{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T14:57:16Z","timestamp":1792681036887,"version":"4.5.0"},"reference-count":39,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2025,1,6]],"date-time":"2025-01-06T00:00:00Z","timestamp":1736121600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004386","name":"Universiti Malaya","doi-asserted-by":"publisher","award":["BK039-2015"],"award-info":[{"award-number":["BK039-2015"]}],"id":[{"id":"10.13039\/501100004386","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>Gestational Weight Gain (GWG) modulates pregnancy outcomes and long-term offspring metabolic health. The 2009 Institute of Medicine (IOM) GWG recommendations have largely been validated in Caucasian and mono-ethnic East Asian cohorts. Asians are at higher metabolic risk at a lower body mass index (BMI), and this has prompted the World Health Organization (WHO) to identify lower BMI cut-offs for risk evaluation amongst Asians. This prospective observational cohort study aimed to determine if 2009 IOM GWG thresholds are applicable in a contemporary multi-ethnic South-East Asian cohort. We recruited 875 mothers from an urban Malaysian tertiary clinic during screening for gestational diabetes mellitus (GDM) from 2014\u20132021. Data collected included measures of insulin-sensitivity, total GWG (maternal weight at delivery\u2013self-reported pre-gravid weight), and neonatal anthropometrics (birthweight and skinfold-thickness measured with Harpenden calipers). BMI was stratified by Caucasian (overweight \u226525kg\/m<jats:sup>2<\/jats:sup>, obese \u226530kg\/m<jats:sup>2<\/jats:sup>) as well as Asian (overweight \u226523kg\/m<jats:sup>2<\/jats:sup>, obese \u226527.5kg\/ m<jats:sup>2<\/jats:sup>) cut-offs, and patients categorized by 2009 IOM GWG reference ranges. The cohort comprised 67% Malay-, 23% Chinese- and 10% Indian-descent mothers with a high prevalence of overweight\/obesity (Asian cut-offs 56.9% vs Caucasian 44%). When Asian BMI cut-offs were deployed, excessive GWG incidence increased (34.1% \u2192 40.6%) whilst inadequate GWG declined (30% \u2192 24.8%) (p&lt;0.05). Upon multivariate-analysis (adjusting for age, parity, race, GDM, insulin-sensitivity, baby-gender) excessive GWG categorized with Caucasian BMI cut-offs was significantly associated with increased risk of macrosomia (adjusted odds ratio (aOR) 8.65, 95% confidence interval (CI) 1.07\u201370.01), Neonatal-Fat-Mass (NFM) &gt;90th centile (aOR 2.14, 95% CI 1.02\u20134.45) and Sum-of-Skinfold Thickness (SSFT) &gt;90th centile (aOR 3.88, 95% CI 1.77\u20138.51). Excessive GWG by Asian cut-offs was also associated with increased risk of SSFT &gt;90th centile (aOR 5.75, 95% CI 2.35\u201314.10). Inadequate GWG by both Caucasian and Asian BMI cut-offs was associated with Small-for-Gestational-Age (SGA) status (aOR 4.30, 95% CI 2.48\u20137.45 and aOR 3.66, 95% CI 2.13\u20136.30 respectively). In conclusion, the 2009 IOM GWG recommendations, using either Caucasian or regional Asian BMI cut-offs, are applicable in a contemporary Malay majority South-East Asian cohort in terms of predicting abnormal neonatal adiposity. Importantly, the association with neonatal adiposity is independent of increased maternal insulin resistance characteristic of Asians.<\/jats:p>","DOI":"10.1371\/journal.pone.0316837","type":"journal-article","created":{"date-parts":[[2025,1,6]],"date-time":"2025-01-06T18:35:52Z","timestamp":1736188552000},"page":"e0316837","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":5,"title":["Are the 2009 Institute of Medicine gestational weight gain recommendations applicable in a contemporary South-East Asian pregnancy cohort? Results of a prospective analysis"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5304-925X","authenticated-orcid":true,"given":"Yong Ting","family":"Tai","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-1702-5516","authenticated-orcid":true,"given":"Jun Kit","family":"Khoo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Quan Hziung","family":"Lim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6214-6924","authenticated-orcid":true,"given":"Lee-Ling","family":"Lim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharmila Sunita","family":"Paramasivam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeyakantha","family":"Ratnasingam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas Ken Yoong","family":"Hee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tharsini","family":"Sarvanandan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying Guat","family":"Ooi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-7605-0586","authenticated-orcid":true,"given":"Victoria