{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T12:41:03Z","timestamp":1793018463249,"version":"4.5.0"},"reference-count":40,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2020,9,2]],"date-time":"2020-09-02T00:00:00Z","timestamp":1599004800000},"content-version":"unspecified","delay-in-days":1,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["81873816"],"award-info":[{"award-number":["81873816"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2020,7,22]]},"published-print":{"date-parts":[[2020,9]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To assess the associations of gestational weight gain (GWG) in early and late pregnancy with subsequent risks of adverse pregnancy outcomes in Chinese women.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Prospective cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Shanghai, China.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>We studied 2630 nulliparous singleton pregnant women with complete data on weight gain in early (\u226417 weeks of gestation) and late (&gt;17 weeks) pregnancy in the Shanghai Birth Cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>GWG was standardised into z-scores by gestational age and categorised as low (z-score &lt;\u22121), normal (\u22121 to +1) and high (&gt;1). The adjusted relative risks (aRRs) and 95%CIs were estimated through log-binomial regression models. Interaction effects between GWG and some other adjustment factors were tested, further stratified analyses were performed separately where interaction terms were significant.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcome measures<\/jats:title>\n                    <jats:p>Adverse maternal and neonatal outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Independent from GWG in late pregnancy, higher GWG in early pregnancy was associated with higher risks of gestational diabetes mellitus (aRR: 1.66; 95% CI: 1.11 to 2.48), caesarean section (aRR: 1.21; 95% CI: 1.05 to 1.39) and prolonged hospitalisation (aRR: 1.56; 95% CI: 1.03 to 2.38). Higher GWG in late pregnancy was independently associated with higher risks of caesarean section (aRR: 1.24; 95% CI: 1.09 to 1.41), large for gestational age (aRR: 2.01; 95% CI: 1.50 to 2.7) and macrosomia (aRR: 1.90; 95% CI: 1.30 to 2.78). In addition, the risk of gestational hypertension increased significantly with increased total GWG (aRR: 1.78; 95% CI: 1.14 to 2.76). The effects of GWG in late pregnancy on maternal and neonatal outcomes were significantly different between the women bearing a female and the women bearing male fetus.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The GWG associations with adverse pregnancy outcomes differ at early and late pregnancy, and there may be effect modification by fetal sex in the association of GWG in late pregnancy with some pregnancy outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2020-038187","type":"journal-article","created":{"date-parts":[[2020,9,3]],"date-time":"2020-09-03T02:36:42Z","timestamp":1599100602000},"page":"e038187","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":45,"title":["Gestational weight gain and adverse pregnancy outcomes: a prospective cohort study"],"prefix":"10.1136","volume":"10","author":[{"given":"Yuelin","family":"Wu","sequence":"first","affiliation":[{"name":"Department of Obstetrics, Shanghai First Maternity and Infant Hospital, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheng","family":"Wan","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Shanghai First Maternity and Infant Hospital, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shengyi","family":"Gu","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhengqian","family":"Mou","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lingling","family":"Dong","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Shanghai First Maternity and Infant Hospital, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1794-1312","authenticated-orcid":false,"given":"Zhongcheng","family":"Luo","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynaecology, Mount Sinai Hospital, Lunenfeld-Tanenbaum Research Institute, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1098-5010","authenticated-orcid":false,"given":"Xiaolin","family":"Hua","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Shanghai First Maternity and Infant Hospital, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2020,9,2]]},"reference":[{"key":"2026062608003234000_10.9.e038187.1","doi-asserted-by":"crossref","first-page":"2207","DOI":"10.1001\/jama.2017.3635","article-title":"Association of gestational weight gain with maternal and infant outcomes: a systematic review and meta-analysis","volume":"317","author":"Goldstein","year":"2017","journal-title":"JAMA"},{"key":"2026062608003234000_10.9.e038187.2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.i555"},{"key":"2026062608003234000_10.9.e038187.3","doi-asserted-by":"crossref","first-page":".e751","DOI":"10.1016\/j.ajog.2016.03.021","article-title":"Impact