Abstract
Objective:
Examine the effect of prepregnancy weight and maternal gestational weight gain on postterm delivery rates.
Study Design:
This was a retrospective cohort study of term, singleton births (N=375 003). We performed multivariable analyses of the association between postterm pregnancy and both prepregnancy body mass index (BMI) and maternal weight gain.
Result:
Prolonged or postterm delivery (41 or 42 weeks) was increasingly common with increasing prepregnancy weight (P<0.001) and increasing maternal weight gain (P<0.001). Underweight women were 10% less likely to deliver postterm than normal weight women who gain within the recommendations (adjusted odds ratio 0.90 (95% confidence interval 0.83, 0.97)). Overweight women who gain within or above recommendations were also at increased risk of a 41-week delivery. Finally, obese women were at increased risk of a 41-week delivery with increasing risk with increasing weight (below, within and above recommendations adjusted odds ratios 1.19, 1.21, and 1.27, respectively).
Conclusion:
Elevated prepregnancy weight and maternal weight gain both increase the risk of a postterm delivery. Although most women do not receive preconceptional care, restricting weight gain to the within the recommended range can reduce the risk of postterm pregnancy in normal, overweight and obese women.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Buy this article
- Purchase on SpringerLink
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others
References
Lu GC, Rouse DJ, DuBard M, Cliver S, Kimberlin D, Hauth JC . The effect of the increasing prevalence of maternal obesity on perinatal morbidity. Am J Obstet Gynecol 2001; 185 (4): 845–849.
Usha Kiran TS, Hemmadi S, Bethel J, Evans J . Outcome of pregnancy in a woman with an increased body mass index. BJOG 2005; 112 (6): 768–772.
Stotland NE, Washington AE, Caughey AB . Prepregnancy body mass index and the length of gestation at term. Am J Obstet Gynecol 2007; 197 (4): 378 e1–5.
Cedergren MI . Maternal morbid obesity and the risk of adverse pregnancy outcome. Obstet Gynecol 2004; 103 (2): 219–224.
Norwitz ER, Snegovskikh VV, Caughey AB . Prolonged pregnancy. When should we intervene? Clin Obstet Gynceol 2007; 50 (2): 547.
Caughey AB, Musci TJ . Complications of term pregnancies beyond 37 weeks of gestation. Obstet Gyencol 2004; 103 (1): 57–62.
Caughey AB, Stotland NE, Washington AE, Escobar GJ . Maternal and obstetric complications of pregnancy are associated with increasing gestational age at term. Am J Obstet Gynecol 2007; 196 (2): 155 e1–6.
WHO. Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser 2000; 894: i–xii, 1–253.
Ramos GA, Caughey AB . The interrelationship between ethnicity and obesity on obstetric outcomes. Am J Obstet Gynecol 2005; 193 (3 Pt 2): 1089–1093.
Caughey AB, Bishop JT . Maternal complications of pregnancy increase beyond 40 weeks of gestation in low-risk women. J Perinatol 2006; 26: 540–545.
Ehrenberg HM, Dierker L, Milluzzi C, Mercer BM . Prevalence of maternal obesity in an urban center. Am J Obstet Gynceol 2002; 187 (5): 1189–1193.
Sebire NJ, Jolly M, Wadsworth J, Joffe M, Beard RW, Regan L et al. Maternal obesity and pregnancy outcome: a study of 287,213 pregnancies in London. Int J Obesity 2001; 25: 1175–1182.
Qin C, Hsia J, Berg CJ . Variation between last-menstrual-period and clinical estimates of gestational age in vital records. Am J Epidemiol 2008; 167: 646–652.
Mustafa G, David RJ . Comparative accuracy of clinical estimate versus menstrual gestational age in computerized birth certificates. Public Health Rep 2001; 116: 15–21.
Alexander GR, Tompkins ME, Petersen DJ, Hulsey TC, Mor J . Discordance between LMP-based and clinically estimated gestational age: implications for research, programs, and policy. Public Health Rep 1995; 110: 395–402.
