{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T15:14:07Z","timestamp":1786115647343,"version":"build-2736575974"},"reference-count":34,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T00:00:00Z","timestamp":1785801600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100002842","name":"Chiang Mai University","doi-asserted-by":"publisher","award":["The Chiang Mai University International Visiting Professor Fellowship scheme."],"award-info":[{"award-number":["The Chiang Mai University International Visiting Professor Fellowship scheme."]}],"id":[{"id":"10.13039\/501100002842","id-type":"DOI","asserted-by":"publisher"}]},{"award":["The Chiang Mai University International Visiting Professor Fellowship scheme."],"award-info":[{"award-number":["The Chiang Mai University International Visiting Professor Fellowship scheme."]}],"id":[{"id":"https:\/\/ror.org\/05m2fqn25","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nurs. Rep.","Nursing Reports"],"abstract":"<jats:p>Background: Thai obstetric nurses follow WHO gestational weight gain (GWG) guidelines to prevent gestational diabetes mellitus (GDM). However, these Western-derived guidelines misclassify approximately 16% of Thai pregnant women, who carry excess metabolic risk at lower BMI values than Western populations. Objectives: To derive and validate Thai-specific GWG targets using Thai BMI cut-points across five BMI subgroups and assess implications for nursing practice in GDM prevention. Methods: Retrospective cohort study of 1396 Thai singleton pregnancies at a maternal and child hospital (2023\u20132025). GWG targets were derived as interquartile ranges (P25\u2013P75) from a healthy-outcomes subgroup (n = 706), with validity confirmed by multivariable logistic regression and a 70:30 derivation\/validation split. Results: GDM prevalence was 15.8%, with a rising crude trend that was attenuated after accounting for a mid-study change in screening protocol. Provisional Thai-specific GWG targets were underweight\/normal weight 11.5\u201318.0 kg, overweight 9.7\u201318.0 kg, obesity class I 9.1\u201316.0 kg, and obesity class II+ 5.8\u201312.1 kg. Inadequate GWG in obesity class I was associated with a 3.92-fold GDM risk increase (aOR 3.92, 95% CI 2.12\u20137.24, p &lt; 0.001). Adherence improved from 34.7% (IOM 2009) to 50.2% with Thai-specific targets. Conclusions: These Thai-specific GWG targets are provisional, single-centre pilot estimates. They appear clinically safe and are substantially more achievable than IOM 2009 criteria and are offered to inform BMI-appropriate antenatal counselling and to justify a multi-centre validation study, rather than as ranges that are ready for immediate national adoption.<\/jats:p>","DOI":"10.3390\/nursrep16080274","type":"journal-article","created":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T15:08:09Z","timestamp":1785856089000},"page":"274","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Development of Thai-Specific Gestational Weight Gain Targets Using Asian BMI Cut-Points: Implications for Nursing and Midwifery Practice in Preventing Gestational Diabetes Mellitus"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1338-0789","authenticated-orcid":false,"given":"Piyanut","family":"Xuto","sequence":"first","affiliation":[{"name":"Faculty of Nursing, Chiang Mai University, 110\/406 Intawaroros rd., Suthep, Muang, Chiang Mai 50200, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0951-2208","authenticated-orcid":false,"given":"Daniel","family":"Bressington","sequence":"additional","affiliation":[{"name":"Faculty of Nursing, Chiang Mai University, 110\/406 Intawaroros rd., Suthep, Muang, Chiang Mai 50200, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4008-5446","authenticated-orcid":false,"given":"Lawitra","family":"Khiaokham","sequence":"additional","affiliation":[{"name":"Faculty of Nursing, Chiang Mai University, 110\/406 Intawaroros rd., Suthep, Muang, Chiang Mai 50200, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9965-5319","authenticated-orcid":false,"given":"Patompong","family":"Khaw-on","sequence":"additional","affiliation":[{"name":"Faculty