of maternal knowledge of recommended weight gain in pregnancy on gestational weight gain","volume":"214","author":"Shulman","year":"2016","journal-title":"Am J Obstet Gynecol"},{"key":"2026062608003234000_10.9.e038187.4","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1097\/AOG.0000000000001780","article-title":"Association of gestational weight gain expectations and advice on actual weight gain","volume":"129","author":"Krukowski","year":"2017","journal-title":"Obstet Gynecol"},{"key":"2026062608003234000_10.9.e038187.5","unstructured":"Rasmussen KM , Yaktine AL , Institute of Medicine (US), National Research Council (US) Committee to Reexamine IOM Pregnancy Weight Guidelines . Weight gain during pregnancy: reexamining the guidelines. Washington (DC: National Academies Press., 2009."},{"key":"2026062608003234000_10.9.e038187.6","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.6458"},{"key":"2026062608003234000_10.9.e038187.7","doi-asserted-by":"crossref","first-page":"2175","DOI":"10.1001\/jama.2017.6265","article-title":"Gestational weight gain and outcomes for mothers and infants","volume":"317","author":"Caughey","year":"2017","journal-title":"JAMA"},{"key":"2026062608003234000_10.9.e038187.8","doi-asserted-by":"publisher","DOI":"10.1038\/ijo.2014.175"},{"key":"2026062608003234000_10.9.e038187.9","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1001\/jamapediatrics.2017.4016","article-title":"Association of timing of weight gain in pregnancy with infant birth weight","volume":"172","author":"Retnakaran","year":"2018","journal-title":"JAMA Pediatr"},{"key":"2026062608003234000_10.9.e038187.10","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1038\/ijo.2013.185","article-title":"Weight gain, total fat gain and regional fat gain during pregnancy and the association with gestational diabetes: a population-based cohort study","volume":"38","author":"Sommer","year":"2014","journal-title":"Int J Obes"},{"key":"2026062608003234000_10.9.e038187.11","doi-asserted-by":"publisher","DOI":"10.3109\/09513590.2012.730571"},{"key":"2026062608003234000_10.9.e038187.12","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0140376","article-title":"Early gestational weight gain rate and adverse pregnancy outcomes in Korean women","volume":"10","author":"Cho","year":"2015","journal-title":"PLoS One"},{"key":"2026062608003234000_10.9.e038187.13","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1093\/ije\/dyy277","article-title":"Cohort profile: the Shanghai birth cohort","volume":"48","author":"Zhang","year":"2019","journal-title":"Int J Epidemiol"},{"key":"2026062608003234000_10.9.e038187.14","doi-asserted-by":"crossref","first-page":"973","DOI":"10.1111\/1471-0528.15034","article-title":"Pregnancy weight gain by gestational age and stillbirth: a population-based cohort study","volume":"125","author":"Johansson","year":"2018","journal-title":"BJOG"},{"key":"2026062608003234000_10.9.e038187.15","doi-asserted-by":"crossref","first-page":"799","DOI":"10.1111\/cen.13412","article-title":"Maternal thyroid function, prepregnancy obesity and gestational weight gain-The generation R study: a prospective cohort study","volume":"87","author":"Collares","year":"2017","journal-title":"Clin Endocrinol"},{"key":"2026062608003234000_10.9.e038187.16","unstructured":"Organization WH . Obesity: preventing and managing the global epidemic.Report of a WHO consultation, 2000."},{"key":"2026062608003234000_10.9.e038187.17","doi-asserted-by":"crossref","first-page":"e741","DOI":"10.1016\/j.ajog.2015.12.026","article-title":"Maternal fat, but not lean, mass is increased among overweight\/obese women with excess gestational weight gain","volume":"214","author":"Berggren","year":"2016","journal-title":"Am J Obstet Gynecol"},{"key":"2026062608003234000_10.9.e038187.18","first-page":"97","article-title":"[Chinese neonatal birth weight curve for different gestational age]","volume":"53","author":"Zhu","year":"2015","journal-title":"Zhonghua Er Ke Za Zhi"},{"key":"2026062608003234000_10.9.e038187.19","unstructured":"Yee L , Caughey A , Cheng Y . Association between gestational weight gain and perinatal outcomes in women with chronic hypertension. Am J Obstet Gynecol 2017;09."