Wei Fang","family":"Boey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saravanaa","family":"Nalliah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peng Chiong","family":"Tan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mukhri","family":"Hamdan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pavai","family":"Sthaneshwar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nurshadia","family":"Samingan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Azanna","family":"Ahmad Kamar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Azriyanti","family":"Anuar Zaini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Syahrizan","family":"Samsuddin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-4990-7847","authenticated-orcid":true,"given":"Md Syazwan","family":"Md Amin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nurbazlin","family":"Musa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shubash Shander","family":"Ganapathy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2035-344X","authenticated-orcid":true,"given":"Karuthan","family":"Chinna","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad Yazid","family":"Jalaludin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shireene Ratna","family":"Vethakkan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,1,6]]},"reference":[{"issue":"9","key":"pone.0316837.ref001","doi-asserted-by":"crossref","first-page":"e2233250","DOI":"10.1001\/jamanetworkopen.2022.33250","article-title":"Analysis and Comparison of Early Childhood Nutritional Outcomes Among Offspring of Chinese Women Under the Chinese 2021 and US 2009 Gestational Weight Gain Guidelines","volume":"5","author":"F Chen","year":"2022","journal-title":"JAMA Netw Open"},{"issue":"21","key":"pone.0316837.ref002","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":"RF Goldstein","year":"2017","journal-title":"JAMA"},{"issue":"1","key":"pone.0316837.ref003","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1186\/s12916-018-1128-1","article-title":"Gestational weight gain across continents and ethnicity: systematic review and meta-analysis of maternal and infant outcomes in more than one million women","volume":"16","author":"RF Goldstein","year":"2018","journal-title":"BMC Med"},{"issue":"3","key":"pone.0316837.ref004","doi-asserted-by":"crossref","first-page":"R711","DOI":"10.1152\/ajpregu.00310.2010","article-title":"Maternal obesity and fetal metabolic programming: a fertile epigenetic soil","volume":"299","author":"MJ Heerwagen","year":"2010","journal-title":"Am J Physiol Regul Integr Comp Physiol"},{"key":"pone.0316837.ref005","volume-title":"Weight Gain During Pregnancy: Reexamining the Guidelines. The National Academies Collection: Reports funded by National Institutes of Health","author":"KM Rasmussen","year":"2009"},{"issue":"7","key":"pone.0316837.ref006","doi-asserted-by":"crossref","first-page":"e0181164","DOI":"10.1371\/journal.pone.0181164","article-title":"Is it appropriate for Korean women to adopt the 2009 Institute of Medicine recommendations for gestational weight gain?","volume":"12","author":"JH Wie","year":"2017","journal-title":"PLoS One"},{"issue":"9","key":"pone.0316837.ref007","doi-asserted-by":"crossref","first-page":"4397","DOI":"10.1177\/0300060519861463","article-title":"Effect of maternal weight gain according to the Institute of Medicine recommendations on pregnancy outcomes in a Chinese population","volume":"47","author":"P Guan","year":"2019","journal-title":"J Int Med Res"},{"issue":"9","key":"pone.0316837.ref008","doi-asserted-by":"crossref","first-page":"e2233256","DOI":"10.1001\/jamanetworkopen.2022.33256","article-title":"Comparison of Chinese vs US Gestational Weight Gain Guidelines for Chinese Women","volume":"5","author":"HJ Teede","year":"2022","journal-title":"JAMA Netw Open"},{"key":"pone.0316837.ref009","volume-title":"Regional Office for the Western P. The Asia-Pacific perspective: redefining obesity and its treatment","author":"World Health Organization","year":"2000"},{"issue":"11 Suppl 1","key":"pone.0316837.ref010","doi-asserted-by":"crossref","first-page":"S9","DOI":"10.1210\/jc.2008-1595","article-title":"Obesity and the metabolic syndrome in developing countries","volume":"93","author":"A Misra","year":"2008","journal-title":"J Clin Endocrinol Metab"},{"issue":"1","key":"pone.0316837.ref011","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1186\/s12884-020-03335-7","article-title":"Monitoring gestational weight gain and prepregnancy BMI using the 2009 IOM guidelines in the global population: a systematic review and meta-analysis","volume":"20","author":"JA Martinez-Hortelano","year":"2020","journal-title":"BMC