GESTATIONAL WEIGHT GAIN AND OBSTETRIC OUTCOME IN A TERTIARY CARE CENTRE.

GWG is a critical determinant of maternal and neonatal health in both the short and long term. An increasing proportion of women now entering pregnancy in an overweight or obese state, making GWG a key clinical concern. Both excessive and less than adequate GWG are linked to adverse obstetrics outcomes—excessive GWG is related to macrosomia, LGA, GDM, HDP, caesarean delivery (LSCS), PPWR, and long-term risks such as obesity, cardiovascular disease, and diabetes. In contrast, less than adequate GWG is related to LBW, small-for-gestational-age (SGA) infants, fetal growth restriction (FGR) and NICU admissions.¹

GWG is influenced by pre-pregnancy BMI. Weight gain during pregnancy is multifactorial and results from maternal fat stores, fetal growth, placenta, amniotic fluid, and increased blood volume. IOM 2009 provides BMI-specific GWG recommendations Table 1, while WHO BMI classification 1998 Table 2 is commonly used for stratification. However, there are currently no asian-specific GWG guidelines, and existing recommendations are largely based on Western populations, limiting their applicability.²

Table 1: Iom Weight Gain Recommendations For Pregnancy (2009)³

Table 2: Who Classification According To Bmi⁴

Abnormal GWG also affects long-term child health, contributing to altered growth patterns, obesity risk, and metabolic disorders. Both excessive and less than adequate GWG increases NICU admissions due to complications such as macrosomia or growth restriction-related morbidity. Overall, maintaining appropriate GWG through individualized nutritional counselling and antenatal monitoring is necessary for optimizing maternal, fetal, and long-term health outcomes.

This study was therefore designed to evaluate GWG and its association with obstetric outcomes in pregnant women attending the institute due to limited regional data.

This prospective study was conducted in the department of Obstetrics and Gynecology at Sri Guru Ram Das University of Health Sciences and Research, Vallah, Sri Amritsar, from July 2024 to December 2025. The total number of study participants recruited at the beginning were 547, of whom 47 were lost to follow up, leaving 500 participants for final analysis.

Table 3, shows the sociodemographic and clinical profile of the pregnant women included in the analysis. Among the 500 pregnant women, the majority aged between 20–25 years (43.2%), followed by 26–30 years (29.0%) and ≥30 years (26.4%), while only 1.4% were below 20 years of age. Most participants belonged to the lower-middle socioeconomic class (74.4%), with the remaining 25.6% in the upper-middle class. Predominant proportion of study participants were from rural area (94.2%) and only 5.8% from urban areas. BMI was classified according to WHO (1998) criteria due to limited GWG guidelines for Asian populations. Majority had a normal BMI (44.6%), Overweight women constituted 21.8%, while obesity was present in a significant proportion, including 26.4% in Obese Class I and 1.4% in Obese Class II, with no cases in Obese Class III. Only 5.8% of participants were underweight. Maternal anthropometric data showed that the first trimester visit (used as a proxy for pre-pregnancy) weight ranged from 38 to 90 kg, with a mean of 64.18 ± 12.00 kg. BMI ranged from 15.22 to 36.26 kg/m², with a mean BMI of 25.83 ± 4.82 kg/m².

Table 3: Sociodemographic And Clinical Profile Of Study Participants

Table 4, demonstrates GWG among participants ranged from 5 to 22 kg, with a mean of 12.91 ± 4.26 kg. Nearly half of the women (45.2%) had excessive GWG, while 32.8% achieved adequate weight gain. In contrast, 22.0% had less than adequate GWG.

Table 4, shows the association between BMI and GWG which was statistically significant (χ² = 281.987, p = 0.001). Most underweight women (75.86%) had less than adequate GWG, while none had excessive gain. Women with normal BMI showed a more balanced distribution, though adequate GWG was most common (42.60%). Among overweight women, the majority (56.88%) achieved adequate GWG. In contrast, all obese women (100%) had excessive GWG.

