{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T10:55:51Z","timestamp":1783421751631,"version":"3.54.6"},"reference-count":53,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2024,1,29]],"date-time":"2024-01-29T00:00:00Z","timestamp":1706486400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"University of Vienna"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>A too-high gestational weight gain, in combination with steadily increasing obesity rates among women of reproductive age, represents an enormous obstetrical problem, as obesity and high gestational weight gain are associated with enhanced fetal growth, low vital parameters, and increased cesarean section rates. This medical record-based study investigates the association patterns between too-low as well as too-high gestational weight gain, according to the 2009 Institute of Medicine (IOM) guidelines, and fetal growth, as well as birth mode and pregnancy outcome. The data of 11,755 singleton births that had taken place between 2010 and 2020 at the Public Clinic Donaustadt in Vienna, Austria, were analyzed. Birth weight, birth length, head circumference, APGAR scores, and pH values of the arterial umbilical cord blood described fetal growth as well as the vital parameters after birth. Gestational weight gain was classified as too low, recommended, or too high according to the different weight status categories of the IOM guidelines. Birth weight, birth length, and head circumference of the newborn were significantly increased (p &lt; 0.001) among underweight, normal-weight, and overweight women who gained more weight than recommended. Among obese women, only birthweight was significantly (p &lt; 0.001) higher among women who gained more weight than recommended. Furthermore, a too-high gestational weight gain was significantly associated with an increased risk of macrosomia and emergency cesarean sections among underweight, normal-weight, and overweight women, but not among obese ones. Obese and morbidly obese women experiencing excessive gestational weight gain showed no significantly increased risk of macrosomia or emergency cesarean section. However, among obese mothers, a too-low gestational weight gain reduced the risk of emergency cesarean sections significantly (p = 0.010). Consequently, the IOM recommendations for gestational weight gain fit only partly for pregnant women in Austria. In the case of obese and morbidly obese women, new guidelines for optimal pregnancy weight gain should be considered.<\/jats:p>","DOI":"10.3390\/ijerph21020147","type":"journal-article","created":{"date-parts":[[2024,1,29]],"date-time":"2024-01-29T04:57:07Z","timestamp":1706504227000},"page":"147","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["The Impact of Higher Than Recommended Gestational Weight Gain on Fetal Growth and Perinatal Risk Factors\u2014The IOM Criteria Reconsidered"],"prefix":"10.3390","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3220-7271","authenticated-orcid":false,"given":"Sylvia","family":"Kirchengast","sequence":"first","affiliation":[{"name":"Department of Evolutionary Anthropology, University of Vienna, 1030 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josef","family":"Fellner","sequence":"additional","affiliation":[{"name":"Department of Evolutionary Anthropology, University of Vienna, 1030 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Haury","sequence":"additional","affiliation":[{"name":"Department of Evolutionary Anthropology, University of Vienna, 1030 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Magdalena","family":"Kraus","sequence":"additional","affiliation":[{"name":"Department of Evolutionary Anthropology, University of Vienna, 1030 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonia","family":"Stadler","sequence":"additional","affiliation":[{"name":"Department of Evolutionary Anthropology, University of Vienna, 1030 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teresa","family":"Sch\u00f6llauf","sequence":"additional","affiliation":[{"name":"Department of Evolutionary Anthropology, University of Vienna, 1030 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3790-0251","authenticated-orcid":false,"given":"Beda","family":"Hartmann","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics, Clinic Donaustadt, 1030 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,1,29]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2023, July 19). (WHO) (Hrsg.) Obesity and Overweight. Available online: www.who.int\/news-room\/fact-sheets\/detail\/obesity-and-overweight."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1016\/j.metabol.2018.09.005","article-title":"The epidemiology of obesity","volume":"92","author":"Chooi","year":"2019","journal-title":"Metabolism"},{"key":"ref_3","unstructured":"Kluge, H.H.P. (2022). Weltgesundheitsorganisation Regionalb\u00fcro f\u00fcr Europa, WHO. WHO European Regional Obesity Report."