Risk factors for excessive gestational weight gain in a UK population: a biopsychosocial model approach

Garay et al. BMC Pregnancy and Childbirth https://doi.org/10.1186/s12884-020-03519-1 (2021) 21:43 RESEARCH ARTICLE Open Access Risk factors for excessive gestational weight gain in a UK population: a biopsychosocial model approach S. M. Garay1, L. A. Sumption1, R. M. Pearson2 and R. M. John1* Abstract Background: Gestational weight gain (GWG) can have implications for the health of both mother and child. However, the contributing factors remain unclear. Despite the advantages of using a biopsychosocial approach, this approach has not been applied to study GWG in the UK. This study aimed to investigate the risk factors of excessive GWG in a UK population, employing a biopsychosocial model. Methods: This study utilised data from the longitudinal Grown in Wales (GiW) cohort, which recruited women in late pregnancy in South Wales. Specifically, data was collected from midwife recorded notes and an extensive questionnaire completed prior to an elective caesarean section (ELCS) delivery. GWG was categorised according to Institute of Medicine (IOM) guidelines. The analysis was undertaken for 275 participants. Results: In this population 56.0% of women had excessive GWG. Increased prenatal depression symptoms (Exp(B)= 1.10, p=.019) and an overweight (Exp(B)=4.16, p<.001) or obese (Exp(B)=4.20, p=.010) pre-pregnancy BMI, consuming alcohol in pregnancy (Exp(B)=.37, p=.005) and an income of less than £18,000 (Exp(B)=.24, p=.043) and £25–43,000 (Exp(B)=.25, p=.002) were associated with excessive GWG. Conclusion: GWG is complex and influenced by a range of biopsychosocial factors, with the high prevalence of excessive weight gain in this population a cause for concern. Women in the UK may benefit from a revised approach toward GWG within the National Health Service (NHS), such as tracking weight gain throughout pregnancy. Additionally, this research provides evidence for potential targets for future interventions, and potentially at-risk populations to target, to improve GWG outcomes. Background The weight a woman gains during pregnancy, or gestational weight gain (GWG), can have implications for the health of both mother and child [1–3]. Inadequate GWG has been associated with higher risk of small-forgestational age (SGA) infants and preterm birth [4]. Conversely, excessive GWG is suggested to be related to higher risk of large-for-gestational age infants (LGA), macrosomia, caesarean section (CS) delivery [4, 5], * Correspondence: 1 Biomedicine Division, School of Biosciences, Cardiff University, Cardiff CF10 3AX, UK Full list of author information is available at the end of the article postpartum weight retention [6], gestational hypertension and augmentation of labour [7]. The timing of the excessive GWG in pregnancy could also be of importance, with the suggestion that there may be a critical period where GWG is most detrimental [3]. Additionally, there is recent evidence suggesting GWG is associated with childhood obesity [3, 8, 9]. In 2009 the Institute of Medicine updated their existing guidelines on recommended GWG to incorporate the World Health Organisation (WHO) maternal prepregnancy body mass index (BMI) categories. These guidelines advise underweight women to gain 15.5-18 kg, healthy-weight women 11.5-16 kg, overweight women © The Author(s). 2021 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. 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However, a recent systematic review of over one million pregnant women demonstrated that only 30% of women obtained the recommended GWG, with 23 and 47% having inadequate or excessive GWG, respectively [4]. It has been suggested that the prevalence of excessive GWG is increasing [11]. Pre-pregnancy overweight or obese BMI has consistently been identified as a risk factor for excessive GWG across a range of countries [12, 13]. However, evidence for other potential contributing factors is mixed. Studies have suggested a variety of contributing factors including lower socioeconomic status or social inequalities [3, 13], increased food intake and height [12], an age of over 30 years [14], hypertension [15] and parity [16]. Existing literature does not consistently employ a biopsychosocial approach, which explicitly recognises the individual and important interacting influences of biomedical, psychological and social factors on health, despite the growing consensus that this may help explain the complex nature of GWG [12]. We were unable to identify previous research examining the prevalence and risk factors of GWG in the United Kingdom (UK). This is an important oversight as, unlike other countries such as America, in the UK GWG is not tracked through pregnancy [17]. It has been reported that, in the UK pregnant women were generally unconcerned about GWG, with the suggestion that this was partly due to a lack of information from health professionals who were unsure of what to advise regarding GWG [18]. The National Institute for Health and Care Excellence (NICE) recommends that all pregnant women, in particular women with a high BMI, receive guidance on diet and physical activity but there is no specific emphasis on weight gain. The aim of the current study was to investigate the potential biopsychosocial risk factors for excessive GWG in a UK population, utilising the Grown in Wales (GiW) cohort. Method Participants The Grown in Wales cohort is a longitudinal study in the South Wales region of the United Kingdom, which has previously been described in detail [19]. Briefly, women with a term pregnancy were recruited by research midwives at the University Hospital of Wales, at the presurgical appointment for an elective caesarean section (ELCS) between 1st September 2015 and 31st November 2016. Women were invited to participate in the study if it was a singleton term pregnancy without infectious diseases or fetal anomalies. Full ethical approval was obtained via the Wales Research E (...truncated)