Patterns of Gestational Weight Gain and Infants Born Large-for-Gestational Age Across Consecutive Pregnancies

Published:December 07, 2018DOI:



      Factors that occur between consecutive pregnancies may influence repeated excessive gestational weight gain (GWG) and infants born large-for-gestational age (LGA). We examined interpregnancy interval, weight retention, and GWG in women's first pregnancy as predictors of excessive GWG and LGA in women's second pregnancy.


      We used data from women's first two live births during the First Baby Study, a 3-year prospective observational cohort of first-time mothers (N = 549). GWG was calculated as weight at delivery minus prepregnancy weight for first and second pregnancies and categorized using the Institute of Medicine guidelines. Weight retention at 6 and 12 months and interpregnancy interval (time from first live birth to conception of second infant) were quantified. Infants were considered LGA if birthweight was in the 90th percentile or greater for gestational age.


      Many women (51.7%) exceeded GWG recommendations in both pregnancies. Women who exceeded guidelines in their first pregnancy had a 5.08 greater odds (p < .01) for exceeding guidelines in their second pregnancy, compared with women who did not exceed guidelines in their first pregnancy. Interpregnancy interval and weight retention had no association with exceeding guidelines in women's second pregnancy. Exceeding guidelines in women's first pregnancy resulted in a 4.48 greater odds (p < .01) of first-born infants being LGA, and exceeding guidelines in women's second pregnancy resulted in a 1.82 greater odds of second-born infants being large-for-gestational age (p = .02), compared with women who met guidelines in their first or second pregnancy, respectively.


      Exceeding GWG guidelines in women's first pregnancy predicted exceeding guidelines in their second pregnancy, independent of interpregnancy interval and weight retention.
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      Elizabeth L. Adams, MS, is a doctoral student in the Department of Nutrition and the Center for Childhood Obesity Research at Penn State. She studies the development of multidisciplinary, family-based obesity prevention interventions designed to promote healthy behaviors and growth across early childhood.


      Michele E. Marini, MS, is a data analyst and statistician for the Center of Childhood Obesity Research at Penn State. Her expertise includes research design, data management, and data analysis.


      Krista S. Leonard, MS, is a doctoral student in the Department of Kinesiology at Penn State. She studies behavioral strategies that include physical activity, healthy eating, and psychological components to help manage weight gain among pregnant women with overweight/obesity.


      Danielle Symons Downs, PhD, is a Professor of Kinesiology and Obstetrics/Gynecology and Director of the Exercise Psychology Laboratory at Penn State. She is an expert in women's health, motivation, and designing effective health-behavior change interventions (exercise, weight) in women before/during/after pregnancy.


      Ian M. Paul, MD, MSc, is Chief of the Division of Academic General Pediatrics and Vice Chair of Faculty Affairs at Penn State College of Medicine in Hershey, Pennsylvania. He is a clinical researcher in preventative interventions, with obesity prevention as the primary interest.


      Jennifer L. Kraschnewski, MD, MPH, is Associate Professor of Medicine, Pediatrics, and Public Health Science at the Penn State College of Medicine. She is a community-engaged clinician-investigator with a research focus on behavioral interventions to support healthier lifestyles.


      Kristen H. Kjerulff, MA, PhD, is Professor, Departments of Public Health Sciences and Obstetrics and Gynecology, Penn State University, College of Medicine. She studies maternity/reproductive health care and common treatments and procedures. She was Principal Investigator of the First Baby Study.


      Jennifer S. Savage, PhD, is the Director of the Center for Childhood Obesity Research at Penn State University. Her research focuses on individual factors affecting the development of behavioral controls and food intake.