of Nursing, Chiang Mai University, 110\/406 Intawaroros rd., Suthep, Muang, Chiang Mai 50200, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-9365-0733","authenticated-orcid":false,"given":"Nantarat","family":"Matayaboon","sequence":"additional","affiliation":[{"name":"Faculty of Nursing, Chiang Mai University, 110\/406 Intawaroros rd., Suthep, Muang, Chiang Mai 50200, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suraphan","family":"Sangsawang","sequence":"additional","affiliation":[{"name":"Regional Health Promotion Center 1, Department of Health, Ministry of Public Health, Chiang Mai 50100, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nantawan","family":"Janta","sequence":"additional","affiliation":[{"name":"Regional Health Promotion Center 1, Department of Health, Ministry of Public Health, Chiang Mai 50100, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pradab","family":"Sungplipan","sequence":"additional","affiliation":[{"name":"Regional Health Promotion Center 1, Department of Health, Ministry of Public Health, Chiang Mai 50100, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suratsawadee","family":"Wiangsuwan","sequence":"additional","affiliation":[{"name":"Regional Health Promotion Center 1, Department of Health, Ministry of Public Health, Chiang Mai 50100, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sujitra","family":"Chaiwatthanakorn","sequence":"additional","affiliation":[{"name":"Regional Health Promotion Center 1, Department of Health, Ministry of Public Health, Chiang Mai 50100, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ampaporn","family":"Phiwon","sequence":"additional","affiliation":[{"name":"Regional Health Promotion Center 1, Department of Health, Ministry of Public Health, Chiang Mai 50100, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kamonchanok","family":"Khetwang","sequence":"additional","affiliation":[{"name":"Regional Health Promotion Center 1, Department of Health, Ministry of Public Health, Chiang Mai 50100, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ratchaneewan","family":"Charuloedphong","sequence":"additional","affiliation":[{"name":"Regional Health Promotion Center 1, Department of Health, Ministry of Public Health, Chiang Mai 50100, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,4]]},"reference":[{"key":"ref_1","unstructured":"Institute of Medicine and National Research Council (2009). Weight Gain During Pregnancy: Reexamining the Guidelines, The National Academies Press."},{"key":"ref_2","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":"ref_3","doi-asserted-by":"crossref","unstructured":"Lim, S., Ji, L., Tham, K.W., Misra, A., and Kadowaki, T. (2026). Clinical obesity in Asian people: Bridging the gap between adiposity and disease. Nat. Rev. Endocrinol., ahead of print.","DOI":"10.1038\/s41574-026-01239-8"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Goldstein, R.F., Abell, S.K., Ranasinha, S., Misso, M.L., Boyle, J.A., Harrison, C.L., Black, M.H., Li, N., Hu, G., and Corrado, F. (2018). 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., 16.","DOI":"10.1186\/s12916-018-1128-1"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"World Health Organization Expert Consultation (2004). Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet, 363, 157\u2013163.","DOI":"10.1016\/S0140-6736(03)15268-3"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1127","DOI":"10.7326\/M24-0161","article-title":"Body Mass Index Thresholds for Asians: A race correction in Need of Correction?","volume":"177","author":"Bajaj","year":"2024","journal-title":"Ann. Intern. Med."},{"key":"ref_7","unstructured":"Department of Health, Ministry of Public Health, Thailand (2019). Manual Guideline for Antenatal Care, Ministry of Public Health. (In Thai)."