scholarly journals The Effects of Pre-Pregnancy Body Mass Index and Gestational Weight Gain on the Risk of Preeclampsia at a Tertiary Referral Hospital, Northern Tanzania

2020 ◽  
Author(s):  
Nelago Tukondjeni Amagulu ◽  
Bariki Mchome ◽  
Julius Pius Alloyce ◽  
Kingsly Tobi ◽  
Eusebius Maro
Keyword(s):  
Weight Gain ◽  
Gestational Weight Gain ◽  
Multinomial Logistic Regression ◽  
Normal Weight ◽  
Excessive Weight Gain ◽  
Gestational Weight ◽  
Excessive Weight ◽  
Northern Tanzania ◽  
Increased Risk ◽  
In Pregnancy

Abstract Background: Pre/eclampsia and other hypertensive disorders of pregnancy contributed to 18% of the maternal mortality reported in Northern Tanzanian. There is increasing prevalence of obesity in Tanzania which is related to excessive weight gain in pregnancy. Both high BMI and excessive gestation weight gain are identified to increase risk of PE and subtypes, however this is still inconclusive and little is known about the joint effect of pre-pregnancy BMI and GWG on risk of PE and its subtypes in Africa. We evaluated the independent and joint effects of pre-pregnancy BMI and GWG on the risk of pre-eclampsia and its subtypes among women who delivered at Kilimanjaro Christian Medical Center (KCMC) from October 2018 to May 2019, Northern Tanzania.Methods: We performed a retrospective birth cohort study from October 2018 to May 2019 at KCMC, Tanzania. Pre-pregnancy BMI was categorized using WHO categories into Underweight (˂ 18.5kg/m²), Normal weight (18.5-24.9kg/m²), Overweight (25-29.9kg/m²) and Obese (≥ 30kg/m²). Gestational Weight Gain (GWG) was categorized using the 2009 Institute of Medicine (IOM) guidelines into Inadequate, Adequate and Excessive weight gain in pregnancy. Multinomial logistic regression analysis was used to adjust for confounders using relative risk, 95% confidence interval for the risk ratios (RR) that did not cross 1 and p<0.05 were regarded statistically significant.Results: Among the 1309 women analysed, 5.3% were Underweight, 51.1% Normal weight, 26.9% Overweight and 16.7% were Obese. About 43.5% had excessive GWG. Women with PE were 9.5%. Both obesity and excessive GWG independently increased risk of PE with adjusted RR=2.42, 95%CI: 1.48-3.96 and RR=1.77, 95%CI: 1.16-2.69 when compared to normal BMI and adequate GWG respectively. Jointly, Obesity and Excessive GWG had the highest risk of PE (ARR=4.95, 95%CI: 2.21-11.10). The increased risk was similar for Mild PE (MPE), Severe PE or eclampsia (SP/E) and Late Onset PE (LOPE). No association was found for Early Onset PE (EOPE).Conclusion: Pre-pregnancy Obesity and Excessive GWG independently and jointly increases risk for PE and the risk varies by PE subtype.

scholarly journals The influence of pre-pregnancy body mass index and gestational weight gain on pregnancy outcomes in two-child women

2019 ◽  
Author(s):  
Hanqing Chen ◽  
Suhua Zou ◽  
Zhuyu Li ◽  
Jianbo Yang ◽  
Jian Cai ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Weight Gain ◽  
Gestational Weight Gain ◽  
Body Mass ◽  
Perinatal Outcomes ◽  
Normal Weight ◽  
Excessive Weight Gain ◽  
Gestational Weight ◽  
Excessive Weight ◽  
Weight Gain During Pregnancy

