{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T14:26:31Z","timestamp":1788531991830,"version":"build-2803163510"},"reference-count":19,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T00:00:00Z","timestamp":1788480000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background\/Objectives: Obesity and excessive gestational weight gain (EGWG) are known risk factors for adverse outcomes in pregnancy, but the comparative risk is less well defined and increasingly relevant in an era of increasing use of weight loss medications. We aimed to determine whether EGWG was associated with adverse maternal and neonatal outcomes, compared with prepregnancy obesity. Methods: Multicenter retrospective cohort study of pregnant patients who delivered a singleton within a single university health system from 2019\u20132024. Patients with missing prepregnancy body mass index (BMI) data, BMI &lt; 18.5 kg\/m2, or pregestational diabetes were excluded. Logistic regression with propensity score weights and g-computation were used to evaluate if the incidence of several adverse maternal and neonatal outcomes were impacted by prepregnancy obesity and gestational weight gain (GWG). p values were adjusted for multiple comparisons. Results: Among the 129,615 pregnancies included, 28,516 (22.0%) had prepregnancy obesity, 36,943 (28.5%) were overweight prior to pregnancy, and 64,156 (49.5%) had a normal BMI prior to pregnancy. When compared to patients with obesity, patients with normal prepregnancy BMI and EGWG had a lower risk of adverse maternal and neonatal outcomes, including gestational diabetes, gestational hypertension, preeclampsia, eclampsia, cesarean delivery, and postpartum hemorrhage, as well as large and small for gestational age birthweight, stillbirth, neonatal intensive care unit admission, neonatal mechanical ventilation, respiratory distress syndrome, intraventricular hemorrhage, necrotizing enterocolitis, and sepsis. Beneficial effects were attenuated for patients with overweight prepregnancy BMI or for larger EGWG. Conclusions: Lower prepregnancy BMI, even with the potential unintended consequence of EGWG, may be more favorable than untreated prepregnancy obesity with regard to perinatal outcomes.<\/jats:p>","DOI":"10.3390\/jcm15176858","type":"journal-article","created":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T13:50:44Z","timestamp":1788529844000},"page":"6858","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prepregnancy Obesity Versus Excessive Gestational Weight Gain: A Comparative Evaluation of Adverse Outcomes"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7574-2234","authenticated-orcid":false,"given":"Samuel","family":"Schultz","sequence":"first","affiliation":[{"name":"Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2310-6003","authenticated-orcid":false,"given":"David","family":"Krantz","sequence":"additional","affiliation":[{"name":"Northwell Health Laboratories, Northwell Health, New Hyde Park, NY 11042, USA"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"methodology","vocabulary":"credit"},{"role":"software","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5534-6928","authenticated-orcid":false,"given":"Matthew J.","family":"Blitz","sequence":"additional","affiliation":[{"name":"Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, South Shore University Hospital, Bay Shore, NY 11706, USA"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4837-8059","authenticated-orcid":false,"given":"Ashley N.","family":"Battarbee","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Center for Women\u2019s Reproductive Health, University of Alabama at Birmingham, Birmingham, AL 35294, USA"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1966-9578","authenticated-orcid":false,"given":"Moti","family":"Gulersen","sequence":"additional","affiliation":[{"name":"Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"American College of Obstetricians and Gynecologists (2021). Obesity in Pregnancy: ACOG Practice Bulletin, Number 230. Obstet. Gynecol., 137, e128\u2013e144.","DOI":"10.1097\/AOG.0000000000004395"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1056\/NEJMra1801040","article-title":"Obesity in Pregnancy","volume":"387","author":"Creanga","year":"2022","journal-title":"N. Engl. J. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"j1","DOI":"10.1136\/bmj.j1","article-title":"Obesity and pregnancy: Mechanisms of short term and long term adverse consequences for mother and child","volume":"356","author":"Catalano","year":"2017","journal-title":"BMJ"},{"key":"ref_4","unstructured":"Yaktine, A.L., and Rasmussen, K.M. (2009). Institute of Medicine (US) Committee to Reexamine IOM Pregnancy Weight Guidelines. Weight Gain During Pregnancy: Reexamining the Guidelines, National Academies Press. [1st ed.]."