Gestational weight management in women with class III obesity : associations with obstetric and perinatal outcomes.

BACKGROUND

Class III obesity is associated with increased maternal and neonatal complications. Gestational weight gain (GWG) is a modifiable factor that may influence these outcomes, but evidence in women with severe obesity remains limited.

PURPOSE: To evaluate the impact of GWG adherence to the Institute of Medicine (IOM) and Journal of the American Medical Association (JAMA) recommendations on obstetric and neonatal outcomes in women with class III obesity, and to explore the role of nutritional follow-up.

METHODS

Retrospective, single-center cohort study including women with class III obesity who delivered a singleton at the University Hospital of Reims, France. Women were classified according to whether they exceeded GWG recommendations from IOM (≤9 kg) and JAMA (<6 kg), and by receipt of nutritional counseling. The primary outcome was mode of delivery. Secondary outcomes included maternal, obstetric, and neonatal morbidity.

MAIN FINDINGS: Among 300 women, exceeding GWG recommendations was not significantly associated with mode of delivery (IOM p=0.23; JAMA p=0.27). Non-excessive GWG was associated with shorter labor (IOM: 260 vs. 401.5 min, p<0.001), reduced postpartum hemorrhage (IOM: ORa 0.44; 95% CI: 0.20-0.98; p=0.044), lower birthweight, and decreased risk of LGA neonates (IOM: ORa 0.31; 95% CI: 0.11-0.85; p=0.024). Nutritional follow-up was limited, with few women receiving structured guidance.

CONCLUSIONS

In women with class III obesity, non-excessive GWG according to recommendations does not appear to affect the mode of delivery. It seems to be associated with shorter labor and a lower risk of macrosomia.