Abstract Background Pre-pregnancy body mass index and gestational weight gain were related to perinatal outcomes. It was not know the changes of pre-pregnancy body mass index, weight gain during pregnancy and its effect on perinatal outcomes in two-child women.Methods This was a retrospective study. Data of single term women delivered in the First Affiliated Hospital of Sun Yat-sen University were collected from July 2017 to June 2018. Gestational weight gain criteria of the American Institute of Medical Research and pre-pregnancy body mass index classes were used to evaluate the effects on pregnancy outcomes.Results A total of 3049 cases were enrolled in the study. Overweight cases was 9.0% and obesity was 2.4%. The weight gain of the two-child women was less than that of primipara(12.4±3.9vs13.3±4.0kg, P<0.001). The proportion of primipara with excessive weight gain was higher compared to two-child women(20.1%versus17.3%, P<0.001). There were 40.0% overweight primipara and 55.2% of two-child women had excessive weight gain. And 40.5% primipara and 54.5% two-child women of obesity had excessive weight gain during pregnancy. Obese primipara increased the risk of pre-eclampsia (aOR2.38, 95%CI 0.76-7.46). And the odds of diabetes mellitus and large for gestational age also increased in this group (aOR3.49, 95%CI 1.46-8.35 and aOR7.65, 95%CI 1.83-31.97, respectively). Two-child women had similar results. Underweight primipara with excessive weight gain increased the pre-eclampsia risk (aOR2.26, 95%CI 0.29-17.46). Normal weight and overweight/obese primipara also had similar results. But in two-child women, only overweight/obesity increased the risk of pre-eclampsia (aOR2.01, 95%CI 0.41-9.98). Underweight two-child women with less weight gain increased the risk of diabetes(aOR2.06, 95%CI 0.43-9.8). Two-child women with overweight/obese increased the odds of LGA even if they had less weight gain(aOR2.58, 95%CI 0.11-63.22). Normal weight primipara and two-child women with overweight and obese with excessive weight gain had similar results. On the other way, underweight primipara with less weight gain increased the risk of SGA(aOR1.74, 95%CI 0.81-3.76).Conclusions Gestational weight gain of two-child women was less than primipara. Overweight/obese women with excessive weight gain of two-child women increased the risk of adverse outcomes.

Gestational weight gain in a migration context: are migrant women more at risk of inadequate or excessive weight gain during pregnancy?

2021 ◽  
pp. jech-2021-216619
Author(s):  
Lorraine Poncet ◽  
Henri Panjo ◽  
Thomas Schmitz ◽  
Dominique Luton ◽  
Laurent Mandelbrot ◽  
...  
Keyword(s):  
Weight Gain ◽  
Gestational Weight Gain ◽  
Multinomial Logistic Regression ◽  
Normal Weight ◽  
Sub Saharan Africa ◽  
Migrant Women ◽  
Gestational Weight ◽  
Increased Risk ◽  
Sub Saharan ◽  
Inadequate Prenatal Care

BackgroundInadequate or excessive gestational weight gain (GWG) is associated with adverse maternal and neonatal outcomes. Little is known on adequacy of GWG in migrant women. This study investigates whether migrant women in France are at higher risk of inadequate or excessive GWG, and what characteristics are associated with GWG in migrant and non-migrant groups.MethodsWe used data from the PreCARE multicentric prospective cohort (N=10 419). The study includes 5403 women with singleton deliveries, with non-migrant (n=2656) and migrant (n=2747) status. We used multinomial logistic regression, adjusting for maternal age and parity, to investigate the association of migrant status, socioeconomic status-related variables and GWG. In stratified analyses, we identified factors associated with GWG in both groups.ResultsCompared with non-migrant women, migrant women had increased risk of inadequate GWG (adjusted odds ratio (aOR) 1.18; 95% CI 1.03 to 1.34). Non-migrant women with foreign origins had increased risk of excessive GWG (aOR 1.58; 95% CI 1.30 to 1.92). Women born in Sub-Saharan Africa had increased risk of both inadequate and excessive GWG. Regardless of migration status, women with lower education and women who did not start pregnancy with a normal weight were less likely to gain adequately. Inadequate prenatal care was associated with inadequate GWG only among non-migrant women.ConclusionMigrant women are at higher risk of inadequate GWG.

scholarly journals Gestational Weight Gain Particularly Affects the Risk of Large for Gestational Age Infants in Non-obese Mothers

2019 ◽  
Vol 79 (11) ◽  
pp. 1183-1190 ◽  
Author(s):  
Friederike Weschenfelder ◽  
Thomas Lehmann ◽  
Ekkehard Schleussner ◽  
Tanja Groten
Keyword(s):  
Risk Factor ◽  
Weight Gain ◽  
Gestational Weight Gain ◽  
Gestational Age ◽  
Significant Risk ◽  
Normal Weight ◽  
Large For Gestational Age ◽  
Excessive Weight Gain ◽  
Gestational Weight ◽  
Excessive Weight

