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The role of gestational weight gain (GWG) in this context is not well established. The objective of this study was to evaluate the association between GWG and perineal injury among overweight and obese primiparous women.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A retrospective cohort study was conducted at a tertiary center between 2012\u20132023, including primiparous women with singleton, term (\u2265\u200937 weeks), vertex vaginal deliveries and pre-pregnancy BMI\u2009\u2265\u200925.0\u202fkg\/m\n                      <jats:sup>2<\/jats:sup>\n                      . Women were categorized by GWG based on Institute of Medicine guidelines: below (Group\u202fA), within (Group\u202fB), or above recommendations (Group\u202fC). Exclusion criteria included cesarean delivery, diabetes, multiple gestations, stillbirth, preterm birth, non-vertex presentation, and maternal age\u2009&lt;\u200918 or\u2009&gt;\u200945 years. Perineal injury was defined as any perineal laceration or episiotomy. Univariate and multivariable logistic regression analyses were performed.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 5,082 deliveries, 13.1% were in Group\u202fA, 28.2% in Group\u202fB, and 58.7% in Group\u202fC. Episiotomy rates were higher in Group\u202fC versus Groups\u202fA\/B (38.7% vs. 34.7%\/34.5%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.011), while overall perineal injury (87.2%\u201388.5%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.652) and OASI rates (0.5\u20131.0%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.428) did not differ. In multivariate analysis, GWG was not associated with perineal injury. Independent risk factors included epidural analgesia (OR\u2009=\u20091.39, 95%\u202fCI\u202f1.10\u20131.75), vacuum-assisted delivery (VAD) (OR\u2009=\u20092.83, 95%\u202fCI\u202f2.07\u20133.86), higher birthweight (OR\u2009=\u20091.06 per 100 gr., 95%\u202fCI\u202f1.03\u20131.08), and advanced gestational age (OR\u2009=\u20091.13, 95%\u202fCI\u202f1.04\u20131.23).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>GWG was not associated with perineal injury, whereas VAD, epidural analgesia, increased birthweight, and advanced gestational age were independent risk factors.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00404-025-08291-1","type":"journal-article","created":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T18:52:57Z","timestamp":1767639177000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Impact of gestational weight gain on perineal injury in overweight and obese primiparous women"],"prefix":"10.1007","volume":"313","author":[{"given":"Itamar","family":"Gilboa","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Gabbai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmanuel","family":"Attali","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronen","family":"Gold","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asnat","family":"Groutz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yariv","family":"Yogev","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoav","family":"Baruch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,1,5]]},"reference":[{"issue":"13","key":"8291_CR1","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1186\/1471-2393-13-59","volume":"7","author":"LA Smith","year":"2013","unstructured":"Smith LA, Price N, Simonite V, Burns EE (2013) Incidence of and risk factors for perineal trauma: a prospective observational study. 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