Table 2.
Total gestational weight change classified according to the 2009 National Academy of Medicine recommendations and the association with cardiovascular and diabetes mortality (n=46,042).
| Weight Change by 2009 NAM Recommendation | |||
|---|---|---|---|
| Below | Within | Above | |
| Pre-pregnancy BMI Status | Cardiovascular Disease Mortality | ||
| < 18·5 kg/m2 | |||
| Mortality rate per 1000 person years (95% CI)b | 1·8 (1·6, 2·0) | 1·2 (1·0, 1·5) | 1·9 (1·2, 2·9) |
| Unadjusted HR (95% CI) | 1·34 (1·00, 1·79) | 1 (Reference) | 1·73 (1·01, 2·97) |
| Adjusted HR (95% CI)c | 1·18 (0·89, 1·58) | 1 (Reference) | 1·84 (1·08, 3·12) |
| 18·5 – 24·9 kg/m2 | |||
| Mortality rate per 1000 person years (95% CI)b | 2·0 (1·9, 2·1) | 2·1 (1·9, 2·2) | 2·5 (2·2, 2·8) |
| Unadjusted HR (95% CI) | 1·01 (0·92, 1·11) | 1 (Reference) | 1·22 (1·06, 1·41) |
| Adjusted HR (95% CI)c | 0·93 (0·84, 1·02) | 1 (Reference) | 1·20 (1·04, 1·37) |
| 25·0 – 29·9 kg/m2 | |||
| Mortality rate per 1000 person years (95% CI)b | 3·8 (3·5, 4·2) | 3·4 (3·1, 3·7) | 3·4 (3·1, 3·8) |
| Unadjusted HR (95% CI) | 1·16 (1·01, 1·34) | 1 (Reference) | 1·03 (0·88, 1·22) |
| Adjusted HR (95% CI)c | 1·08 (0·94, 1·26) | 1 (Reference) | 1·12 (0·94, 1·33) |
| ≥ 30·0 kg/m2 | |||
| Mortality rate per 1000 person years (95% CI)b | 5·9 (5·2, 6·5) | 5·2 (4·4, 6·0) | 5·2 (4·6, 6·0) |
| Unadjusted HR (95% CI) | 1·23 (0·99, 1·52) | 1 (Reference) | 1·05 (0·85, 1·30) |
| Adjusted HR (95% CI)c | 1·12 (0·90, 1·40) | 1 (Reference) | 1·08 (0·86, 1·34) |
| Pre-pregnancy BMI Status | Diabetes Mortality | ||
| < 18·5 kg/m2 | |||
| Mortality rate per 1000 person years (95% CI)b | 0·2 (0·1, 0·2) | 0·3 (0·2, 0·4) | 0·2 (0·0, 0·7) |
| Unadjusted HR (95% CI) | 0·87 (0·36, 2·08) | 1 (Reference) | 0·73 (0·10, 5·12) |
| Adjusted HR (95% CI)c | 0·68 (0·25, 1·89) | 1 (Reference) | 0·90 (0·13, 6·35) |
| 18·5 – 24·9 kg/m2 | |||
| Mortality rate per 1000 person years (95% CI)b | 0·3 (0·2, 0·3) | 0·3 (0·3, 0·4) | 0·4 (0·3, 0·5) |
| Unadjusted HR (95% CI) | 0·74 (0·58, 0·93) | 1 (Reference) | 0·99 (0·63, 1·56) |
| Adjusted HR (95% CI)c | 0·62 (0·48, 0·79) | 1 (Reference) | 0·95 (0·61, 1·47) |
| 25·0 – 29·9 kg/m2 | |||
| Mortality rate per 1000 person years (95% CI)b | 0·6 (0·5, 0·7) | 0·5 (0·4, 0·6) | 0·9 (0·7, 1·1) |
| Unadjusted HR (95% CI) | 1·07 (0·72, 1·59) | 1 (Reference) | 1·69 (1·19, 2·40) |
| Adjusted HR (95% CI)c | 0·97 (0·64, 1·48) | 1 (Reference) | 1·77 (1·23, 2·54) |
| ≥ 30·0 kg/m2 | |||
| Mortality rate per 1000 person years (95% CI)b | 1·4 (1·1, 1·7) | 1·5 (1·1, 2·0) | 1·4 (1·1, 1·8) |
| Unadjusted HR (95% CI) | 0·86 (0·59, 1·25) | 1 (Reference) | 0·86 (0·58, 1·27) |
| Adjusted HR (95% CI)c | 0·76 (0·51, 1·13) | 1 (Reference) | 0·83 (0·55, 1·27) |
Abbreviations: BMI, body mass index; CI, confidence interval; HR, hazard ratio; National Academy of Medicine, NAM.
Recommendations for total gestational weight gain (2009): Pre-pregnancy BMI <18·5 kg/m2 (12·5–18·0 kg); 18·5–24·9 kg/m2 (11·5–16·0 kg); 25·0–29·9 kg/m2 (7·0–11·5 kg); ≥ 30·0 kg/m2 (5·0–9·0 kg).
Mortality rate estimated obtained from a single imputed dataset.
Analyses adjusted for the following index pregnancy variables: age, smoking, race/ethnicity, parity, marital status, income, education, preexisting diabetes, preexisting cardiovascular conditions, preexisting cancer/tumors, preexisting neurological conditions, preexisting renal conditions, preexisting respiratory conditions, prior pregnancy loss, site, study year, pre-pregnancy body mass index, gestational week at delivery.