Table 4: Distribution Of Gestational Weight Gain (Gwg) As Per Iom Recommendations And Its Association With Bmi

(a) Distribution of GWG

(b) Association of GWG with BMI

Table 5, demonstrates 21.6% of women had GDM and 15.4% experienced HDP. Most participants (62.4%) underwent LSCS, while 37.2% had vaginal deliveries and only 0.4% underwent operative vaginal deliveries. The association between GWG and maternal outcomes was statistically significant. Most GDM cases (94.4%) occurred in the excess GWG group, with only 5.6% in the less than adequate group and none in the adequate group. HDP was also highest in the excess GWG group (46.8%), followed by less than adequate (40.3%), and lowest in the adequate group (13.0%). Regarding delivery, LSCS was most common in the excess GWG group (52.6%), compared to adequate (26.9%) and less than adequate (20.5%). Vaginal deliveries were more frequent in the adequate (42.6%) and less than adequate (24.5%) groups, while lower in the excess GWG group (33.0%). Operative vaginal deliveries were only seen in excess GWG group. Overall, excess GWG was associated with higher risks of GDM, HDP and cesarean delivery.

Table 5: Association Of Gwg With Maternal Outcomes

(a) GDM and HDP

(b) Mode of Delivery

Table 6, demonstrates that majority of neonates had a normal Apgar score (≥7), accounting for 91.8%, while 8.2% had a score <7 at 5 minutes. Most new-borns were appropriate for gestation age (AGA) (82.0%), with smaller proportions being SGA (8.0%) and LGA (7.0%). FGR was observed in 4.4% of neonates. About 22.2% required NICU admission, while 77.8% did not. Neonatal mortality was 2.4%, with a survival rate of 96.4%. GWG showed a statistically significant association with neonatal outcomes. Less than adequate GWG was linked to the majority of SGA (87.5%) and FGR (86.4%) cases, and 100% of NICU admissions in that group. Adequate GWG was associated only with AGA (37.8%) and LGA (25.7%) outcomes, with no SGA or FGR cases. Excess GWG contributed mainly to LGA (57.1%), with smaller contributions to SGA (12.5%) and FGR (13.6%). Significant associations were observed for SGA, AGA, FGR, and NICU admission (p = 0.001), while LGA showed no significant association.

Table 6: Association Of Gwg With Neonatal Outcomes

This prospective observational study evaluated GWG and its association with maternal and neonatal outcomes among 500 antenatal women. First trimester weight was used as a surrogate for pre-pregnancy weight, which is supported by studies such as Kominiarek MA et al10. and Retnakaran R et al. (2022)5, demonstrating a strong correlation between early pregnancy and pre-conceptional weight.

In the present study, 45.2% of women had excessive GWG, 22.0% had inadequate GWG, and only 32.8% achieved recommended weight gain, closely aligning with findings from Goldstein RF et al.11, who reported similar global trends (45% excessive, 23% inadequate, and 32% adequate GWG). A significant association between BMI and GWG (p < 0.001) was observed, with underweight women more prone to less than adequate GWG and overweight/obese women, particularly the latter, showing a strong tendency toward excessive GWG. These findings were consistent with Bhavadharini B et al., Kominiarek MA et al.10and Goldstein RF et al.11, who identified pre-pregnancy BMI as a key determinant of GWG.

Excessive GWG was significantly associated with adverse maternal outcomes, including higher rates of GDM (21.6%), hypertensive disorders (15.4%), and cesarean delivery. Similar associations have been reported by Singh K et al., Ramoniene G et al12, and Kominiarek MA et al.10, attributing these outcomes to increased maternal adiposity, insulin resistance, and metabolic disturbances.

Regarding neonatal outcomes, most neonates were AGA (82%), with smaller proportions of SGA (8%) and LGA (7%). Less than adequate GWG was significantly associated with SGA, fetal growth restriction (FGR), and increased NICU admissions, consistent with findings from Goldstein RF et al. and Chowdhury R et al.13. Conversely, excessive GWG was linked to macrosomia and LGA, as also reported by Ajit R et al.14

Overall, the study findings were in agreement with existing literature, demonstrating that both less than adequate and excessive GWG adversely affect maternal and neonatal outcomes. These results emphasize the importance of appropriate nutritional counselling, early identification, BMI-based monitoring to achieve optimal GWG and improve pregnancy outcomes.

GWG patterns in this study were similar to global trends, with a high prevalence of excessive and less than adequate weight gain. BMI was the key determinant of GWG and related outcomes. Excessive GWG was associated with adverse maternal outcomes (GDM, HDP, cesarean delivery), while less than adequate GWG was linked to poor neonatal outcomes (SGA, FGR). Overall, achieving BMI-appropriate GWG through early antenatal counselling, proper nutritional guidance and regular monitoring of maternal weight is essential to improve maternal and neonatal outcomes.

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