When it comes to baby’s growth, early pregnancy weight may matter more than later gains

When you’re pregnant, you spend a lot of time on scales. Every doctor appointment begins with hopping (or waddling) up for a weigh-in. Health care workers then plot those numbers into a (usually) ascending curve as the weeks go by.

A morbid curiosity about exactly how enormous you’re getting isn’t what’s behind the scrutiny. Rather, the pounds put on during pregnancy can give clues about how the pregnancy is progressing.

Weight gain during pregnancy is tied to the birth weight of the new baby: On average, the more weight that mothers gain, the bigger the babes. If a mother gains a very small amount of weight, her baby is more likely to be born too early and too small. And if a mother gains too much weight, her baby is at risk of being born large, which can cause trouble during delivery and future health problems for babies.
But staying within the recommended weight range is hard. Very hard. A 2017 review of studies that, all told, looked at over a million pregnancies around the world showed that the vast majority of women fell outside the weight gain sweet spot. Twenty-three percent of those women didn’t gain enough, and 47 percent gained too much, the review, published in JAMA, shows.

But here’s the tricky part. Many studies on weight gain during pregnancy and babies’ outcomes start monitoring women who are already pregnant. That means that these studies rely on women to remember, and report correctly, their prepregnancy weight. And that might not always be accurate.

A new study offers a more nuanced look at pregnancy weight gain. The results, taken from the pregnancies of more than 1,000 Chinese women, suggest that when it comes to babies’ birth weights, the timing of maternal weight gain matters, a lot.
Overall, a woman’s weight gain during pregnancy was clearly linked to baby’s weight at birth, the researchers found. But within those 40 weeks, there were big differences. Prepregnancy weight and weight gain during the first half of pregnancy are the measurements that matter, researchers suggested in the February JAMA Pediatrics. Weight gain after 18 weeks wasn’t linked to babies’ birth weight, researchers note.

Similar results, described in PLOS ONE, come from a 2017 study of Vietnamese women: Weight gain during the first half of pregnancy had two to three times the influence on infant birth outcomes than weight gain in the second half of pregnancy. It’s worth mentioning that nearly three-quarters of the Vietnamese women gained too little weight during pregnancy. And on the whole, the Chinese women were lean before they got pregnant, scenarios that make it hard to translate those findings to women who began pregnancy overweight.

Still, the point remains that weight gain during the first half of pregnancy (and even before it) may have outsized influence on the baby’s growth. Pregnancy — and the growing baby — change so much from week 0 to week 40. It makes sense that all pregnancy weight gain isn’t all one and the same.

It’s nice to see these complexities emerge as scientists get more fine-grained data. There’s still so much we don’t know about how weight gain during pregnancy, as well as other aspects of the in utero environment, can shape babies’ future health.

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