},{"key":"2026062608003234000_10.9.e038187.20","doi-asserted-by":"publisher","DOI":"10.2337\/dc16-1194"},{"key":"2026062608003234000_10.9.e038187.21","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-3016.2011.01254.x"},{"key":"2026062608003234000_10.9.e038187.22","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2012.03319.x"},{"key":"2026062608003234000_10.9.e038187.23","doi-asserted-by":"crossref","first-page":"1215","DOI":"10.1007\/s10995-011-0846-1","article-title":"Trimester of maternal gestational weight gain and offspring body weight at birth and age five","volume":"16","author":"Margerison-Zilko","year":"2012","journal-title":"Matern Child Health J"},{"key":"2026062608003234000_10.9.e038187.24","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.109.906081"},{"key":"2026062608003234000_10.9.e038187.25","doi-asserted-by":"publisher","DOI":"10.3945\/ajcn.110.009324"},{"key":"2026062608003234000_10.9.e038187.26","doi-asserted-by":"publisher","DOI":"10.3945\/ajcn.114.094946"},{"key":"2026062608003234000_10.9.e038187.27","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1097\/EDE.0000000000000629","article-title":"Patterns of gestational weight gain in early pregnancy and risk of gestational diabetes mellitus","volume":"28","author":"MacDonald","year":"2017","journal-title":"Epidemiology"},{"key":"2026062608003234000_10.9.e038187.28","doi-asserted-by":"publisher","DOI":"10.1007\/s10995-013-1361-3"},{"key":"2026062608003234000_10.9.e038187.29","first-page":"1336","article-title":"[Association between gestational weight gain per trimester\/total gestational weight gain and gestational diabetes mellitus]","volume":"37","author":"Dai","year":"2016","journal-title":"Zhonghua Liu Xing Bing Xue Za Zhi"},{"key":"2026062608003234000_10.9.e038187.30","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1016\/j.diabet.2017.10.006","article-title":"Weight gain in early pregnancy and risk of gestational diabetes mellitus among Latinas","volume":"45","author":"Moore Simas","year":"2019","journal-title":"Diabetes Metab"},{"key":"2026062608003234000_10.9.e038187.31","doi-asserted-by":"crossref","first-page":"875","DOI":"10.1097\/AOG.0000000000002854","article-title":"Association between gestational weight gain and perinatal outcomes","volume":"132","author":"Kominiarek","year":"2018","journal-title":"Obstet Gynecol"},{"key":"2026062608003234000_10.9.e038187.32","doi-asserted-by":"crossref","first-page":"e341","DOI":"10.1016\/j.ajog.2017.05.016","article-title":"Association between gestational weight gain and perinatal outcomes in women with chronic hypertension","volume":"217","author":"Yee","year":"2017","journal-title":"Am J Obstet Gynecol"},{"key":"2026062608003234000_10.9.e038187.33","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000437382.03963.88"},{"key":"2026062608003234000_10.9.e038187.34","doi-asserted-by":"crossref","first-page":"1353","DOI":"10.1080\/14767058.2017.1405388","article-title":"The Institute of medicine recommendation for gestational weight gain is probably not optimal among non-American pregnant women: a retrospective study from China","volume":"32","author":"Jiang","year":"2019","journal-title":"J Matern Fetal Neonatal Med"},{"key":"2026062608003234000_10.9.e038187.35","doi-asserted-by":"crossref","first-page":"1087","DOI":"10.1111\/1471-0528.13519","article-title":"Fetal sex dependency of maternal vascular adaptation to pregnancy: a prospective population\u2010based cohort study","volume":"123","author":"Broere\u2010Brown","year":"2016","journal-title":"BJOG: Int J Obstet Gy"},{"key":"2026062608003234000_10.9.e038187.36","doi-asserted-by":"crossref","first-page":"1016","DOI":"10.3109\/14767058.2013.766712","article-title":"Weight gain regardless of pre-pregnancy BMI and influence of fetal gender in response to labor induction in postdate pregnancy","volume":"26","author":"Torricelli","year":"2013","journal-title":"J Matern Fetal Neonatal Med"},{"key":"2026062608003234000_10.9.e038187.37","doi-asserted-by":"publisher","DOI":"10.1096\/fj.13-227918"},{"key":"2026062608003234000_10.9.e038187.38","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1016\/j.metabol.2017.01.019","article-title":"First and second trimester gestational weight gains are most strongly associated with cord blood levels of hormones at delivery important for glycemic control and somatic growth","volume":"69","author":"Rifas-Shiman","year":"2017","journal-title":"Metabolism"},{"key":"2026062608003234000_10.9.e038187.39","doi-asserted-by":"publisher","DOI":"10.1016\/j.nutres.2014.01.001"},{"key":"2026062608003234000_10.9.e038187.40","unstructured":"Teede H , Harrison C , Lombard C . Case for action: proposal obesity prevention through preventing excess weight gain during pregnancy and postpartum, 2015."}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2020-038187","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T15:01:00Z","timestamp":1782486060000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2020-038187"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,9]]},"references-count":40,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2020,9,2]]},"published-print":{"date-parts":[[2020,9]]}},"alternative-id":["10.1136\/bmjopen-2020-038187"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2020-038187","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,9]]}}}