Associations of Gestational Weight Gain With Maternal Body Mass Index, Waist Circumference, and Blood Pressure Measured 16 Years After Pregnancy: The Avon Longitudinal Study of Parents and Children

The long-term effects of gestational weight gain (GWG) on postpartum maternal health outcomes are unclear. Although there is some evidence for an association between GWG and postpartum weight retention, studies have not investigated the possible association between GWG and cardiovascular disease risk factors or disease in later life.

This prospective population-based birth cohort study examined possible associations of prepregnancy weight and GWG with maternal outcomes, including body mass index (BMI, in kg/m2), waist circumference (WC), and blood pressure (BP) 16 years after pregnancy. The participants were 2356 mothers enrolled in the Avon Longitudinal Study of Parents and Children study. Associations of GWG with maternal outcomes were evaluated using the 2009 Institute of Medicine (IOM) recommendations for GWG. Adjustments were made for potential confounders, including age at outcome measurement, offspring sex, parity, smoking, total caloric intake during pregnancy, physical activity, social class, mode of delivery, and duration of breast-feeding.

Women with low GWG as defined by the IOM recommendations had a lower mean BMI (adjusted odds ratio (aOR), −1.56; 95% confidence interval [CI], −2.12 to −1.00) and WC (aOR, −3.37 cm; 95% CI, −4.91 to −1.83 cm) compared with women who gained weight as recommended. However, women with a higher than recommended GWG had a greater mean BMI (aOR, 2.90; 95% CI, 2.27–3.52), WC (5.84 cm; 4.15–7.54 cm), systolic BP (aOR, 2.87 mm Hg; 95% CI, 1.22–4.52 mm Hg), and diastolic BP (aOR, 1.00 mm Hg; 95% CI, −0.02 to 2.01 mm Hg) than did those with the recommended GWG. Among women with higher than recommended GWG, the odds of being overweight and central adiposity were 3 times those in women who gained weight as recommended. There was a positive association of prepregnancy weight with all outcomes based on estimates from random-effects multilevel models. In all periods of gestation, GWG was positively associated with later BMI and WC as well as increased odds of being overweight/obesity and central adiposity, but not with systolic BP or diastolic BP.

Midpregnancy GWG (19–28 weeks) greater than that recommended by the IOM was positively associated with long-term greater obesity/overweight, central adiposity, systolic BP, and diastolic BP in women who had normal weight before pregnancy. These findings show long-term adverse outcomes in later life among women with higher than recommended GWG and demonstrate clear benefits for women to gain below the IOM maximum weight gain thresholds.