
ure 2 a
nd
3). M
a
t
e
r
n
al
wei
ght
gai
n
duri
ng
pre
g
na
ncy
decrease
d
wi
t
h
i
n
creasi
n
g pre
-
pre
g
nancy
B
M
I, a
nd
o
b
ese
w
o
m
e
n di
ffe
red
fr
om
t
h
ei
r peer
s wi
t
h
a m
ean of
4
kg
gai
n
e
d
vs. a
b
out
8 k
g
fo
r t
h
e
o
t
h
e
r
wo
m
e
n
.
Also
, ob
ese women
were also
less lik
ely to
be nu
llip
aro
u
s
t
h
an wo
m
e
n
wi
th
a
n
o
rm
al B
M
I.
B
r
eak
fast
i
s
s
k
i
ppe
d
by
6
4
.
5
% o
f
o
v
e
r
wei
g
ht
p
r
eg
na
nt
w
o
m
e
n i
n
t
h
e
1st
t
r
im
est
e
r and
9
0
% i
n
t
h
e
2
nd
one
. A pe
rcent
a
ge o
f
8
0
.
1
7
% (
o
f
whi
c
h 6
3
.
4
1
%
are ove
r
w
ei
g
h
t
)
and
69
.8
3% (
o
f
whi
c
h
59
.2
6
%
are
ove
r
w
ei
g
h
t
)
of
p
r
eg
na
nt
w
o
m
e
n
do
not
pract
ice any physic
al activity.
3.
1.
Discussion
I
n
t
h
is stud
y,
62
.5
%
o
f
wo
m
e
n
w
ith
a
no
r
m
a
l
p
r
e-
pr
eg
n
a
n
c
y BMI
,
25
% of ov
erw
e
igh
t
and
1
2
.5
% of
obe
se w
o
m
e
n had a
n
exce
ssi
ve earl
y
g
e
st
at
i
onal
wei
ght
gai
n
(
p
=
0
.0
2)
great
er t
h
an t
h
e 2
0
0
9
IOM
recom
m
endat
i
ons
.
In
200
9,
th
e
U.S. Institu
te
of
Med
i
cin
e
(IOM)
pub
lish
e
d
rev
i
sed
g
u
i
d
e
lin
es for g
e
statio
n
a
l weigh
t
gai
n
.
The
g
o
al
of t
h
ese
gui
del
i
n
es i
s
t
o
opt
i
m
i
ze bot
h m
a
ternal
a
nd c
h
i
l
d
out
c
o
m
e
s, and
t
o
dec
r
ease t
h
e rat
e
s
o
f
b
o
t
h
m
a
ter
n
al po
stp
a
r
t
u
m
an
d
ch
ild
hood
ob
esity [
1
7
]
. Th
ese gu
id
eli
n
es do
no
t sp
ecif
ically ad
d
r
ess th
e
t
i
m
i
ng
of
exce
ssi
ve
wei
g
ht
g
a
i
n
d
u
r
i
n
g t
h
e
pre
g
nancy
(ear
l
y
vs. l
a
t
e
).
As ob
esity b
e
co
m
e
s
m
o
re p
r
ev
alen
t in
p
r
eg
n
a
n
c
y, it is in
creasing
l
y im
p
o
r
tan
t
for
clin
ician
s
to
m
oni
t
o
r gest
at
i
onal
wei
ght
g
a
i
n
. O
u
r dat
a
sug
g
est
a
di
ve
rge
n
ce i
n
wei
ght
gai
n
pat
t
e
r
n
s as ea
rl
y
as 12
–
14
weeks.
Wom
e
n who e
x
cee
de
d pregna
ncy weight rec
o
mm
e
ndations starte
d to accelerate
their weight gain at
t
h
e be
gi
n
n
i
n
g
of t
h
e sec
o
n
d
t
r
im
est
e
r and
gai
n
e
d
a m
a
j
o
rity o
f
weigh
t
d
u
ring
th
at tri
m
ester.
Wo
m
e
n
who
gaine
d
m
o
re t
h
an two
kgs a
t
12–14 wee
k
s were likel
y to e
x
ceed ge
stational wei
g
ht gain (96 %
positive
p
r
ed
ictiv
e
v
a
lue [9
5 % CI 79–9
9 %])
.
All o
b
e
se women
h
a
d
m
i
n
i
mal weig
h
t
g
a
in
to
n
o
weight g
a
in
u
n
til
m
i
d
-
p
r
egn
a
n
c
y.