Abstract Introduction The birth of a large for gestational age (LGA) infant is a significant risk factor for birth complications and maternal morbidity and an even higher risk factor for offspring obesity, metabolic syndrome and cardiovascular disease in later life. Relevant factors affecting the risk of delivering an LGA infant are maternal pre-gravid obesity, excessive gestational weight gain exceeding the recommendations of the Institute of Medicine (IOM) and diabetes in pregnancy. We aimed to determine what matters most in terms of the risk of fetal overgrowth. Materials and Methods We performed a database analysis of 12 701 singleton term deliveries documented in our university hospital birth registry from 2003 to 2014. Multivariate logistic regression analysis was used to determine the adjusted odds ratios. Results Excessive weight gain had the strongest impact on LGA (OR: 1.249 [95% CI: 1.018 – 1.533]) compared to maternal pre-gravid body mass index (BMI) (OR: 1.083 [95% CI: 1.066 – 1.099]) and diabetes (OR: 1.315 [95% CI: 0.997 – 1.734]). Keeping gestational weight gain within the recommendations of the IOM resulted in a risk reduction for LGA of 20% (OR: 0.801 [95% CI: 0.652 – 0.982]). The risk for LGA increases by 6.9% with each kg weight gain. Normal weight women (BMI 18.5 – 24.9 kg/m2) and moderately overweight women (BMI 25 – 29.9 kg/m2) showed the highest increase in LGA rates per kg weight gain during pregnancy (OR: 1.078 [95% CI: 1.052 – 1.104] and OR: 1.058 [95% CI: 1.026 – 1.09], resp.). Only in underweight (< 18.5 kg/m2) and normal weight women the risk of LGA birth is strongly influenced by diabetes (OR 11.818 [95% CI: 1.156–120.782] and 1.564 [95% CI: 1.013–2.415]). Conclusion Excessive weight gain is particularly important for non-obese women. These women are therefore a target cohort for intervention, as each prevented additional kilogram weight gain reduces the risk of LGA by more than 5%.

scholarly journals Gestational weight gain, nutritional status and blood pressure in pregnant women

2019 ◽  
Vol 53 ◽  
pp. 57 ◽  
Author(s):  
Chiara Alzineth Silva Campos ◽  
Maira Barreto Malta ◽  
Paulo Augusto Ribeiro Neves ◽  
Bárbara Hatzlhoffer Lourenço ◽  
Marcia C Castro ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Weight Gain ◽  
Vitamin A ◽  
Pregnant Women ◽  
Gestational Weight Gain ◽  
Excessive Weight Gain ◽  
Gestational Weight ◽  
The Third ◽  
Excessive Weight ◽  
Prevalence Ratios

OBJECTIVE: To evaluate whether weekly gestational weight gain is associated with anemia, vitamin A insufficiency, and blood pressure levels in the third trimester of pregnancy. METHODS: A prospective study with 457 pregnant women attending primary care in Cruzeiro do Sul, Acre. The weekly gestational weight gain rate measured between the second and third trimesters was classified as insufficient, adequate, and excessive according to the recommendations of the Institute of Medicine 2009. The outcomes at the beginning of the third gestational trimester were: anemia (Hb < 110 g/L), vitamin A insufficiency (serum retinol<1.05 μmol/L) and blood pressure levels (continuous values, in mmHg). Age-adjusted prevalence ratios, schooling, and use of vitamin and mineral supplements were calculated in Poisson regression models with robust variance. RESULTS: A total of 18.6% of pregnant women had insufficient weekly weight gain, and 59.1% had excessive weight gain. The frequencies of anemia, vitamin A insufficiency and hypertension (systolic blood pressure ≥ 140 mmHg or diastolic ≥ 90 mmHg) were 17.5%, 13.4%, and 0.6%, respectively. The prevalence ratios for anemia among pregnant women with insufficient and excessive weight gain were 0.41 (95%CI 0.18–0.93) and 1.00 (95%CI 0.63–1.59), respectively, when compared to pregnant women with adequate weight gain. For vitamin A insufficiency, the adjusted prevalence ratio was significantly higher among pregnant women with insufficient weight gain (2.85, 95%CI 1.55–5.24) and no difference for excessive weight gain (1.53, 95%CI 0.84–2.74) when compared to pregnant women with adequate weight gain. Pregnant women with excessive weight gain had higher mean systolic blood pressure (111.10; 95%CI 109.9–112.2) when compared to pregnant women with insufficient weight gain (107.50; 95%CI 105.4–109.6) and adequate (106.20; 95%CI 104.3–108.20). CONCLUSIONS: Insufficient weekly gestational weight gain was associated with the risk of vitamin A insufficiency. Excessive weight gain, in turn, was associated with higher blood pressure values at the beginning of the third gestational trimester.

