{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T18:43:17Z","timestamp":1793904197942,"version":"4.8.0"},"reference-count":40,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,3,14]],"date-time":"2026-03-14T00:00:00Z","timestamp":1773446400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T00:00:00Z","timestamp":1793836800000},"content-version":"vor","delay-in-days":236,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100014538","name":"Lembaga Pengelola Dana Pendidikan","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100014538","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Public Health"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Current recommendations for adequate gestational weight gain (GWG) are based on body mass index (BMI) classes proposed by the WHO. However, for Asian populations alternative BMI classifications have been suggested. This study aims to explore the associations between GWG and pregnancy outcomes using WHO, Asian and Indonesian BMI cutoffs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A prospective longitudinal study was conducted in the Parepare district, Indonesia. Of 1216 pregnant women enrolled, 953 mother-child dyads had complete newborn data. BMI was categorized into: underweight, normal weight, overweight, and obesity according to WHO, Asian and Indonesian BMI cutoffs. IOM criteria were used to determine GWG adequacy. Adverse pregnancy outcomes were: small for gestational age, preterm birth and low birth weight. For all three BMI classifications, logistic regression analyses were performed to examine the association between GWG and pregnancy outcomes. Additionally, we conducted a goodness of fit test to compare the model performance for each BMI classification method.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The prevalence of underweight was 11.4% regardless of BMI classification. The prevalence of overweight was 22.2%, 33.3%, and 11.8%, whereas the prevalence of obesity was 6.8%, 14.4%, and 17.3% using the WHO, Asian and Indonesian cutoffs, respectively. Across all BMI classifications, a considerable proportion of women who were classified as underweight (&gt;\u200970%) or normal weight (&gt;\u200969%) exhibited inadequate GWG. The Asian BMI classification had the highest proportion of excessive GWG (15.2%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Gestational weight gain classes based on Asian BMI cutoffs corresponded better with adverse pregnancy outcomes than WHO or Indonesian BMI cutoffs. We hypothesize that implementing the Asian BMI classification may better identify risks for adverse pregnancy outcomes, enabling more accurate and timely interventions targeting (pre)pregnancy to improve outcomes for mother and child.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12889-026-26818-2","type":"journal-article","created":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T09:26:00Z","timestamp":1773653160000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Associations between gestational weight gain and pregnancy outcomes using WHO, Asian, and Indonesian BMI classifications: a prospective longitudinal study in Parepare, Indonesia"],"prefix":"10.1186","volume":"26","author":[{"given":"Sabaria Manti","family":"Battung","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. Razak","family":"Thaha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eline M.","family":"van der Beek","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henk","family":"Groen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,14]]},"reference":[{"issue":"6","key":"26818_CR1","doi-asserted-by":"publisher","first-page":"1750","DOI":"10.1093\/ajcn\/87.6.1750","volume":"87","author":"EA Nohr","year":"2008","unstructured":"Nohr EA, Vaeth M, Baker JL, S\u00f8rensen TI, Olsen J, Rasmussen KM. Combined associations of prepregnancy body mass index and gestational weight gain with the outcome of pregnancy. Am J Clin Nutr TA - TT -. 