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1016\/S0735-1097(03)00784-8","article-title":"Obesity and cardiovascular disease: The Hippocrates paradox","volume":"42","author":"Lavie","year":"2003","journal-title":"J. Am. College Cardiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1210\/endrev\/bnz014","article-title":"Review: Diabetes, Obesity and Cancer\u2014Pathophysiology and Clinical Implications","volume":"41","author":"Lega","year":"2019","journal-title":"Endocr. Rev."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1016\/j.endinu.2022.04.007","article-title":"Obesity management in women of reproductive age","volume":"70","author":"Andreu","year":"2023","journal-title":"Endocrinol. Diabetes Nutr."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"801","DOI":"10.4103\/njcp.njcp_1587_21","article-title":"Prevalence of obesity in women of reproductive age group and related factors. A study from Southeastern Turkey","volume":"25","author":"Sahin","year":"2022","journal-title":"Niger. J. Clin. Pract."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Mosha, D., Paulo, H.A., Mwanyika-Sando, M., Mboya, I.B., Madzorera, I., Leyna, G.H., Msuya, S.E., B\u00e4rnighausen, T.W., Killewo, J., and Fawzi, W.W. (2021). Risk factors for overweight and obesity among women of reproductive age in Dar es Salaam, Tanzania. BMC Nutr., 7.","DOI":"10.1186\/s40795-021-00445-z"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1159\/000508975","article-title":"Reappraisal of gestational weight gain recommendations in obese pregnant women: A population-based Study of 337,590 births","volume":"13","author":"Devlieger","year":"2020","journal-title":"Obes. Facts"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"703","DOI":"10.1089\/jwh.2010.2397","article-title":"Transition to overweight or obesity among women of reproductive age","volume":"20","author":"Hillemeier","year":"2011","journal-title":"J. Womens Health"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1515\/ijamh-2021-0058","article-title":"Correlation between obesity, gestational diabetes mellitus, and pregnancy outcomes: An overview","volume":"33","author":"Zehravi","year":"2021","journal-title":"Int. J. Adolesc. Med. Health"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1007\/s10354-015-0410-5","article-title":"Gender Obesity Report\u2014Einfluss von Adipositas auf Reproduktion und Schwangerschaft","volume":"166","author":"Harreiter","year":"2016","journal-title":"Wien. Med. Wochenschr."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"840","DOI":"10.1016\/j.fertnstert.2017.01.017","article-title":"Obesity and female infertility: Potential mediators of obesity\u2019s impact","volume":"10","author":"Broughton","year":"2017","journal-title":"Fertil. Steril."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1144","DOI":"10.1038\/s41372-018-0144-5","article-title":"Maternal overweight and obesity increase the risk of fetal acidosis during labor","volume":"38","author":"Johansson","year":"2018","journal-title":"J. Perinatol."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Kirchengast, S., and Hartmann, B. (2018). Recent Lifestyle Parameters Are Associated with Increasing Caesarean Section Rates among Singleton Term Births in Austria. Int. J. Environ. Res. Public Health, 16.","DOI":"10.3390\/ijerph16010014"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Lewandowska, M. (2021). Maternal Obesity and Risk of Low Birth Weight, Fetal Growth Restriction, and Macrosomia: Multiple Analyses. Nutrients, 13.","DOI":"10.3390\/nu13041213"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Syb\u00f6ck, K., Hartmann, B., and Kirchengast, S. (2023). Maternal Prepregnancy Obesity Affects Foetal Growth, Birth Outcome, Mode of Delivery, and Miscarriage Rate in Austrian Women. Int. J. Environ. Res. Public Health, 20.","DOI":"10.3390\/ijerph20054139"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1016\/S0029-7844(97)00578-4","article-title":"Pregnancy outcome and weight gain recommendations for the morbidly obese woman","volume":"91","author":"Bianco","year":"1998","journal-title":"Obstet. Gynecol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1111\/1471-0528.13797","article-title":"Gestational weight gain and preterm birth in obese women: A systematic review and meta-analysis","volume":"123","author":"Faucher","year":"2015","journal-title":"BJOG Int. J. Obstet. Gynaecol."},{"key":"ref_20","first-page":"1","article-title":"Socioeconomic and clinical factors associated with excessive gestational weight gain","volume":"17","author":"Kouba","year":"2023","journal-title":"Arch. Gynecol. Obs."