Association between Gestational Weight Gain Adequacy and Adverse Maternal and Neonatal Outcomes

2018 ◽  
Vol 36 (06) ◽  
pp. 615-623 ◽  
Author(s):  
Han-Yang Chen ◽  
Suneet Chauhan
Keyword(s):  
Weight Gain ◽  
Gestational Weight Gain ◽  
Neonatal Morbidity ◽  
Error Variance ◽  
Normal Weight ◽  
Adverse Outcomes ◽  
Live Births ◽  
Gestational Weight ◽  
Increased Risk ◽  
Regression Adjustment

Objectives To estimate the prevalence of gestational weight gain (GWG) adequacy according to the 2009 guidelines, and to examine the association between GWG adequacy and the adverse outcomes, stratified by prepregnancy body mass index (BMI). Study Design A retrospective cohort study, using the 2011 to 2013 U.S. linked birth/infant death datasets, restricted to nonanomalous singleton live births at 37 to 41 weeks. The adverse outcomes included composite maternal morbidity (CMM), composite neonatal morbidity (CNM), and neonatal and infant mortalities. We used multivariable Poisson's regression models with robust error variance to examine the association between GWG adequacy and adverse outcomes. Results Of 8,656,791 singleton live births, 20, 32, and 48% had inadequate, adequate, and excessive GWG, respectively. After multivariable regression adjustment, compared with adequate GWG, excessive GWG had 1.10 (1.08–1.13) and 1.12 (1.10–1.14) times higher risk of CMM and CNM, respectively; similar findings were observed in BMI subgroups. Compared with adequate GWG, inadequate GWG had 1.14 (1.03–1.26) and 1.12 (1.07–1.18) times higher risk of neonatal and infant mortalities, respectively. Similar results were noted among women with normal weight. Conclusion Excessive GWG was associated with an increased risk of CMM and CNM, while inadequate GWG was associated with a higher risk of neonatal and infant mortalities.

scholarly journals Associations Between Pre-Pregnancy Body Mass Index, Gestational Weight Gain and Preterm Birth: a Cohort Study in Wuhan, China

2020 ◽  
Author(s):  
Yiyang Guo ◽  
Chao Xiong ◽  
Aifen Zhou ◽  
Ronghua Hu ◽  
Rong Yang ◽  
...  
Keyword(s):  
Cohort Study ◽  
Weight Gain ◽  
Preterm Birth ◽  
Gestational Weight Gain ◽  
Early Pregnancy ◽  
Tracking System ◽  
Normal Weight ◽  
Elevated Risk ◽  
Gestational Weight ◽  
Increased Risk

Abstract Background Preterm birth (PTB) is the leading cause of neonatal mortality and morbidity worldwide. Methods This cohort study was designed to investigate the associations between pre-pregnancy BMI, total gestational weight gain (GWG), and GWG during early pregnancy with PTB utilizing data of 83,096 Chinese women from the Maternal and Children Healthcare Information Tracking System of Wuhan, China. Results Women who were underweight, overweight or obese prior to pregnancy had an overall elevated risk of PTB, compared to their normal weight counterparts. Women with total GWG below the IOM recommendation had an increased risk of PTB compared to women who had GWG within the recommendation, whereas an increasing risk of PTB was observed asweekly early pregnancy GWGincreased. When stratified by subtypes of PTB, pre-pregnancy underweight was associated with higher risk of spontaneous PTB, and pre-pregnancy overweight /obese increased the risk of both spontaneous PTB and medically indicated PTB. Women with total GWG below the IOM recommendation had elevated risk for spontaneous PTB and PROM, and women with GWG above the recommendation had decreased risk for all three subtypes of PTB, whereas risk for the three subtypes of PTB increased along with increasing weekly GWG of early pregnancy. Conclusions Maternal underweight, overweight/obesity, total GWG, and GWG during early pregnancy should be considered in combination to reduce the risk of PTB, women should modify their weight gains during pregnancy according to the results.