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Jatavan, P., Luewan, S., Sirilert, S., and Tongsong, T. (2023). Trends in the prevalence of diabetes mellitus in pregnancy during the past two decades in northern Thailand. Healthcare, 11.","DOI":"10.3390\/healthcare11091315"},{"key":"ref_9","unstructured":"Tongprasert, F., Srisupundit, K., Luewan, S., Traisrisilp, K., Jatavan, P., Sirilert, S., Kamlungkuea, T., Parapob, N., Sakunpansap, N., and Wongyai, M. (2026). Maternal-Fetal Medicine Annual Report 2025, Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University. Available online: https:\/\/w1.med.cmu.ac.th\/obgyn\/files\/2026\/01\/MFM25.pdf."},{"key":"ref_10","unstructured":"Aekplakorn, W., Puckcharern, H., and Satheannoppakao, W. (2026, January 15). Thai National Health Examination Survey VI, B.E. 2562\u20132563. Faculty of Medicine Ramathibodi Hospital, Mahidol University: Bangkok, Thailand, 2021. Available online: https:\/\/kb.hsri.or.th\/dspace\/handle\/11228\/5425."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2485689","DOI":"10.1080\/16549716.2025.2485689","article-title":"Prevalence of non-communicable disease risk factors and their association with economic status: Findings from the 2021 health behaviour of population survey in Thailand","volume":"18","author":"Vichitkunakorn","year":"2025","journal-title":"Glob. Health Action"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"109050","DOI":"10.1016\/j.diabres.2021.109050","article-title":"IDF Diabetes Atlas: Estimation of global and regional gestational diabetes mellitus prevalence for 2021 by International Association of Diabetes in Pregnancy Study Group\u2019s Criteria","volume":"183","author":"Wang","year":"2022","journal-title":"Diabetes Res. Clin. Pract."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Kunasegaran, T., Balasubramaniam, V.R.M.T., Arasoo, V.J.T., Palanisamy, U.D., and Ramadas, A. (2021). Gestational diabetes mellitus in Southeast Asia: A Scoping Review. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18031272"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"763","DOI":"10.1210\/endrev\/bnac003","article-title":"A clinical update on gestational diabetes mellitus","volume":"43","author":"Sweeting","year":"2022","journal-title":"Endocr. Rev."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"995","DOI":"10.1111\/jog.12293","article-title":"Relation between gestational weight gain and pregnancy outcomes","volume":"40","author":"Sunsaneevithayakul","year":"2014","journal-title":"J. Obstet. Gynaecol. Res."},{"key":"ref_16","first-page":"161","article-title":"Comparison of gestational weight gain recommendations between study from Thai population and U.S. Institute of Medicine","volume":"24","author":"Thanaratsiriworakul","year":"2016","journal-title":"Thai J. Obstet. Gynaecol."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Aoyama, T., Li, D., and Bay, J.L. (2022). Weight gain and nutrition during pregnancy: An analysis of clinical practice guidelines in the Asia-Pacific region. Nutrients, 14.","DOI":"10.3390\/nu14061288"},{"key":"ref_18","unstructured":"Murray-Davis, B., Berger, H., Melamed, N., Mawjee, K., Syed, M., Barrett, J., Ray, J.G., Geary, M., McDonald, S.D., and DOH-NET (Diabetes, Obesity and Hypertension in Pregnancy Research Network) (2024). Gestational weight gain counselling practices among different antenatal health care providers: A qualitative grounded theory study. BMC Pregnancy Childbirth, 20."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Hollis, J.L., Deroover, K., Daly, J., Tully, B., Foster, M., Lecathelinais, C., Pennell, C., Wiggers, J., and Kingsland, M. (2024). Antenatal care practices for gestational weight gain: A cross-sectional survey of antenatal care providers\u2019 reported provision and barriers to providing recommended care. BMC Pregnancy Childbirth, 24.","DOI":"10.1186\/s12884-024-06860-x"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"103653","DOI":"10.1016\/j.midw.2023.103653","article-title":"A mixed methods systematic review of midwives\u2019 clinical practices related to prenatal care of women with obesity","volume":"121","author":"Hyer","year":"2023","journal-title":"Midwifery"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Chairat, T., Ratinthorn, A., Limruangrong, P., and Boriboonhirunsarn, D. (2023). Prevalence and related factors of inappropriate gestational weight gain among pregnant women with overweight\/obesity in Thailand. BMC Pregnancy Childbirth, 23.","DOI":"10.1186\/s12884-023-05635-0"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1186\/s43058-024-00655-z","article-title":"Barriers and enablers to addressing smoking, nutrition, alcohol consumption, physical activity and gestational weight gain (SNAP-W) as part of antenatal care: A mixed methods systematic review","volume":"5","author":"Dilworth","year":"2024","journal-title":"Implement Sci. Commun."