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"773","DOI":"10.1097\/AOG.0000000000000739","article-title":"Prevalence and characteristics associated with gestational weight gain adequacy","volume":"125","author":"Deputy","year":"2015","journal-title":"Obstet. Gynecol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1038\/ejcn.2014.40","article-title":"Body composition changes in pregnancy: Measurement, predictors and outcomes","volume":"68","author":"Widen","year":"2014","journal-title":"Eur. J. Clin. Nutr."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"109913","DOI":"10.1016\/j.diabres.2022.109913","article-title":"Weight gain during pregnancy: A narrative review on the recent evidence","volume":"188","author":"Dalfra","year":"2022","journal-title":"Diabetes Res. Clin. Pr."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1007\/s11892-020-1296-1","article-title":"Gestational Weight Gain: Update on Outcomes and Interventions","volume":"20","author":"Champion","year":"2020","journal-title":"Curr. Diabetes Rep."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1080\/07853890.2022.2159063","article-title":"Inappropriate gestational weight gain impact on maternofetal outcomes in gestational diabetes","volume":"55","author":"Santos","year":"2023","journal-title":"Ann. Med."},{"key":"ref_26","unstructured":"Rasmussen, K.M., Yaktine, A.L., and Institute of Medicine (U.S.) (2009). Weight Gain During Pregnancy: Reexamining the Guidelines, National Academies Press."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"American College of Obstetricians and Gynecologists (2013). ACOG Committee opinion no. 548: Weight gain during pregnancy. Obstet. Gynecol., 121, 210\u2013212.","DOI":"10.1097\/01.AOG.0000425668.87506.4c"},{"key":"ref_28","first-page":"853","article-title":"Gestational weight gain influences neonatal outcomes in women with obesity and gestational diabetes","volume":"69","author":"Marino","year":"2022","journal-title":"Endocrinol. Diabetes Y Nutr."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e072249","DOI":"10.1136\/bmj-2022-072249","article-title":"Suboptimal gestational weight gain and neonatal outcomes in low and middle-income countries: Individual participant data meta-analysis","volume":"382","author":"Perumal","year":"2023","journal-title":"BMJ"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"214e1","DOI":"10.1016\/j.ajog.2013.04.035","article-title":"Gestational weight gain and obesity: Are 20 pounds too much?","volume":"209","author":"Kominiarek","year":"2013","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Kirchengast, S., and Hartmann, B. (2021). Pregnancy Outcome during the First COVID-19 Lockdown in Vienna, Austria. Int. J. Environ. Res. Public Health., 18.","DOI":"10.3390\/ijerph18073782"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1","DOI":"10.52905\/hbph2023.2.74","article-title":"The associations between artificial reproductive technologies (ART) and newborn size, as well as perinatal risk factors among singleton births in Vienna, Austria","volume":"2","author":"Kirchengast","year":"2023","journal-title":"Hum. Biol. Public Health"},{"key":"ref_33","unstructured":"World Health Organisation (2000). Physical Status: The Use and Interpretation of Anthropometry, WHO."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1016\/j.bpobgyn.2016.08.003","article-title":"Macrosomia","volume":"38","author":"Peixoto","year":"2017","journal-title":"Best Pr. Res. Clin. Obstet. Gynaecol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1213\/00000539-195301000-00041","article-title":"Proposal for a new method of evaluation of the newborn infant","volume":"32","author":"Apgar","year":"1953","journal-title":"Curr. Res. Anesth. Analg."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"605","DOI":"10.37358\/RC.19.2.6965","article-title":"Determining an Umbilical Cord pH Cutoff Value for Predicting Neonatal Morbidity Related to Intrapartum Hypoxia","volume":"70","author":"Mogos","year":"2019","journal-title":"Rev. Chim."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1016\/j.pedneo.2012.08.005","article-title":"Relationship Between Oxygen Saturation and Umbilical Cord pH Immediately After Birth","volume":"53","author":"Uslu","year":"2012","journal-title":"Pediatr. Neonatol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1016\/j.tjog.2016.06.016","article-title":"Pregestational body mass index, gestational weight gain, and risks for adverse pregnancy outcomes among Taiwanese women: A retrospective cohort study","volume":"55","author":"Hung","year":"2016","journal-title":"Taiwan. J. Obs. Gynecol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"860","DOI":"10.1007\/s10995-008-0318-4","article-title":"Does Gestational Weight Gain Affect the Risk of Adverse Maternal and Infant Outcomes in Overweight Women?","volume":"15","author":"Langford","year":"2008","journal-title":"Matern. Child Health J."