Maternal and Child Health Journal

, Volume 19, Issue 11, pp 2462–2469 | Cite as

Associations of Early and Late Gestational Weight Gain with Infant Birth Size

  • Pandora L. Wander
  • Colleen M. Sitlani
  • Sylvia E. Badon
  • David S. Siscovick
  • Michelle A. Williams
  • Daniel A. Enquobahrie



Associations of gestational weight gain (GWG) during specific periods of pregnancy with infant birth size have been inconsistent. Infant sex-specific differences in these associations are unknown


Information on GWG (kg) [total, early (<20 weeks gestation), and late (≥20 weeks gestation)] and indices of infant birth size including birthweight (BW), ponderal index (PI), crown-heel length (CHL), and head circumference (HC) was collected from 3,621 pregnant women. We calculated adjusted mean differences and 95 % confidence intervals (CIs) relating total, early and late GWG to infant birth size using multivariable linear regression procedures. We used stratified analyses and interaction terms to test whether associations differed by infant sex.


One-kg increases in total, early or late GWG were associated with BW increases of 17.2 g (95 % CI 13.8–18.9), 14.1 g (95 % CI 10.3–18.0), and 21.0 g (95 % CI 16.7–25.4), respectively. Early GWG–BW and late GWG–BW associations were different (p = 0.026). Sex-stratified total GWG–BW associations were similar to overall results. There were sex-specific differences in early GWG–BW and late GWG–BW associations. Among females, early GWG–BW (12.0 g, 95 % CI 6.7–17.2) and late GWG–BW (24.2 g, 95 % CI 18.2–30.3) associations differed (p = 0.0042); the corresponding associations did not differ among males. Total, early, and late GWG were associated with CHL and HC, but not with PI. Associations did not differ for early or late GWG.

Conclusions for Practice

For comparable GWG, late-GWG-related BW increase is greater than early-GWG-related BW increase, particularly among female infants.


Gestational weight gain Birth weight Infant sex Fetal growth 



This research was supported by awards from the National Institutes of Health (R01HD-32562, T32 HD052462, and K01HL103174).