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"(2013). ACOG Committee opinion no. 548: Weight gain during pregnancy. Obstet. Gynecol., 121, 210.","DOI":"10.1097\/01.AOG.0000425668.87506.4c"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Mamun, A.A., Callaway, L.K., O\u2019CAllaghan, M.J., Williams, G.M., Najman, J.M., Alati, R., Clavarino, A., and Lawlor, D.A. (2011). Associations of maternal pre-pregnancy obesity and excess pregnancy weight gains with adverse pregnancy outcomes and length of hospital stay. BMC Pregnancy Childbirth, 11.","DOI":"10.1186\/1471-2393-11-62"},{"key":"ref_7","unstructured":"(2019). LifeCycle Project-Maternal Obesity Childhood Outcomes Study Group. Association of Gestational Weight Gain with Adverse Maternal Infant Outcomes. JAMA, 321, 1702\u20131715."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"199","DOI":"10.7326\/ANNALS-24-01590","article-title":"Efficacy and Safety of Glucagon-Like Peptide-1 Receptor Agonists for Weight Loss Among Adults Without Diabetes: A Systematic Review of Randomized Controlled Trials","volume":"178","author":"Moiz","year":"2025","journal-title":"Ann. Intern. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"807","DOI":"10.1007\/s11606-025-09950-4","article-title":"Effects of Glucagon-Like Peptide-1 Receptor Agonists After Treatment Withdrawal: A Systematic Review and Meta-Analysis","volume":"41","author":"Zhou","year":"2025","journal-title":"J. Gen. Intern. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1414","DOI":"10.1001\/jama.2021.3224","article-title":"Effect of Continued Weekly Subcutaneous Semaglutide vs Placebo on Weight Loss Maintenance in Adults with Overweight or Obesity: The STEP 4 Randomized Clinical Trial","volume":"325","author":"Rubino","year":"2021","journal-title":"JAMA"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2186","DOI":"10.1001\/jama.2025.20951","article-title":"Gestational Weight Gain and Pregnancy Outcomes After GLP-1 Receptor Agonist Discontinuation","volume":"334","author":"Maya","year":"2025","journal-title":"JAMA"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1097\/AOG.0000000000005995","article-title":"Gestational Weight Gain and Hypertensive Disorders of Pregnancy with Prepregnancy and Early Pregnancy Glucagon-Like Peptide-1 Receptor Agonist Exposure","volume":"147","author":"Pondugula","year":"2025","journal-title":"Obstet. Gynecol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"103191","DOI":"10.1016\/j.jogc.2025.103191","article-title":"Outcomes of Maternal Periconceptional Exposure to Glucagon-Like Peptide-1 Receptor Agonists: A Scoping Review of Evidence and Reporting Trends","volume":"48","author":"Lee","year":"2025","journal-title":"J. Obstet. Gynaecol. Can."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2118","DOI":"10.1055\/a-2565-1687","article-title":"Association of Prepregnancy Obesity versus Excessive Gestational Weight Gain with Adverse Neonatal Outcomes in the United States","volume":"42","author":"McLaren","year":"2025","journal-title":"Am. J. Perinatol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2182","DOI":"10.1055\/a-2568-9060","article-title":"Association of Prepregnancy Obesity versus Excessive Gestational Weight Gain with Adverse Maternal Outcomes in the United States","volume":"42","author":"McLaren","year":"2025","journal-title":"Am. J. Perinatol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e12690","DOI":"10.1111\/cob.12690","article-title":"What is known about the use of weight loss medication in women with overweight\/obesity on fertility and reproductive health outcomes? A scoping review","volume":"14","author":"Maslin","year":"2024","journal-title":"Clin. Obes."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1472","DOI":"10.1016\/S0140-6736(24)00255-1","article-title":"Safety of low weight gain or weight loss in pregnancies with class 1, 2, and 3 obesity: A population-based cohort study","volume":"403","author":"Johansson","year":"2024","journal-title":"Lancet"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1830","DOI":"10.1016\/S0140-6736(18)30311-8","article-title":"Before the beginning: Nutrition and lifestyle in the preconception period and its importance for future health","volume":"391","author":"Stephenson","year":"2018","journal-title":"Lancet"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"(2019). ACOG Committee Opinion No. 762: Prepregnancy Counseling. Obstet. Gynecol., 133, e78\u2013e89.","DOI":"10.1097\/AOG.0000000000003013"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/17\/6858\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T13:59:18Z","timestamp":1788530358000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/17\/6858"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,4]]},"references-count":19,"journal-issue":{"issue":"17","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["jcm15176858"],"URL":"https:\/\/doi.org\/10.3390\/jcm15176858","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,4]]}}}