Effect of weight gain rate in the second and third trimesters of pregnancy on maternal and neonatal health: a cross-sectional study

Wen Hua; Sha Lu; Lijun Zhang; Fangfang Chen; Jiahui Xu; Danxiao Wang; Nisile Kakongoma; Wensheng Hu

doi:10.1016/j.clnesp.2025.07.004

Effect of weight gain rate in the second and third trimesters of pregnancy on maternal and neonatal health: a cross-sectional study

Clin Nutr ESPEN. 2025 Jul 9:S2405-4577(25)01754-1. doi: 10.1016/j.clnesp.2025.07.004. Online ahead of print.

Authors

Wen Hua¹, Sha Lu², Lijun Zhang³, Fangfang Chen⁴, Jiahui Xu⁵, Danxiao Wang¹, Nisile Kakongoma⁴, Wensheng Hu⁶

Affiliations

¹ Cixi People's Hospital Medicine and Health Group, Ningbo, People's Republic of China.
² Department of Obstetrics and Gynecology, Hangzhou Women's Hospital (Hangzhou Maternity and Child Health Care Hospital), Hangzhou, People's Republic of China; Department of Obstetrics and Gynecology, The Affiliated Hangzhou Women's Hospital of Hangzhou Normal University, Hangzhou, People's Republic of China.
³ Hangzhou City of Shangcheng Center for Disease Control and Prevention, Hangzhou, People's Republic of China.
⁴ The Fourth Clinical School of Zhejiang Chinese Medicine University, Hangzhou, People's Republic of China.
⁵ Jinhua Municipal Central Hospital Medical Group, Jinhua, People's Republic of China.
⁶ Department of Obstetrics and Gynecology, The Affiliated Hangzhou Women's Hospital of Hangzhou Normal University, Hangzhou, People's Republic of China; Department of Obstetrics, Women's Hospital, School of medicine, Zhejiang University, Hangzhou, People's Republic of China. Electronic address: huws@zju.edu.cn.

PMID: 40645330
DOI: 10.1016/j.clnesp.2025.07.004

Abstract

Objective: We aimed to investigate the association between gestational weight gain rate (GWGR) in the second and third trimesters (ISTT) and both pregnancy complications and perinatal outcomes.

Methods: This was a cross-sectional study of data from the 2,664 pregnant women between March 2018 and December 2018. Pregnant women were grouped by different GWGRs ISTT according to the latest recommendation for maternal weight gain in 2021 and they were classified as below (insufficient GWGR), within (normal GWGR) and above (excessive GWGR) the standard. According to the level of pre-pregnancy body mass index (BMI), these pregnancies were further divided into low BMI, normal BMI and high BMI subgroups. Pregnancy complications and outcomes in each group were analyzed. One-way ANOVA test, Chi-squared test, Fisher's exact test and Logistic regression were used for statistical analysis.

Results: Logistic regression analysis demonstrated that excessive GWGR was associated with an increased risk of hypertensive disorders of pregnancy (HDP) (AOR = 2.197, 95%CI: 1.561-5.274), hyperlipidemia (AOR = 1.567, 95%CI: 1.284-1.871), macrosomia (AOR = 1.788, 95%CI: 1.183-2.702), LGA (AOR = 1.661, 95%CI: 1.327-2.088), preterm neonates (AOR = 2.416, 95%CI: 1.429-3.519) and caesarean section (AOR = 1.434, 95%CI: 1.191-1.727), while a decreased risk of gestational diabetes mellitus (GDM) (AOR = 0.436, 95%CI: 0.332-0.572); and insufficient GWGR was associated with a decreased risk of hyperlipidemia (AOR = 0.578, 95%CI: 0.351-0.951) and gestational hepatic dysfunction (AOR = 0.348, 95%CI: 0.182-0.811), while an increased risk of GDM (AOR = 2.212, 95%CI: 1.652-2.962). In the low BMI subgroup, insufficient GWGR were associated with a decreased risk of GDM respectively (AOR = 0.295, 95%CI: 0.139-0.629; AOR = 0.471, 95%CI: 0.234-0.948). In the high BMI subgroup, insufficient GWGR was associated with an increased risk of GDM (AOR = 3.593, 95%CI: 1.586-8.140), hyperlipidemia (AOR = 4.929, 95%CI: 1.315-18.479) and preterm neonates (AOR = 3.083, 95%CI: 1.050-9.155), and excessive GWGR was associated with an increased risk of GDM (AOR = 2.819, 95%CI: 1.346-3.208), hyperlipidemia (AOR =2.029, 95%CI: 1.168-5.365), macrosomia (AOR = 3.008, 95%CI: 1.003-9.020), LGA (AOR = 1.459, 95%CI: 1.046-2.036) and caesarean section (AOR = 1.552, 95%CI: 1.142-2.110).

Conclusions: In this study, we found that 65.4% of women did not achieve optimal GWGR. Insufficient GWGR ISTT was associated with decreased risk of pregnancy complications, in particular with hyperlipidemia. Excessive GWGR ISTT was associated with severe adverse birth outcomes, especially among women with high pre-pregnancy BMI. Although associations between GWGR and perinatal outcomes were observed, subsequent longitudinal studies are required to establish causal relationships.

Keywords: cohort studies; gestational weight gain rate in the second and third trimesters; pregnancy complications; pregnancy outcomes.