Conflicts of interest

The authors report no conflicts of interest


  1. 1.
    IOM. (2009) In K. M. Rasmussen, A. L. Yaktine, (Ed.), Weight gain during pregnancy: Reexamining the guidelines. Washington (DC).Google Scholar
  2. 2.
    Smith, D. E., Lewis, C. E., Caveny, J. L., Perkins, L. L., Burke, G. L., & Bild, D. E. (1994). Longitudinal changes in adiposity associated with pregnancy. The CARDIA study. Coronary artery risk development in young adults study. JAMA, the Journal of the American Medical Association, 271(22), 1747–1751.CrossRefPubMedGoogle Scholar
  3. 3.
    Frankel, S., Elwood, P., Sweetnam, P., Yarnell, J., & Smith, G. D. (1996). Birthweight, body-mass index in middle age, and incident coronary heart disease. Lancet, 348(9040), 1478–1480.CrossRefPubMedGoogle Scholar
  4. 4.
    Oberg, S., Cnattingius, S., Sandin, S., Lichtenstein, P., & Iliadou, A. N. (2011). Birth weight predicts risk of cardiovascular disease within dizygotic but not monozygotic twin pairs: A large population-based co-twin-control study. Circulation, 123(24), 2792–2798.CrossRefPubMedGoogle Scholar
  5. 5.
    Abramowicz, J. S., Ahn, J. T. (2014). Fetal macrosomia. UpToDate [cited 2014 4/25/14].
  6. 6.
    Mandy, G. T. (2014). Small for gestational age infant. [cited 2014 4/25/2014].
  7. 7.
    Ogden, C. L., Carroll, M. D., Kit, B. K., & Flegal, K. M. (2014). Prevalence of childhood and adult obesity in the United States, 2011–2012. JAMA, the Journal of the American Medical Association, 311(8), 806–814.CrossRefPubMedGoogle Scholar
  8. 8.
    Yu, Z., Han, S., Zhu, J., Sun, X., Ji, C., & Guo, X. (2013). Pre-pregnancy body mass index in relation to infant birth weight and offspring overweight/obesity: A systematic review and meta-analysis. PLoS One, 8(4), e61627.PubMedCentralCrossRefPubMedGoogle Scholar
  9. 9.
    Neufeld, L., Pelletier, D. L., & Haas, J. D. (1999). The timing of maternal weight gain during pregnancy and fetal growth. American Journal of Human Biology, 11(5), 627–637.CrossRefPubMedGoogle Scholar
  10. 10.
    Billewicz, W. C., & Thomson, A. M. (1957). Clinical significance of weight trends during pregnancy. British Medical Journal, 1(5013), 243–247.PubMedCentralCrossRefPubMedGoogle Scholar
  11. 11.
    Davenport, M. H., Ruchat, S. M., Giroux, I., Sopper, M. M., & Mottola, M. F. (2013). Timing of excessive pregnancy-related weight gain and offspring adiposity at birth. Obstetrics and Gynecology, 122(2 Pt 1), 255–261.CrossRefPubMedGoogle Scholar
  12. 12.
    Clifton, V. L. (2010). Review: Sex and the human placenta: mediating differential strategies of fetal growth and survival. Placenta, 31(Suppl), S33–S39.CrossRefPubMedGoogle Scholar
  13. 13.
    Louis, G. B., & Platt, R. (2011). Reproductive and perinatal epidemiology. Oxford; New York: Oxford University Press.CrossRefGoogle Scholar
  14. 14.
    Lampl, M., Gotsch, F., Kusanovic, J. P., Gomez, R., Nien, J. K., Frongillo, E. A., et al. (2010). Sex differences in fetal growth responses to maternal height and weight. American Journal of Human Biology, 22(4), 431–443.PubMedCentralCrossRefPubMedGoogle Scholar
  15. 15.
    Brown, Z. A., Schalekamp-Timmermans, S., Tiemeier, H. W., Hofman, A., Jaddoe, V. W., & Steegers, E. A. (2014). Fetal sex specific differences in human placentation: A prospective cohort study. Placenta, 35(6), 359–364.CrossRefPubMedGoogle Scholar
  16. 16.
    Clayton, J. A., & Collins, F. S. (2014). Policy: NIH to balance sex in cell and animal studies. Nature, 509(7500), 282–283.CrossRefPubMedGoogle Scholar
  17. 17.
    Rudra, C. B., Sorensen, T. K., Luthy, D. A., & Williams, M. A. (2008). A prospective analysis of recreational physical activity and preeclampsia risk. Medicine and Science in Sports and Exercise, 40(9), 1581–1588.CrossRefPubMedGoogle Scholar
  18. 18.
    Ditmier, L. F. (2006). New developments in obesity research. New York: Nova Science Publishers.Google Scholar
  19. 19.
    Durie, D. E., Thornburg, L. L., & Glantz, J. C. (2011). Effect of second-trimester and third-trimester rate of gestational weight gain on maternal and neonatal outcomes. Obstetrics and Gynecology, 118(3), 569–575.CrossRefPubMedGoogle Scholar
  20. 20.
    Chellakooty, M., Skibsted, L., Skouby, S. O., Andersson, A. M., Petersen, J. H., Main, K. M., et al. (2002). Longitudinal study of serum placental GH in 455 normal pregnancies: Correlation to gestational age, fetal gender, and weight. The Journal of Clinical Endocrinology and Metabolism, 87(6), 2734–2739.CrossRefPubMedGoogle Scholar
  21. 21.
    Geary, M. P., Pringle, P. J., Rodeck, C. H., Kingdom, J. C., & Hindmarsh, P. C. (2003). Sexual dimorphism in the growth hormone and insulin-like growth factor axis at birth. The Journal of Clinical Endocrinology and Metabolism, 88(8), 3708–3714.CrossRefPubMedGoogle Scholar
  22. 22.
    Buckberry, S., Bianco-Miotto, T., Bent, S. J., Dekker, G. A., & Roberts, C. T. (2014). Integrative transcriptome meta-analysis reveals widespread sex-biased gene expression at the human fetal-maternal interface. Molecular Human Reproduction, 20(8), 810–819.PubMedCentralCrossRefPubMedGoogle Scholar
  23. 23.
    Roland, M. C., Friis, C. M., Godang, K., Bollerslev, J., Haugen, G., & Henriksen, T. (2014). Maternal factors associated with fetal growth and birthweight are independent determinants of placental weight and exhibit differential effects by fetal sex. PLoS One, 9(2), e87303.PubMedCentralCrossRefPubMedGoogle Scholar
  24. 24.
    Lin, C. J., DeRoo, L. A., Jacobs, S. R., & Sandler, D. P. (2012). Accuracy and reliability of self-reported weight and height in the sister study. Public Health Nutrition, 15(6), 989–999.PubMedCentralCrossRefPubMedGoogle Scholar
  25. 25.
    Russell, A., Gillespie, S., Satya, S., & Gaudet, L. M. (2013). Assessing the accuracy of pregnant women in recalling pre-pregnancy weight and gestational weight gain. Journal of Obstetrics and Gynaecology Canada, 35(9), 802–809.PubMedGoogle Scholar
  26. 26.
    Neufeld, L. M., Haas, J. D., Grajeda, R., & Martorell, R. (2004). Changes in maternal weight from the first to second trimester of pregnancy are associated with fetal growth and infant length at birth. The American Journal of Clinical Nutrition, 79(4), 646–652.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Pandora L. Wander
    • 1
    • 2
  • Colleen M. Sitlani
    • 2
  • Sylvia E. Badon
    • 1
  • David S. Siscovick
    • 1
    • 2
    • 3
  • Michelle A. Williams
    • 4
  • Daniel A. Enquobahrie
    • 1
  1. 1.Department of EpidemiologyUniversity of WashingtonSeattleUSA
  2. 2.Department of MedicineUniversity of WashingtonSeattleUSA
  3. 3.New York Academy of MedicineNew YorkUSA
  4. 4.Department of EpidemiologyHarvard UniversityBostonUSA

Personalised recommendations