2008;87(6):1750\u20139.","journal-title":"Am J Clin Nutr TA - TT"},{"key":"26818_CR2","unstructured":"Viswanathan M, Siega-Riz AM, Moos MK, et al. Outcomes of maternal weight gain. Evid Rep Technol Assess (Full Rep). 2008;(168):1\u2013223. https:\/\/pubmed.ncbi.nlm.nih.gov\/18620471\/."},{"issue":"4","key":"26818_CR3","doi-asserted-by":"publisher","first-page":"671","DOI":"10.1038\/ijo.2014.179","volume":"39","author":"L Hrolfsdottir","year":"2015","unstructured":"Hrolfsdottir L, Rytter D, Olsen SF, et al. Gestational weight gain in normal weight women and offspring cardio-metabolic risk factors at 20 years of age. Int J Obes. 2015;39(4):671\u20136.","journal-title":"Int J Obes"},{"issue":"21","key":"26818_CR4","doi-asserted-by":"publisher","first-page":"2207","DOI":"10.1001\/jama.2017.3635","volume":"317","author":"RF Goldstein","year":"2017","unstructured":"Goldstein RF, Abell SK, Ranasinha S, et al. Association of gestational weight gain with maternal and infant outcomes: a systematic review and meta-analysis. JAMA. 2017;317(21):2207\u201325.","journal-title":"JAMA"},{"issue":"22","key":"26818_CR5","doi-asserted-by":"publisher","first-page":"2362","DOI":"10.1001\/jama.2013.6295","volume":"309","author":"S Cnattingius","year":"2013","unstructured":"Cnattingius S, Villamor E, Johansson S, et al. Maternal Obesity and Risk of Preterm Delivery. JAMA. 2013;309(22):2362\u201370. https:\/\/doi.org\/10.1001\/jama.2013.6295.","journal-title":"JAMA"},{"issue":"8","key":"26818_CR6","doi-asserted-by":"publisher","first-page":"621","DOI":"10.1111\/obr.12288","volume":"16","author":"J Marchi","year":"2015","unstructured":"Marchi J, Berg M, Dencker A, Olander EK, Begley C. Risks associated with obesity in pregnancy, for the mother and baby: a systematic review of reviews. Obes Rev. 2015;16(8):621\u201338.","journal-title":"Obes Rev"},{"issue":"9542","key":"26818_CR7","doi-asserted-by":"publisher","first-page":"1164","DOI":"10.1016\/S0140-6736(06)69473-7","volume":"368","author":"E Villamor","year":"2006","unstructured":"Villamor E, Cnattingius S. Interpregnancy weight change and risk of adverse pregnancy outcomes: a population-based study. Lancet. 2006;368(9542):1164\u201370. https:\/\/doi.org\/10.1016\/S0140-6736(06)69473-7.","journal-title":"Lancet"},{"key":"26818_CR8","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/1471-2393-14-167","volume":"14","author":"C Scott","year":"2014","unstructured":"Scott C, Andersen CT, Valdez N, et al. No global consensus: a cross-sectional survey of maternal weight policies. BMC Pregnancy Childbirth. 2014;14:1\u201310.","journal-title":"BMC Pregnancy Childbirth"},{"key":"26818_CR9","unstructured":"IsmailLC, Bishop DC, Pang R, et al. Gestational weight gain standards based on women enrolled in the Fetal Growth Longitudinal Study of the INTERGROWTH-21st Project: a prospective longitudinal cohort study. BMJ. 2016;352. https:\/\/pubmed.ncbi.nlm.nih.gov\/26926301\/."},{"issue":"3","key":"26818_CR10","doi-asserted-by":"publisher","first-page":"532","DOI":"10.1002\/oby.21011","volume":"23","author":"JA Hutcheon","year":"2015","unstructured":"Hutcheon JA, Platt RW, Abrams B, Himes KP, Simhan HN, Bodnar LM. Pregnancy weight gain charts for obese and overweight women. Obesity. 2015;23(3):532\u20135.","journal-title":"Obesity"},{"issue":"5","key":"26818_CR11","doi-asserted-by":"publisher","first-page":"1278","DOI":"10.3945\/ajcn.115.110197","volume":"103","author":"K Johansson","year":"2016","unstructured":"Johansson K, Hutcheon JA, Stephansson O, Cnattingius S. Pregnancy weight gain by gestational age and BMI in Sweden: a population-based cohort study. Am J Clin Nutr. 2016;103(5):1278\u201384.","journal-title":"Am J Clin Nutr"},{"key":"26818_CR12","doi-asserted-by":"publisher","unstructured":"Yaktine AL, Rasmussen KM, Institute of Medicine (US), National Research Council (US). and Committee to Reexamine IOM Pregnancy Weight Guidelines. Weight Gain During Pregnancy Reexamining the Guidelines. National Academies Press (US). https:\/\/doi.org\/10.17226\/12584.","DOI":"10.17226\/12584"},{"issue":"9403","key":"26818_CR13","doi-asserted-by":"publisher","first-page":"157","DOI":"10.1016\/S0140-6736(03)15268-3","volume":"363","author":"KCB Tan","year":"2004","unstructured":"Tan KCB. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004;363(9403):157\u201363.","journal-title":"Lancet"},{"issue":"3","key":"26818_CR14","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1046\/j.1467-789X.2002.00065.x","volume":"3","author":"P Deurenberg","year":"2002","unstructured":"Deurenberg P, Deurenberg-Yap M, Guricci S. Asians are different from Caucasians and from each other in their body mass index\/body fat per cent relationship. Obes Rev. 2002;3(3):141\u20136.","journal-title":"Obes Rev"},{"issue":"1","key":"26818_CR15","first-page":"82","volume":"21","author":"IH Tsai","year":"2012","unstructured":"Tsai IH, Chen CP, Sun FJ, Wu CH, Yeh SL. Associations of the pre-pregnancy body mass index and gestational weight gain with pregnancy outcomes in Taiwanese women. Asia Pac J Clin Nutr. 2012;21(1):82\u20137.","journal-title":"Asia Pac J Clin Nutr"},{"issue":"4","key":"26818_CR16","doi-asserted-by":"publisher","first-page":"1002","DOI":"10.1111\/jog.12307","volume":"40","author":"TX Ee","year":"2014","unstructured":"Ee TX, Allen JC Jr, Malhotra R, Koh H, \u00d8stbye T, Tan TC. Determining optimal gestational weight gain in a multiethnic A sian population. J Obstet Gynaecol Res. 2014;40(4):1002\u20138.","journal-title":"J Obstet Gynaecol Res"},{"key":"26818_CR17","unstructured":"World Health Organization. Project: Development of global gestational weight gain standards. 2023. https:\/\/cdn.who.int\/media\/docs\/default-source\/nutrition-and-food-safety\/development-of-global-gestational-weight-gain-standards\/who-gestational-weight-gain-standards-background.pdf."},{"key":"26818_CR18","unstructured":"Mnistry of Health of Indonesia. Riset Kesehatan Dasar. 2013. 2013 https:\/\/repository.badankebijakan.kemkes.go.id\/id\/eprint\/4428\/1\/LAPORANNASIONALRISKESDASTAHUN2013DALAMBENTUKANGKA.pdf."},{"key":"26818_CR19","unstructured":"Ministry of Health of Indonesia. Riset Kesehatan Dasar 2018. 2018. https:\/\/repository.badankebijakan.kemkes.go.id\/id\/eprint\/3514\/."},{"issue":"1","key":"26818_CR20","doi-asserted-by":"publisher","first-page":"5424","DOI":"10.1038\/s41598-024-54563-2","volume":"14","author":"M Wahidin","year":"2024","unstructured":"Wahidin M, Achadi A, Besral B, et al. Projection of diabetes morbidity and mortality till 2045 in Indonesia based on risk factors and NCD prevention and control programs. Sci Rep. 2024;14(1):5424.","journal-title":"Sci Rep"},{"issue":"1","key":"26818_CR21","doi-asserted-by":"publisher","first-page":"492","DOI":"10.1186\/s12884-022-04815-8","volume":"22","author":"AS Aji","year":"2022","unstructured":"Aji AS, Lipoeto NI, Yusrawati Y, et al. Association between pre-pregnancy body mass index and gestational weight gain on pregnancy outcomes: a cohort study in Indonesian pregnant women. BMC Pregnancy Childbirth. 2022;22(1):492.","journal-title":"BMC Pregnancy Childbirth"},{"issue":"1","key":"26818_CR22","doi-asserted-by":"publisher","first-page":"983","DOI":"10.1186\/s12889-025-22129-0","volume":"25","author":"SM Battung","year":"2025","unstructured":"Battung SM, Groen H, van der Beek EM. Prenatal multiple micronutrient supplementation in the Parepare district, Indonesia; population characteristics and intake adherence. BMC Public Health. 2025;25(1):983. https:\/\/doi.org\/10.1186\/s12889-025-22129-0.","journal-title":"BMC Public Health"},{"key":"26818_CR23","unstructured":"World Health Organization. Body mass index (BMI). https:\/\/www.who.int\/data\/gho\/data\/themes\/topics\/topic-details\/GHO\/body-mass-index."