[1
8
]
. Ano
t
h
e
r
l
a
rge st
u
d
y
of
ove
r 5
8
.
0
00 w
o
m
e
n wi
t
h
i
n
a Dani
s
h
Nat
i
o
n
a
l
B
i
rt
h C
oho
rt
sho
w
ed a m
e
an gest
at
i
o
nal
w
e
i
ght
g
a
in
for ob
ese p
r
im
ip
aro
u
s
wo
m
e
n
o
f
11
.3
kg
and
9
.
9
k
g
for m
u
ltip
arou
s wo
m
e
n
.
In
th
is coho
rt 45
% of
obe
se
wom
e
n
gai
n
e
d
l
e
ss t
h
a
n
10
k
g
a
n
d t
h
e m
ean wei
ght
gai
n
dec
r
ease
d
wi
t
h
i
n
creasi
n
g B
M
I
[
19]
.
Ou
r re
sul
t
s
s
h
owe
d
t
h
at
we
i
ght
gai
n
i
n
pre
g
nancy
wa
s l
o
we
r w
h
e
n
pre
-
p
r
e
gna
nc
y
B
M
I was
el
evat
ed. I
n
pa
rt
i
c
ul
ar, w
o
m
e
n w
ho we
re o
v
e
rwei
ght
o
r
o
b
e
se bef
o
re p
r
e
gna
ncy
ge
neral
l
y
gai
n
ed l
e
ss wei
g
ht
du
ri
n
g
pre
g
na
ncy
an
d very
few w
o
m
e
n
h
a
d
a
n
exce
ssi
v
e
wei
g
ht
gai
n
.
Ho
we
ver
,
d
u
r
i
ng
pre
g
nancy
,
fat
i
s
sto
r
ed
to
secure en
erg
y
su
pp
l
y
d
u
ring
fetal
g
r
o
w
t
h
an
d
lactatio
n
.
In
o
b
e
se wo
m
e
n
,
n
o
ad
d
ition
a
l storag
e is
necessa
ry
, wh
i
c
h sug
g
est
s
t
h
at
pre
gna
nc
y
wei
ght
gai
n
co
ul
d be r
e
st
ri
ct
ed beca
use o
f
phy
si
o
l
ogi
cal
m
echani
s
m
s
. Ou
r st
udy
was
base
d
on
sel
f
-re
po
rt
ed
m
e
asures
o
f
wei
g
ht
be
f
o
re
p
r
eg
nancy
w
h
ereas
m
a
ny
st
udi
es
ha
ve
fo
un
d t
h
at
wei
g
h
t
i
s
m
o
re l
i
k
el
y
t
o
be
un
de
r-
re
po
rt
ed
by
w
o
m
e
n
wi
t
h
a
hi
gh
pre
-
p
r
e
gna
ncy
B
M
I
[2
0]
. Suc
h
a bi
as wo
ul
d t
h
e
r
e
f
o
r
e im
pact
on
t
h
e cal
cul
a
t
i
on of
gest
at
i
ona
l
wei
ght
gai
n
and l
ead t
o
a
n
over
-
est
i
m
a
ti
on of
wei
g
ht
gai
n
i
n
ove
r
w
ei
g
h
t
an
d obe
se wom
e
n.
To
our knowle
dge t
h
ere is a
study that e
x
a
m
ines ge
stational age s
p
ecifi
c weight gai
n
as a pre
d
ictor
f
o
r
ex
cessiv
e
gestatio
n
a
l w
e
igh
t
g
a
in. Ch
m
i
t
o
r
z
et al
. [21
id
en
tif
ied
seco
nd
tr
im
ester
sp
ecif
i
c cu
tof
f
s
as good
pre
d
i
c
t
o
r
s
of e
x
cessi
ve
G
W
G i
n
o
b
ese
an
d
ove
r
w
ei
g
h
t
wom
e
n (
9
3.
3
% PP
V
[9
5 %
C
I
90
–
9
6
%]
)
.
Usi
n
g
secon
d
t
r
im
est
e
r cu
t
o
ffs t
h
ey were ab
le t
o
pred
ict to
tal ex
cessiv
e
g
e
station
a
l wei
g
h
t
g
a
i
n
in m
o
re th
an 70
%
o
f
th
e
po
pu
latio
n [21
]
.