Pregnancy Childbirth"},{"issue":"1","key":"pone.0316837.ref012","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1186\/s12942-024-00376-5","article-title":"Identifying obesogenic environment through spatial clustering of body mass index among adults","volume":"23","author":"KYY Wong","year":"2024","journal-title":"Int J Health Geogr"},{"issue":"1","key":"pone.0316837.ref013","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1186\/s12884-019-2443-z","article-title":"Are women in Singapore gaining weight appropriately during pregnancy: a prospective cohort study","volume":"19","author":"S He","year":"2019","journal-title":"BMC Pregnancy Childbirth"},{"issue":"4","key":"pone.0316837.ref014","first-page":"160","article-title":"The Association of Gestational Weight Gain and the Effect on Pregnancy Outcome Defined by BMI Group among Women Delivered in Hospital Kuala Lumpur (HKL)","author":"Siti Shafura Abas Nurfazlin Rozlan HAMAM","year":"2012","journal-title":"Asian Journal of Clinical Nutrition"},{"issue":"1","key":"pone.0316837.ref015","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1186\/s12905-017-0455-2","article-title":"Pre-pregnancy body mass index and gestational weight gain and their effects on pregnancy and birth outcomes: a cohort study in West Sumatra, Indonesia","volume":"17","author":"H Soltani","year":"2017","journal-title":"BMC Womens Health"},{"issue":"4","key":"pone.0316837.ref016","first-page":"810","article-title":"Pre-pregnancy body mass index and gestational weight gain in Thai pregnant women as risks for low birth weight and macrosomia","volume":"25","author":"T Pongcharoen","year":"2016","journal-title":"Asia Pac J Clin Nutr"},{"key":"pone.0316837.ref017","unstructured":"National Health and Morbidity Survey 2023: Non-Communicable Diseases and Healthcare Demand Institute for Public Health, National Institutes of Health (NIH), Ministry of Health Malaysia; 2024."},{"issue":"3","key":"pone.0316837.ref018","doi-asserted-by":"crossref","first-page":"56","DOI":"10.51866\/oa1138","article-title":"Maternal Obesity and Its Associated Factors and Outcomes in Klang Valley, Malaysia: Findings from National Obstetric Registry","volume":"16","author":"NF Shahrir","year":"2021","journal-title":"Malays Fam Physician"},{"key":"pone.0316837.ref019","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1186\/s40795-020-00348-5","article-title":"The nutrition transition in Malaysia; key drivers and recommendations for improved health outcomes","volume":"6","author":"EV Goh","year":"2020","journal-title":"BMC Nutr"},{"issue":"11","key":"pone.0316837.ref020","doi-asserted-by":"crossref","first-page":"e1794","DOI":"10.1016\/S2214-109X(24)00287-0","article-title":"Assessing the built environment through photographs and its association with obesity in 21 countries: the PURE Study","volume":"12","author":"DJ Corsi","year":"2024","journal-title":"Lancet Glob Health"},{"key":"pone.0316837.ref021","unstructured":"Clinical Practice Guidelines: Management of Diabetes in Pregnancy. Putrajaya: Malaysia Health Technology Assessment Section (MaHTAS); 2017."},{"issue":"9403","key":"pone.0316837.ref022","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1016\/S0140-6736(03)15268-3","article-title":"Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies","volume":"363","author":"WHO Expert Consultation","year":"2004","journal-title":"Lancet"},{"key":"pone.0316837.ref023","unstructured":"HOMA Calculator: University of Oxford Medical Science Division; [cited 2024 23 July]. Available from: https:\/\/www.rdm.ox.ac.uk\/about\/our-clinical-facilities-and-units\/DTU\/software\/homa."},{"issue":"4","key":"pone.0316837.ref024","doi-asserted-by":"crossref","first-page":"1176","DOI":"10.1016\/0002-9378(95)91348-3","article-title":"Anthropometric estimation of neonatal body composition","volume":"173","author":"PM Catalano","year":"1995","journal-title":"Am J Obstet Gynecol"},{"issue":"1","key":"pone.0316837.ref025","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1093\/jn\/134.1.205","article-title":"Early life origins of insulin resistance and type 2 diabetes in India and other Asian countries","volume":"134","author":"CS Yajnik","year":"2004","journal-title":"J Nutr"},{"key":"pone.0316837.ref026","first-page":"100190","article-title":"Optimal gestational weight gain for Chinese women\u2014analysis from a longitudinal cohort with childhood follow-up","volume":"13","author":"Y He","year":"2021","journal-title":"Lancet Reg Health West Pac"},{"issue":"5","key":"pone.0316837.ref027","doi-asserted-by":"crossref","first-page":"1303","DOI":"10.3945\/ajcn.2008.27416","article-title":"Perinatal risk factors for