},{"issue":"9946","key":"26818_CR24","doi-asserted-by":"publisher","first-page":"857","DOI":"10.1016\/S0140-6736(14)60932-6","volume":"384","author":"J Villar","year":"2014","unstructured":"Villar J, Ismail LC, Victora CG, et al. International standards for newborn weight, length, and head circumference by gestational age and sex: the Newborn Cross-Sectional Study of the INTERGROWTH-21st Project. Lancet. 2014;384(9946):857\u201368.","journal-title":"Lancet"},{"issue":"1","key":"26818_CR25","doi-asserted-by":"publisher","first-page":"192","DOI":"10.3758\/BF03206482","volume":"11","author":"EJ Wagenmakers","year":"2004","unstructured":"Wagenmakers EJ, Farrell S. AIC model selection using Akaike weights. Psychon Bull Rev. 2004;11(1):192\u20136. https:\/\/doi.org\/10.3758\/BF03206482.","journal-title":"Psychon Bull Rev"},{"key":"26818_CR26","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12905-017-0455-2","volume":"17","author":"H Soltani","year":"2017","unstructured":"Soltani H, Lipoeto NI, Fair FJ, Kilner K, Yusrawati Y. Pre-pregnancy body mass index and gestational weight gain and their effects on pregnancy and birth outcomes: a cohort study in West Sumatra, Indonesia. BMC Womens Health. 2017;17:1\u201312.","journal-title":"BMC Womens Health"},{"issue":"1","key":"26818_CR27","doi-asserted-by":"publisher","first-page":"322","DOI":"10.1186\/s12884-019-2472-7","volume":"19","author":"E Rogozi\u0144ska","year":"2019","unstructured":"Rogozi\u0144ska E, Zamora J, Marlin N, et al. Gestational weight gain outside the Institute of Medicine recommendations and adverse pregnancy outcomes: analysis using individual participant data from randomised trials. BMC Pregnancy Childbirth. 2019;19(1):322. https:\/\/doi.org\/10.1186\/s12884-019-2472-7.","journal-title":"BMC Pregnancy Childbirth"},{"issue":"1","key":"26818_CR28","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1186\/s12916-018-1128-1","volume":"16","author":"RF Goldstein","year":"2018","unstructured":"Goldstein RF, Abell SK, Ranasinha S, et al. Gestational weight gain across continents and ethnicity: systematic review and meta-analysis of maternal and infant outcomes in more than one million women. BMC Med. 2018;16(1):153. https:\/\/doi.org\/10.1186\/s12916-018-1128-1.","journal-title":"BMC Med"},{"issue":"1","key":"26818_CR29","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1007\/s00404-015-3825-8","volume":"293","author":"C Tian","year":"2016","unstructured":"Tian C, Hu C, He X, et al. Excessive weight gain during pregnancy and risk of macrosomia: a meta-analysis. Arch Gynecol Obstet. 2016;293(1):29\u201335. https:\/\/doi.org\/10.1007\/s00404-015-3825-8.","journal-title":"Arch Gynecol Obstet"},{"key":"26818_CR30","unstructured":"World Health Organization. The Asia-Pacific perspective: redefining obesity and its treatment. Published online 2000. https:\/\/iris.who.int\/handle\/10665\/206936."},{"key":"26818_CR31","doi-asserted-by":"publisher","unstructured":"Tham KW, Abdul Ghani R, Cua SC, et al. Obesity in South and Southeast Asia\u2014A new consensus on care and management. Obes Rev. 2023;24(2). https:\/\/doi.org\/10.1111\/obr.13520.","DOI":"10.1111\/obr.13520"},{"issue":"5","key":"26818_CR32","doi-asserted-by":"publisher","first-page":"1655","DOI":"10.1016\/j.ajog.2004.03.074","volume":"191","author":"Y Yogev","year":"2004","unstructured":"Yogev Y, Xenakis EMJ, Langer O. The association between preeclampsia and the severity of gestational diabetes: the impact of glycemic control. Am J Obstet Gynecol. 2004;191(5):1655\u201360.","journal-title":"Am J Obstet Gynecol"},{"issue":"2","key":"26818_CR33","doi-asserted-by":"publisher","first-page":"340","DOI":"10.2337\/dc07-1596","volume":"31","author":"TD Clausen","year":"2008","unstructured":"Clausen TD, Mathiesen ER, Hansen T, et al. High prevalence of type 2 diabetes and pre-diabetes in adult offspring of women with gestational diabetes mellitus or type 1 diabetes: the role of intrauterine hyperglycemia. Diabetes Care. 2008;31(2):340\u20136.","journal-title":"Diabetes Care"},{"issue":"1","key":"26818_CR34","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1038\/s41572-019-0098-8","volume":"5","author":"HD McIntyre","year":"2019","unstructured":"McIntyre HD, Catalano P, Zhang C, Desoye G, Mathiesen ER, Damm P. Gestational diabetes mellitus. Nat Rev Dis Prim. 2019;5(1):47.","journal-title":"Nat Rev Dis Prim"},{"key":"26818_CR35","doi-asserted-by":"publisher","first-page":"2203","DOI":"10.1007\/s00125-015-3725-2","volume":"58","author":"J Robitaille","year":"2015","unstructured":"Robitaille J. Excessive gestational weight gain and gestational diabetes: importance of the first weeks of pregnancy. Diabetologia. 