scholarly journals Prognosis Associated with Sub-Types of Hyperglycaemia in Pregnancy

2021 ◽  
Vol 10 (17) ◽  
pp. 3904
Author(s):  
Emmanuel Cosson ◽  
Sid Ahmed Bentounes ◽  
Charlotte Nachetergaele ◽  
Narimane Berkane ◽  
Sara Pinto ◽  
...  
Keyword(s):  
Weight Gain ◽  
Gestational Weight Gain ◽  
Gestational Age ◽  
Pregnancy Outcomes ◽  
Insulin Requirement ◽  
Large For Gestational Age ◽  
Gestational Weight ◽  
Hypertensive Disorders ◽  
Increased Risk ◽  
In Pregnancy

We aimed to compare pregnancy outcomes in 4665 women according to the following types of hyperglycaemia in pregnancy sub-types: (i) normoglycaemia, (ii) gestational diabetes mellitus (GDM), (iii) diabetes in pregnancy (DIP), (iv) early-diagnosed (i.e., <22 weeks of gestation) GDM (eGDM), and (v) early-diagnosed DIP (eDIP). The prevalence of normoglycaemia, eGDM, eDIP, GDM, and DIP was 76.4%, 10.8%, 0.6%, 11.7%, and 0.6%, respectively. With regard to pregnancy outcomes, gestational weight gain (11.5 ± 5.5, 9.0 ± 5.4, 8.3 ± 4.7, 10.4 ± 5.3, and 10.1 ± 5.0 kg, p < 0.0001) and insulin requirement (none, 46.0%, 88.5%, 25.5%, and 51.7%; p < 0.001) differed according to the glycaemic sub-types. eGDM and eDIP were associated with higher rates of infant malformation. After adjustment for confounders, with normoglycaemia as the reference, only GDM was associated with large-for-gestational-age infant (odds ratio 1.34 (95% interval confidence 1.01–1.78) and only DIP was associated with hypertensive disorders (OR 3.48 (1.26–9.57)). To conclude, early-diagnosed hyperglycaemia was associated with an increased risk of malformation, suggesting that it was sometimes present at conception. Women with GDM, but not those with eGDM, had an increased risk of having a large-for-gestational-age infant, possibly because those with eGDM were treated early and therefore had less gestational weight gain. Women with DIP might benefit from specific surveillance for hypertensive disorders.

scholarly journals Effect of Gestational Weight Gain on Perinatal Outcomes in Low Risk Pregnancies with Normal Prepregnancy Body Mass Index

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
Mefkure Eraslan Sahin ◽  
Ilknur Col Madendag
Keyword(s):  
Weight Gain ◽  
Perinatal Outcomes ◽  
Normal Weight ◽  
Low Risk ◽  
Excessive Weight Gain ◽  
Gestational Weight ◽  
Prepregnancy Bmi ◽  
Excessive Weight ◽  
Normal Weight Gain ◽  
Adverse Perinatal Outcomes

Objective. This study aimed to clarify the effect of gestational weight gain (GWG) on perinatal outcomes in low risk pregnancies with normal prepregnancy body mass index (BMI). Study Design. A total of 572 low-risk pregnant women with a normal prepregnancy BMI were included. GWG and inadequate or excessive weight gain were defined according to the United States Institute of Medicine updated guidelines. Adverse perinatal outcomes were compared among inadequate, normal, and excessive weight gain groups. Results. Of the 572 pregnant women enrolled, 62 belonged to inadequate GWG group, 80 to excessive GWG group, and 430 to normal GWG group. Maternal age, prepregnancy BMI, gravity, parity, and previous cesarean delivery rates were similar among groups. Adverse perinatal outcomes were not statistically significant among groups. Fetal weight was significantly lower in inadequate weight gain group compared to normal weight gain group (p<0.001) and fetal weight was significantly lower in normal weight gain group compared to excessive weight gain group (p<0.001). Additionally, low birth weight <2.5kgs, birth weight > 4.0kgs, and SGA and LGA rates were similar among groups (P = 0.765, P = 0. 711, P = 0. 702, and P = 0.414, respectively). Although gestational age at delivery was term in normal percentile it was significantly lower in the inadequate weight gain group compared to others (P=0.010). Conclusions. This study showed that an inadequate or excessive weight gain in low-risk pregnancies with a normal prepregnancy BMI did not increase the risk of adverse perinatal outcomes.