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1097\/01.AOG.0000139515.97799.f6","article-title":"Gestational weight gain, macrosomia, and risk of cesarean birth in nondiabetic nulliparas","volume":"104","author":"Stotland","year":"2004","journal-title":"Obstet. Gynecol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1750","DOI":"10.1093\/ajcn\/87.6.1750","article-title":"Combined associations of prepregnancy body mass index and gestational weight gain with the outcome of pregnancy","volume":"87","author":"Nohr","year":"2008","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Go\u0142awski, K., Giermaziak, W., Ciebiera, M., and Wojty\u0142a, C. (2023). Excessive Gestational Weight Gain and Pregnancy Outcomes. J. Clin. Med., 12.","DOI":"10.3390\/jcm12093211"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"2184222","DOI":"10.1080\/14767058.2023.2184222","article-title":"Obesity class I and II and IOM 2009 gestational weight gain recommendations 5-9\u2009kg. An audit on 10,000 term singleton deliveries","volume":"36","author":"Robillard","year":"2023","journal-title":"J. Matern. Fetal Neonatal Med."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Chen, C.-N., Chen, H.-S., and Hsu, H.-C. (2020). Maternal Prepregnancy Body Mass Index, Gestational Weight Gain, and Risk of Adverse Perinatal Outcomes in Taiwan: A Population-Based Birth Cohort Study. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17041221"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1016\/j.wombi.2018.07.011","article-title":"Gestational weight gain and unplanned or emergency cesarean delivery in the United States","volume":"32","author":"Haile","year":"2019","journal-title":"Women Birth"},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Haugen, M., Brants\u00e6ter, A.L., Winkvist, A., Lissner, L., Alexander, J., Oftedal, B., Magnus, P., and Meltzer, H.M. (2014). Associations of pre-pregnancy body mass index and gestational weight gain with pregnancy outcome and postpartum weight retention: A prospective observational cohort study. BMC Pregnancy Childbirth, 14.","DOI":"10.1186\/1471-2393-14-201"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"37168","DOI":"10.1038\/srep37168","article-title":"Association of pre-pregnancy body mass index, gestational weight gain with cesarean section in term deliveries of China","volume":"6","author":"Xiong","year":"2016","journal-title":"Sci. Rep."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"849","DOI":"10.1055\/s-0036-1579650","article-title":"Impact of Gestational Weight Gain on Perinatal Outcomes in Obese Women","volume":"33","author":"Durst","year":"2016","journal-title":"Am. J. Perinatol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"e13509","DOI":"10.1111\/obr.13509","article-title":"Gestational weight gain and mode of delivery by the class of obesity: A meta-analysis","volume":"23","author":"Su","year":"2022","journal-title":"Obes. Rev."},{"key":"ref_50","first-page":"452","article-title":"The association of maternal weight with cesarean risk, labor duration, and cervical dilation rate during labor induction","volume":"103","author":"Nuthalapaty","year":"2004","journal-title":"Obstet. Gynecol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"547","DOI":"10.3109\/14767058.2012.745506","article-title":"Cesarean delivery in obese women: A comprehensive review","volume":"26","author":"Wispelwey","year":"2013","journal-title":"J. Matern. Fetal Neonatal Med."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1111\/obr.12238","article-title":"Can we safely recommend gestational weight gain below the 2009 guidelines in obese women? A systematic review and meta-analysis","volume":"16","author":"Kapadia","year":"2015","journal-title":"Obes. Rev."},{"key":"ref_53","first-page":"100682","article-title":"Gestational weight gain below instead of within the guidelines per class of maternal obesity: A systematic review and meta-analysis of obstetrical and neonatal outcomes","volume":"4","author":"Mustafa","year":"2022","journal-title":"Am. J. Obstet. Gynecol."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/21\/2\/147\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T13:50:58Z","timestamp":1760104258000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/21\/2\/147"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1,29]]},"references-count":53,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2024,2]]}},"alternative-id":["ijerph21020147"],"URL":"https:\/\/doi.org\/10.3390\/ijerph21020147","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,1,29]]}}}