childhood obesity and metabolic dysregulation","volume":"90","author":"PM Catalano","year":"2009","journal-title":"Am J Clin Nutr"},{"issue":"8","key":"pone.0316837.ref028","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1016\/j.earlhumdev.2006.07.001","article-title":"The Dutch famine and its long-term consequences for adult health","volume":"82","author":"T Roseboom","year":"2006","journal-title":"Early Hum Dev"},{"issue":"11","key":"pone.0316837.ref029","first-page":"1119","article-title":"Outcomes of gestational weight gain outside the Institute of Medicine Guidelines","volume":"97","author":"E. Asvanarunat","year":"2014","journal-title":"J Med Assoc Thai"},{"issue":"4","key":"pone.0316837.ref030","doi-asserted-by":"crossref","first-page":"1002","DOI":"10.1111\/jog.12307","article-title":"Determining optimal gestational weight gain in a multiethnic Asian population","volume":"40","author":"TX Ee","year":"2014","journal-title":"J Obstet Gynaecol Res"},{"issue":"5","key":"pone.0316837.ref031","doi-asserted-by":"crossref","first-page":"937","DOI":"10.1007\/s00125-015-3505-z","article-title":"Testing the fuel-mediated hypothesis: maternal insulin resistance and glucose mediate the association between maternal and neonatal adiposity, the Healthy Start study","volume":"58","author":"AL Shapiro","year":"2015","journal-title":"Diabetologia"},{"issue":"1","key":"pone.0316837.ref032","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1111\/ppe.12682","article-title":"The importance of maternal insulin resistance throughout pregnancy on neonatal adiposity","volume":"35","author":"RA Lima","year":"2021","journal-title":"Paediatr Perinat Epidemiol"},{"issue":"2","key":"pone.0316837.ref033","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1007\/s00125-020-05323-0","article-title":"Do variations in insulin sensitivity and insulin secretion in pregnancy predict differences in obstetric and neonatal outcomes","volume":"64","author":"LR Madsen","year":"2021","journal-title":"Diabetologia"},{"issue":"1","key":"pone.0316837.ref034","doi-asserted-by":"crossref","first-page":"2569","DOI":"10.1038\/s41598-017-02863-1","article-title":"Investigation of optimal weight gain during pregnancy for Japanese Women","volume":"7","author":"K Nomura","year":"2017","journal-title":"Sci Rep"},{"issue":"1","key":"pone.0316837.ref035","doi-asserted-by":"crossref","first-page":"17310","DOI":"10.1038\/s41598-019-53809-8","article-title":"Application of Japanese guidelines for gestational weight gain to multiple pregnancy outcomes and its optimal range in 101,336 Japanese women","volume":"9","author":"K Nomura","year":"2019","journal-title":"Sci Rep"},{"issue":"6","key":"pone.0316837.ref036","doi-asserted-by":"crossref","DOI":"10.3390\/nu14061288","article-title":"Weight Gain and Nutrition during Pregnancy: An Analysis of Clinical Practice Guidelines in the Asia-Pacific Region","volume":"14","author":"T Aoyama","year":"2022","journal-title":"Nutrients"},{"issue":"10","key":"pone.0316837.ref037","doi-asserted-by":"crossref","first-page":"e13310","DOI":"10.1111\/obr.13310","article-title":"Weight management across preconception, pregnancy, and postpartum: A systematic review and quality appraisal of international clinical practice guidelines","volume":"22","author":"CL Harrison","year":"2021","journal-title":"Obes Rev"},{"issue":"12","key":"pone.0316837.ref038","doi-asserted-by":"crossref","first-page":"1981","DOI":"10.1007\/s10995-021-03231-2","article-title":"Comparison between American Institute of Medicine Guidelines and Local Recommendation for Gestational Weight Gain in Taiwanese Primiparous Women.","volume":"25","author":"A Waits","year":"2021","journal-title":"Matern Child Health J"},{"issue":"2","key":"pone.0316837.ref039","doi-asserted-by":"crossref","first-page":"2230510","DOI":"10.1080\/14767058.2023.2230510","article-title":"Estimated fetal weight standards of the INTERGROWTH-21(st) project for the prediction of adverse outcomes: a systematic review with meta-analysis","volume":"36","author":"F Rebelo","year":"2023","journal-title":"J Matern Fetal Neonatal Med"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0316837","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,1,6]],"date-time":"2025-01-06T18:36:06Z","timestamp":1736188566000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0316837"}},"subtitle":[],"editor":[{"given":"Zahra","family":"Hoodbhoy","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,1,6]]},"references-count":39,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,1,6]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0316837","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,6]]}}}