Gest
at
i
onal
we
i
ght
gai
n
was s
i
gni
fi
ca
nt
l
y
l
e
ss i
n
ol
der
an
d
m
o
re par
ous
w
o
m
e
n, a fi
n
d
i
n
g c
onsi
s
t
e
nt
with
th
e ex
istin
g
literatu
re [22
]
. In
th
is samp
le, g
e
sta
tion
a
l weig
h
t
g
a
i
n
decreased
with
th
e in
creasi
n
g
ag
e of
t
h
e m
o
t
h
er (2
5%
of
wom
e
n bet
w
ee
n 2
0
a
nd
2
4
.
9
y
ears
vs 1
2
.
5
% i
n
wom
e
n o
f
m
o
re t
h
a
n
3
5
y
e
a
r
s ol
d,
p
=
0.07). Also
, 6
2
.5
%
o
f
nu
llip
aro
u
s
, 12
.5
% o
f
p
r
im
ip
aro
u
s an
d
25
% of
m
u
l
tip
arou
s wo
m
e
n
h
a
d
ex
cessiv
e
weigh
t
g
a
i
n
in th
e
2
n
d
t
r
im
e
s
ter.
Weigh
t
gain
d
e
creas
es
with
th
e in
creasin
g
nu
m
b
er
o
f
ch
ildren (62
.
5
%
i
n
n
u
llip
arou
s
women
v
s
25
% i
n
m
u
lt
ip
arou
s, p=0
.
0
2
).
There is e
v
ide
n
ce that physical
act
i
v
i
t
y
al
on
g wi
t
h
di
et
ary
m
odi
fi
cat
i
on and
wei
g
ht
m
oni
t
o
ri
n
g
can
decrease
gest
at
i
onal
wei
g
ht
g
a
i
n
[
23]
,
[
24]
.
A m
e
t
a
-anal
y
sis by
St
re
ul
i
n
g
et
al
. [2
3]
exa
m
i
n
ed 1
2
ran
d
o
m
i
zed
trials assessing th
e im
p
act o
f
a ph
ysical activ
ity in
t
e
rvent
i
on o
n
G
W
G
.
St
udi
es
i
n
cl
u
d
e
d had pa
rt
i
c
i
p
ant
s
exercise at least three tim
e
s
a week
fo
r
2
0
–
6
0
m
i
n
starti
n
g
in
th
e
first o
r
seco
nd
trimester. Ph
ysical
activ
ity
i
n
cl
ude
d aer
o
b
i
cs, ru
nni
ng
, cy
cl
i
ng, wat
e
r a
e
ro
bi
cs an
d m
u
scl
e
st
ren
g
t
h
e
n
i
n
g.
Wom
e
n wh
o en
ga
ged i
n
any
phy
si
cal
act
i
v
i
t
y
du
ri
n
g
pre
g
nancy
ha
d a
si
gni
fi
cant
l
y
l
o
wer
gest
at
i
o
nal
wei
g
ht
gai
n
c
o
m
p
ared t
o
t
h
ose
wh
o
di
d
n
o
t
(m
ean
di
ffe
re
nce
-0
.6
1
kg;
9
5
% C
I
-
1
.
1
7
,
-0
.0
6)
.
Al
t
h
o
u
g
h
e
x
er
ci
se o
v
eral
l
re
duce
d
t
o
t
a
l
G
W
G
t
h
e
m
e
t
a
-anal
y
si
s di
d
n
o
t
fi
nd
a
d
o
se-
d
e
p
en
de
nt
effect
of
exe
r
ci
se o
n
gest
at
i
o
n
a
l
wei
g
ht
gai
n
.
St
udi
es
have s
h
o
w
n t
h
at
b
o
t
h
zero wei
ght
g
a
i
n
a
nd
weight
loss are assoc
i
at
ed with decreased rate
s
of preeclam
psia, cesarean delivery,
large
for gestational age infants
,
ope
rative va
gi
nal deliveries, and
adm
i
ssi
on t
o
n
e
onat
a
l
i
n
t
e
nsi
v
e ca
re
uni
t
s
[2
5]
,[
26]
.
A lim
itation o
f
o
u
r stu
d
y
is the use o
f
se
lf-re
p
o
rt
ed
we
ights o
f
pa
rticipants. T
h
is is im
portant
because self-re
p
orted wei
ghts
m
a
y cause
m
i
sclassificati
on of ge
stational weight gain.
Obese wom
e
n te
nd to
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
SN
:
2
252
-88
06
IJP
H
S V
o
l
.
