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The Effects of maternal weight gain on maternal and fetal outcomes Jennifer Nelson, MSIII and McKayla Titus, MSIII Faculty Advisor: James R. Beal, Ph.D.

4. There has long been a debate in pregnancy as to how much weight a woman should gain for optimal outcomes for both herself and the infant. Pregnancy is the only common clinical situation where the provider has to care for at least two patients – the mother and the fetus. It is necessary to balance the weight gain needed to optimize the size of the baby without jeopardizing the health of the mother. Gestational weight may also affect the short term as well as the long term maternal and child health, according to the 2009 Institute of Medicine’s report. [1] Studies have shown that there is an increased risk of moderate hypertension, dystocia, macrosomia, and having to proceed to Cesarean section when women’s weight gain was more than 16 kilogram as well as when the women were obese or overweight. [2]

The purpose of this study is to determine the association of maternal weight gain during pregnancy and maternal and neonatal morbidity.

5,-7, & 9. We will conduct a retrospective chart review of women having singleton births women from January 1, 2009 to October 31, 2013 at Trinity Health in Minot, ND. Inclusion criteria will be women 15 or older at the time of delivery and singleton pregnancy.. Exclusionary criteria will be multiple gestation (ICD-9 code 651) pregnancy, and gestational age <22 or >44 weeks, and missing pregnancy height or weight for BMI. The primary outcome will be gestational weight gain based on pre-pregnancy BMI defined as the following: BMI < 18.5 kg/m2, a gain of 28-40 pounds; BMI 18.5-24.9 kg/m2, a gain of 25-35 pounds; BMI 25-29.9 kg/m2, a gain of 15-25 pounds; and BMI >30 kg/m2, a gain of 11-20 pounds.

Data to be recorded will include age, race, education, marital status, pre-pregnancy height, last recorded weight before delivery, weight 1 year after delivery, parity, smoking, and alcohol. Also, maternal complications including, but not limited to, gestational diabetes, hypertensive disorders of pregnancy (pregnancy induced HTN, chronic HTN, transient HTN, pre-eclampsia, eclampsia); epidural use; induction of labor; augmentation of labor; operative vaginal delivery (forceps or vacuum-assisted); cesarean section; post-partum hemorrhage; third/fourth degree tears; abruptio placentae; and length of stay (>3 days excluding Cesarean section). Finally, neonatal complications to be included, but not limited to: fetal distress, Apgar scores, shoulder dystocia, birthweight.

Patients under the age of 16, over the age of 35, or those with a multiple gestation (ICD-9 651) will be excluded from the study. SPSS 21.0 for Windows will be used to analyze demographic and clinical characteristics of patients. Frequencies and relative percentages will be computed for each categorical variable. Chi-square tests or fisher’s exact tests will be performed to determine which categories were significantly different from one another, and t-test and/or ANOVA will be used to compare continuous variables. All p-values will be two-sided, and p-value <0.05 will be considered significant. Missing data will be excluded from analysis.

8 & 10. For the purpose of this study, there will be no physical interaction between the principal investigator and the patients whose charts are being reviewed. Furthermore, no procedures will be performed or direct interaction will occur with patients of this study. Data will be stored securely on password protected computers and files. The data file will not contain any identifying information such as patients’ names or medical record numbers. Only those involved in the research project will be able to access the data. Data will be stored in the Department of Family and Community Medicine at the UND School of Medicine and Health Sciences for a period of six years after analysis.

References:

1. Institute of Medicine (IOM/NRC), National Research Council (2009) Weight gain during pregnancy: Reexamining the Guidelines. Rasmussen KM and Yaktine AL. 2. Latifa Mochhoury, Rachid Razine, Jalal Kasouati, Mariam Kabiri, and Amina Barkat, “Body Mass Index, Gestational Weight Gain, and Obstetric Complications in Moroccan Population,” Journal of Pregnancy, vol. 2013, Article ID 379461, 6 pages, 2013. doi:10.1155/2013/379461