Are the 2009 Institute of Medicine gestational weight gain recommendations applicable in a contemporary South-East Asian pregnancy cohort? Results of a prospective analysis

• Published in: PloS one 2025-01, Vol.20 (1), p.e0316837
• Main Authors: Tai, Yong Ting, Khoo, Jun Kit, Lim, Quan Hziung, Lim, Lee-Ling, Paramasivam, Sharmila Sunita, Ratnasingam, Jeyakantha, Hee, Nicholas Ken Yoong, Sarvanandan, Tharsini, Ooi, Ying Guat, Boey, Victoria Wei Fang, Nalliah, Saravanaa, Tan, Peng Chiong, Hamdan, Mukhri, Sthaneshwar, Pavai, Samingan, Nurshadia, Ahmad Kamar, Azanna, Anuar Zaini, Azriyanti, Samsuddin, Syahrizan, Md Amin, Md Syazwan, Musa, Nurbazlin, Ganapathy, Shubash Shander, Chinna, Karuthan, Jalaludin, Muhammad Yazid, Vethakkan, Shireene Ratna
• Format: Article
• Language: English
• Subjects: Adipose tissue; Analysis; Asian people; Biology and Life Sciences; Birth weight; Body mass index; Body size; Body weight; Body weight gain; Calipers; Cesarean section; Cohort analysis; Diabetes; Diabetes mellitus; Ethnicity; Food; Infants (Newborn); Insulin; Insulin resistance; Medical screening; Medicine and Health Sciences; Metabolism; Mothers; Neonates; Nutrition research; Obesity; Observational studies; Offspring; Overweight; People and Places; Postpartum period; Pregnancy; Pregnancy complications; Pregnant women; Prenatal care; Skinfold thickness; Thickness measurement; White people; Womens health
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0316837

Gestational Weight Gain (GWG) modulates pregnancy outcomes and long-term offspring metabolic health. The 2009 Institute of Medicine (IOM) GWG recommendations have largely been validated in Caucasian and mono-ethnic East Asian cohorts. Asians are at higher metabolic risk at a lower body mass index (BMI), and this has prompted the World Health Organization (WHO) to identify lower BMI cut-offs for risk evaluation amongst Asians. This prospective observational cohort study aimed to determine if 2009 IOM GWG thresholds are applicable in a contemporary multi-ethnic South-East Asian cohort. We recruited 875 mothers from an urban Malaysian tertiary clinic during screening for gestational diabetes mellitus (GDM) from 2014–2021. Data collected included measures of insulin-sensitivity, total GWG (maternal weight at delivery–self-reported pre-gravid weight), and neonatal anthropometrics (birthweight and skinfold-thickness measured with Harpenden calipers). BMI was stratified by Caucasian (overweight ≥25kg/m 2 , obese ≥30kg/m 2 ) as well as Asian (overweight ≥23kg/m 2 , obese ≥27.5kg/ m 2 ) cut-offs, and patients categorized by 2009 IOM GWG reference ranges. The cohort comprised 67% Malay-, 23% Chinese- and 10% Indian-descent mothers with a high prevalence of overweight/obesity (Asian cut-offs 56.9% vs Caucasian 44%). When Asian BMI cut-offs were deployed, excessive GWG incidence increased (34.1% → 40.6%) whilst inadequate GWG declined (30% → 24.8%) (p90th centile (aOR 2.14, 95% CI 1.02–4.45) and Sum-of-Skinfold Thickness (SSFT) >90th centile (aOR 3.88, 95% CI 1.77–8.51). Excessive GWG by Asian cut-offs was also associated with increased risk of SSFT >90th centile (aOR 5.75, 95% CI 2.35–14.10). Inadequate GWG by both Caucasian and Asian BMI cut-offs was associated with Small-for-Gestational-Age (SGA) status (aOR 4.30, 95% CI 2.48–7.45 and aOR 3.66, 95% CI 2.13–6.30 respectively). In conclusion, the 2009 IOM GWG recommendations, using either Caucasian or regional Asian BMI cut-offs, are applicable in a contemporary Malay majority South-East Asian cohort in terms of predicting abnormal neonatal adiposity. Importantly, the association with neonatal adip