Study Links High Pregnancy Weight Gain to Higher Death Risk in Later Decades

Higher amount of pregnancy weight gain had a higher risk of death from heart disease or diabetes in the decades that followed, according to a new analysis of 50 years of data published in The Lancet and led by researchers from the University of Pennsylvania’s Perelman School of Medicine. The researchers examined a huge national data set that spanned from the time a person gave birth to the next five decades, measuring mortality rates to demonstrate the possible long-term impacts of prenatal weight gain. All weight groups analyzed had a higher risk of death, including those who were underweight, normal weight, or overweight prior to their pregnancies, but there was no increase in risk among those who were obese.

“We hope that this work leads to greater efforts to identify new, effective, and safe ways to support pregnant people in achieving a healthy weight gain,” said the study’s lead author, Stefanie Hinkle, PhD, an assistant professor of Epidemiology and Obstetrics and Gynecology at Penn. “We showed that gaining weight during pregnancy within the current guidelines may protect against possible negative impacts much later in life, and this builds upon evidence of the short-term benefits for both maternal health and the health of the baby.”

Hinkle and her colleagues, who included members of Penn’s departments of Biostatistics, Epidemiology and Informatics, and Obstetrics and Gynecology, as well as the Intramural Research Program of the National Institute of Child Health and Human Development, examined data from the Collaborative Perinatal Project, as they had previously shown links between pregnancy complications and higher death rates in the following years. This effort cataloged data from a racially diverse cohort of people who gave birth in the 1950s or 1960s and matched their records to death data that spanned from 1966 to 2016, around 50 years later. The researchers reviewed data from over 45,000 participants, including their BMIs and weight fluctuations throughout pregnancy, and compared it to current recommendations. These figures were then connected to fatalities from any cause, followed by deaths from cardiovascular or diabetes-related causes.

Modern weight increase recommendations during pregnancy were established in 2009 and are closely related to a person’s weight at the start of their pregnancy. They range from 28 to 40 pounds for persons classified as “underweight” by BMI to 11 to 20 pounds for those classified as “obese.” Currently, over half of pregnant women acquire more weight than is recommended.

By 2016, around 39% of the cohort had died, and the death rate increased in relation to pre-pregnancy BMI – those with the lowest BMI died at a lesser rate than those with the highest BMI.

The risk of death from heart disease increased by 84% among people who were “underweight” before pregnancy but gained more than the (now) recommended amount of weight. When those regarded to be of “normal” weight prior to pregnancy (approximately two-thirds of the cohort) acquired more weight than recommended, their risk of all-cause mortality increased by 9%, and their risk of heart disease-related death increased by 20%. Finally, those classified as “overweight” had a 12% increased chance of dying if they acquired more weight than is now recommended, as well as a 12% increased risk of diabetes-related death.

The study revealed no link between excessive weight increase during pregnancy and subsequent fatalities among obese women. While their study was not designed to investigate that exact point, Hinkle believes that this group’s already high death rate may have had an impact on this discovery.

Weight increase during pregnancy does not occur in a vacuum, since health care access, nutrition, and stress can all play a role. However, now that Hinkle and her colleagues have a better understanding of the long-term consequences linked with unhealthy increases, they hope to discover more that will help solve the issue.

“We are committed to delving deeper into the various factors that can affect pregnant individuals’ ability to achieve healthy weight gain during pregnancy,” Hinkle said. “Our team is dedicated to exploring the social, structural, biological, and individual aspects that play a role in this process.”

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