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"von Elm, E., Altman, D.G., Egger, M., Pocock, S.J., G\u00f8tzsche, P.C., and Vandenbroucke, J.P. (2007). STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies. PLoS Med., 4.","DOI":"10.1371\/journal.pmed.0040296"},{"key":"ref_24","unstructured":"Seabold, S., and Perktold, J. (July, January 28). Statsmodels: Econometric and Statistical Modeling with Python. Proceedings of the 9th Python in Science Conference, Austin, TX, USA."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"105405","DOI":"10.1016\/j.jbc.2023.105405","article-title":"Beta-cell compensation and gestational diabetes","volume":"299","author":"Usman","year":"2023","journal-title":"J. Biol. Chem."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Alston, M.C., Redman, L.M., and Sones, J.L. (2022). An overview of obesity, cholesterol, and systemic inflammation in preeclampsia. Nutrients, 14.","DOI":"10.3390\/nu14102087"},{"key":"ref_27","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_28","doi-asserted-by":"crossref","unstructured":"Rogozi\u0144ska, E., Zamora, J., Marlin, N., Betr\u00e1n, A.P., Astrup, A., Bogaerts, A., Cecatti, J.G., Dodd, J.M., Facchinetti, F., and Geiker, N.R. (2019). Gestational weight gain outside the Institute of Medicine recommendations and adverse pregnancy outcomes: Analysis using individual participant data from randomized trials. BMC Pregnancy Childbirth, 19.","DOI":"10.1186\/s12884-019-2472-7"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1063","DOI":"10.1016\/j.ajog.2004.06.070","article-title":"Placental corticotropin-releasing hormone (CRH), spontaneous preterm birth, and fetal growth restriction: A prospective investigation","volume":"191","author":"Wadhwa","year":"2004","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"de Jersey, S., Guthrie, T., Callaway, L., Tyler, J., New, K., and Nicholson, J. (2022). A theory driven, pragmatic trial implementing changes to routine antenatal care that supports recommended pregnancy weight gain. BMC Pregnancy Childbirth, 22.","DOI":"10.1186\/s12884-022-04750-8"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1111\/jnu.12813","article-title":"Effectiveness of a nurse-led mHealth app to prevent excessive gestational weight gain among overweight and obese women: A randomized controlled trial","volume":"55","author":"Chen","year":"2023","journal-title":"J. Nurs. Scholarsh."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1055\/s-0043-1766109","article-title":"Guidelines on how to monitor gestational weight gain during antenatal care","volume":"45","author":"Surita","year":"2023","journal-title":"Rev. Bras. Ginecol. Obstet."},{"key":"ref_33","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_34","doi-asserted-by":"crossref","unstructured":"Liu, X., Wang, H., Yang, L., Zhao, M., Magnussen, C.G., and Xi, B. (2022). Associations between gestational weight gain and adverse birth outcomes: A population-based retrospective cohort study of 9 million mother-infant pairs. Front Nutr., 9.","DOI":"10.3389\/fnut.2022.811217"}],"container-title":["Nursing Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2039-4403\/16\/8\/274\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T04:19:08Z","timestamp":1785989948000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2039-4403\/16\/8\/274"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,4]]},"references-count":34,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["nursrep16080274"],"URL":"https:\/\/doi.org\/10.3390\/nursrep16080274","relation":{},"ISSN":["2039-4403"],"issn-type":[{"value":"2039-4403","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,4]]}}}