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Maternal Underweight Status and Inadequate Rate of Weight Gain during the Third Trimester of Pregnancy Increases the Risk of Preterm Delivery^1,2,

Anna Maria Siega-Riz^*,3, Linda S. Adair^* and Calvin J. Hobel

^* Department of Nutrition, University of North Carolina School of Public Health, Chapel Hill, NC 27516 Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA 90048

This study examines the differences in the pattern of weight gain according to trimesters of pregnancy for women who delivered term vs. preterm and analyzes the independent effect of prepregnancy weight status and rate of weight gain on delivering preterm. The differential effects of these variables on the etiological pathways of prematurity (preterm labor and preterm rupture of the amniotic membranes) were also examined. Data were collected prospectively from 7589 pregnant women receiving care in public health clinics in the West Los Angeles area. Eighty percent of women identified themselves as being of Hispanic origin. Multivariate logistic regression techniques were used to isolate the role of each nutritional variable from other factors that may influence birth outcome. Women who delivered preterm had patterns of weight gain similar to women delivering term infants. Underweight status (body mass index <19.8 kg/m²) before pregnancy nearly doubled the likelihood of delivering preterm [adjusted odds ratio (AOR) 1.98, 95% confidence interval (CI) = 1.33, 2.98). Inadequate weight gain in the third trimester defined as <0.34, 0.35, 0.30 and 0.30 kg/wk for underweight, normal weight, over-weight and obese women, respectively, increased the risk by a similar magnitude (AOR 1.91, 95% Cl = 1.40, 2.61). Slight differentiation of these risk factors occurred when analyzing the etiological pathways of preterm birth. Preconceptional nutrition counseling and promotion of adequate weight gain during the third trimester of pregnancy should be components of public health programs designed to decrease the prevalence of preterm birth.

KEY WORDS: • prematurity • pregnancy • anthropometry • Hispanic women

¹ Funding for parts of the project design, data collection and analyses was provided by the State of California Maternal and Child Health Branch, the March of Dimes, and the University of North Carolina Institute of Nutrition.

² The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked "advertisement" in accordance with 18 USC section 1734 solely to indicate this fact.

³ To whom correspondence should be addressed.

Manuscript received 4 April 1995. Revision accepted 29 September 1995.