2015;58:2203\u20135.","journal-title":"Diabetologia"},{"issue":"6","key":"26818_CR36","doi-asserted-by":"publisher","first-page":"e018778","DOI":"10.1136\/bmjopen-2017-018778","volume":"8","author":"E Oteng-Ntim","year":"2018","unstructured":"Oteng-Ntim E, Mononen S, Sawicki O, Seed PT, Bick D, Poston L. Interpregnancy weight change and adverse pregnancy outcomes: a systematic review and meta-analysis. BMJ Open. 2018;8(6):e018778.","journal-title":"BMJ Open"},{"issue":"5","key":"26818_CR37","doi-asserted-by":"publisher","first-page":"1225","DOI":"10.3945\/ajcn.111.015289","volume":"94","author":"I Nehring","year":"2011","unstructured":"Nehring I, Schmoll S, Beyerlein A, Hauner H, von Kries R. Gestational weight gain and long-term postpartum weight retention: a meta-analysis. Am J Clin Nutr. 2011;94(5):1225\u201331.","journal-title":"Am J Clin Nutr"},{"issue":"1","key":"26818_CR38","doi-asserted-by":"publisher","first-page":"144","DOI":"10.1097\/AOG.0000000000000565","volume":"125","author":"LK Endres","year":"2015","unstructured":"Endres LK, Straub H, McKinney C, et al. Postpartum weight retention risk factors and relationship to obesity at 1 year. Obstet Gynecol. 2015;125(1):144\u201352.","journal-title":"Obstet Gynecol"},{"key":"26818_CR39","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12889-019-7349-1","volume":"19","author":"MJ Josey","year":"2019","unstructured":"Josey MJ, McCullough LE, Hoyo C, Williams-DeVane C. Overall gestational weight gain mediates the relationship between maternal and child obesity. BMC Public Health. 2019;19:1\u20139.","journal-title":"BMC Public Health"},{"key":"26818_CR40","doi-asserted-by":"publisher","first-page":"1667","DOI":"10.1007\/s10995-013-1407-6","volume":"18","author":"D Shin","year":"2014","unstructured":"Shin D, Chung H, Weatherspoon L, Song WO. Validity of prepregnancy weight status estimated from self-reported height and weight. Matern Child Health J. 2014;18:1667\u201374.","journal-title":"Matern Child Health J"}],"container-title":["BMC Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12889-026-26818-2","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12889-026-26818-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12889-026-26818-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T18:02:57Z","timestamp":1793901777000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12889-026-26818-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,14]]},"references-count":40,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["26818"],"URL":"https:\/\/doi.org\/10.1186\/s12889-026-26818-2","relation":{},"ISSN":["1471-2458"],"issn-type":[{"value":"1471-2458","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,14]]},"assertion":[{"value":"1 January 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 February 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 March 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Following the declaration of Helsinki and all procedures involving human participants, the Institutional Ethical Review Board was approved by the University of Hasanuddin (7267\/UN4.14.1\/TP.01.02\/2021). The Investment and Integrated One-stop Services Agency of Parepare (Dinas Penanaman Modal dan Pelayanan Terpadu Satu Pintu) granted access to antenatal records and permission to conduct the study in this region.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"3220"}}