scholarly journals Gestational weight gain and pregnancy outcome in women with excessive pre-pregnancy body mass index

2019 ◽  
pp. 01-07
Author(s):  
Magdalena Smyka ◽  
Katarzyna Kosinska- Kaczynska ◽  
Damian Warzecha ◽  
Miroslaw Wielgos
Keyword(s):  
Body Mass Index ◽  
Weight Gain ◽  
Gestational Weight Gain ◽  
Body Mass ◽  
Gestational Age ◽  
Perinatal Outcomes ◽  
Obese Women ◽  
Excessive Weight Gain ◽  
Gestational Weight ◽  
Excessive Weight

Aim: To evaluate the effects of gestational weight gain on perinatal outcomes in woman with excessive pre-gravid body mass index. Material and Methods: The study group consisted of 197 overweight or obese women who delivered full-term newborns at the 1st Department of Obstetrics and Gynecology, Medical University of Warsaw. Group A included 89 (45.2%) women with inadequate or adequate weight gain. Group B included 108 patients (54.8%) with excessive weight gain during pregnancy. Results: No significant differences in the occurrence of gestational diabetes, hypertension or intrahepatic cholestasis between the analyzed groups were observed. Excessive weight gain was positively correlated with the incidence of cesarean delivery (67.6% vs 32.4%, p=0.009), newborns’ birthweight (3627g±519 vs 3406g±521, p=0.009) and the risk of low for gestational age infants (26.9% vs 12.4%, p=0.01). The highest risk of low for gestational age new born was related to gestational weight gain of about 15 kg. Appropriate preconception counselling for overweight and obese women may reduce the risk of low for gestational age infants.

scholarly journals Dynamics of Gestational Weight Gain in Women with Different Pre-pregnancy Body Weight

2018 ◽  
Vol 24 (4) ◽  
Author(s):  
Svitlana Ostafiichuk
Keyword(s):  
Body Weight ◽  
Weight Gain ◽  
Pregnant Women ◽  
Gestational Weight Gain ◽  
Weight Retention ◽  
National Guidelines ◽  
Excessive Weight Gain ◽  
Gestational Weight ◽  
Excessive Weight ◽  
Weight Gain During Pregnancy

International and national guidelines regulate the gestational weight gain (GWG), depending on the pre-pregnancy body mass index (BMI). Insufficient weight gain increases rate of delivery of small weight babies, and excessive GWG is associated with macrosomia, postpartum weight retention and obesity. Objective: Our objective was to assess the dynamics of GWG in women of different pre-pregnancy body weight.Material and methods: 219 pregnant women with different pre-pregnancy BMI were examined. In 45 ((20.5±2.7) %) patients were diagnosed insufficient, in 100 ((45.7±3.4) %) – normal and in 74 ((33.8±3.2) %) – excessive weight gain during pregnancy period. BMI was calculated by using the standard formula of person’s weight in kilograms divided by the square of her height in meters (kg/m2). Total weight gain was calculated by subtracting the pre-pregnancy weight from the last measured weight before delivery. Statistical analyses were carried out using Statistical program “Statistica 5.5”.Results: It has been established that the women with higher pre-pregnancy BMI have the lower weight gain during the gestation period r = -0.25 (p<0.001). Normal weight women have the highest level of GWG, while pregnant women with obesity have minimal level. However, underweight patients are in the higher risk of pathologically low GWG while overweight and obese women have greater risk of excessive GWG. The dynamics of weight gain during pregnancy shows that deficiency or absent weight gain in the first trimester is associated with an insufficient weight gain to the end of pregnancy r=0.58 (p<0.001). Conversely, rapid onset of excessive weight gain up to 12 weeks of gestation leads to further excessive GWG r = 0.77 (p<0.001).Conclusions: Body weight before pregnancy is an independent determinant of GWG. Adequate weight gain during pregnancy does not lead to obesity in women of all groups, while pathologically low and high GWG leads to inadequate accumulation of adipose tissue, which has negatively affects on the metabolism of maternal and fetal organisms.

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