5, No
. 2,
J
u
ne 2
0
1
6
:
15
1 – 1
5
7
15
6
un
de
rre
po
rt
we
i
ght
an
d t
h
ere
f
ore o
v
e
r
est
i
m
at
e gest
at
i
ona
l
wei
g
ht
gai
n
[
2
7]
. M
easure
d
p
r
e-
pre
g
nancy
wei
g
ht
may not be
uni
v
ersally availa
ble and
first tri
m
ester we
ight
is ofte
n c
o
nsidered
accepta
ble. Our m
e
thodology
of calculatin
g total gestation
a
l weight gai
n
usin
g either
a self-re
po
rted
weig
ht or
doc
um
ented first trim
ester
weigh
t
reflects ho
w clin
ician
s
ex
am
in
e g
e
statio
n
a
l wei
g
h
t
gain
in
a real
wo
rl
d
settin
g.
4.
CO
NCL
USI
O
N
In
ou
r co
h
o
rt
we f
o
u
n
d
that wom
e
n at risk
fo
r
excee
ding gestational weight gai
n
goal
s are norm
al
and
u
nde
r
w
ei
g
h
t
w
o
m
e
n bef
o
re p
r
eg
na
ncy
r
a
t
h
er t
h
a
n
ove
r
w
ei
g
h
t
an
d o
b
e
s
e o
n
es, l
e
ss a
g
ed
(<
35 y
ear
s ol
d
)
,
n
u
llip
arou
s
and
p
r
im
ip
arou
s wo
m
e
n
co
m
p
aring
with
m
u
lti
p
a
rou
s
on
es. Th
is
find
ing
shou
ld en
cou
r
ag
e
h
ealth
pr
ofe
ssi
o
n
al
s t
o
bet
t
e
r i
n
fo
rm
p
r
eg
na
nt
w
o
m
e
n a
b
o
u
t
t
h
e
i
m
port
a
nce
of
wei
g
ht
gai
n
a
d
apt
e
d t
o
t
h
ei
r
B
M
I.
Howe
ver, as less than a t
h
ird of
w
o
m
e
n cur
r
ent
l
y
m
e
et
the rec
o
m
m
ended gest
at
i
o
nal
wei
g
ht
gai
n
li
mits b
y
th
e Institu
te o
f
Med
i
cin
e
, it is i
m
p
o
rtan
t, in a h
ealt
h
pub
lic po
in
t
o
f
v
i
ew, to
set
u
p
prog
ram
s
to
h
e
lp
pre
g
nant
w
o
m
e
n t
o
com
p
l
y
wi
t
h
t
h
e
s
e rec
o
m
m
e
ndat
i
ons.
Fut
u
re
resear
c
h
s
h
oul
d f
o
c
u
s
o
n
i
n
t
e
rve
n
t
i
o
ns t
h
at
p
r
ovi
d
e
ed
ucat
i
o
n r
e
gar
d
i
n
g
fo
o
d
c
hoi
ces
an
d
encourage women to enga
ge
in physical
activ
ity early
in
p
r
egn
a
n
c
y. These in
terv
en
tion
s
sho
u
l
d
sp
ecificall
y
t
a
rget
wom
e
n
wh
o
gai
n
m
o
re wei
g
ht
at
t
h
e
begi
nni
ng
o
f
t
h
e seco
n
d
t
r
i
m
est
e
r.
REFERE
NC
ES
[1]
K. M
.
F
l
egal
,
et al.
, “Prevalence of obesity
and
trends in the d
i
stribution of bo
d
y
mass
index among US adults,
1999–2010,”
JA
MA
, vo
l. 307, pp
. 491–497
, 2012
.
[2]
CDC, “Pregnancy
nutrition
surveillance
n
a
tio
n. Summar
y
o
f
trends
in
maternal health
indictors,” 2011
.
http://www.cdc.gov/ pednss/pnss_tables/tab
l
es_n
umeric.htm. Retr
ieved
Februar
y
2
5
, 2014
.
[3]
Am
erican Col
l
e
g
e of Obs
t
etr
i
ci
ans
and G
y
neco
logis
t
s
,
“
O
bes
i
t
y
in pregn
a
nc
y,
”
ACOG Comm
ittee Opinion
549
.
Washington, DC
, ACOG, 2013
.
[4]
Institute
of Me
dicin
e
, “
W
e
ight
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