State of Missouri Department of Health and Senior Services. http://health.mo.gov/data/livebirths/dataelements.php, accessed 30 September 2009.
Piper JM, Mitchel Jr EF, Snowden M, Hall C, Adams M, Taylor P . Validation of 1989 Tennessee birth certificates using maternal and newborn hospital records. Am J Epidemiol 1993; 137: 758–768.
Cooper WO, Hernandez-Diaz S, Arbogast PG, Dudley JA, Dyer S, Gideon PS et al. Major congenital malformations after first-trimester exposure to ACE inhibitors. New Engl J Medicine 2006; 354: 2443–2451.
Peterson DJ, Alexander GR . Seasonal variation in adolescent conceptions, induced abortions, and late initiation of prenatal care. Public Health Rep 1992; 107: 701–706.
Alexander GR, Cornely DA . Prenatal care utilization: its measurement and relationship to pregnancy outcomes. Am J Prev Med 1987; 3: 243–253.
Wen L, Badgtett R, Cornell J . Number needed to treat: a descriptor for weighing therapeutic options. Am J Health Syst Pharm 2005; 62: 2031–2036.
Feig DS, Naylor CD . Eating for two: are guidelines for weight gain during pregnancy too liberal? Lancet 1998; 351: 1054–1055.
Rasmussen KM, Yaktine AL (eds). Committee to Reexamine IOM Pregnancy Weight Guidelines, Institute of Medicine, National Research Council. Weight Gain During Pregnancy: Reexamining the Guidelines. National Academy Press: Washington (DC), 2009.
Stotland NE, Cheng YW, Hopkins LM, Caughey AB . Gestational weight gain and adverse neonatal outcome among term infants. Obstet Gynecol 2006; 108: 635–643.
Bianco AT, Smilen SW, Davis Y, Lopez S, Lapinski R, Lockwood CJ . Pregnancy outcome and weight gain recommendations for the morbidly obese woman. Obstet Gynecol 1998; 91: 97–102.
Kiel DW, Dodson EA, Artal R, Boehmer TK, Leet TL . Gestational weight gain and pregnancy outcomes in obese women: how much is enough? Obstet Gynecol 2007; 110 (4): 752–758.
Carmichael SL, Abrams B . A critical review of the relationship between gestational weight gain and preterm delivery. Obstet Gynecol 1997; 80: 865–873.
Kramer MS, McLean FH, Boyd ME, Usher R . The validity of gestational age estimation by menstrual dating in term, preterm, and postterm gestations. JAMA 1988; 260: 3306–3308.
Harlow SD, Ephross SA . Epidemiology of menstruation and its relevance to women's health. Epidemiol Rev 1995; 17: 265–286.
Nestler JE . Obesity, insulin, sex steroids and ovulation. Int J Obes 2000; 24 (2): S71–S73.
Savitz DA, Terry JW, Dole N, Thorp JM, Siega-Riz AM, Herring AM . Comparison of pregnancy dating by last menstrual period, ultrasound scanning, and their combination. Am J Obstet Gynecol 2002; 187 (6): 1660–1666.
Høgberg U, Larsson N . Early dating by ultrasound and perinatal outcome: a cohort study. Acta Obstet Gynecol Scand 1997; 76: 907–912.
Bhattacharya S, Campbell DM, Liston WA, Bhattacharya S . Effect of body mass index on pregnancy outcome in nulliparous women delivering singleton babies. BMC Public Health 2007; 7: 168.
Olson MB, Shaw LJ, Kaizar EE, Kelsey SF, Bittner V, Reis SE et al., WISE Study Group. Obesity distribution and reproductive hormone levels in women: a report from the NHLBI-sponsored WISE study. J Womens Health (Larchmt) 2006; 15 (7): 836–842.
Smith R . Mechanisms of disease: parturition. N Engl J Med 2007; 356: 271–283.
Simic M, Wåhlin IA, Marsál K, Källén K . Maternal obesity is a potential source of error in mid-trimester ultrasound estimation of gestational age. Ultrasound Obstet Gynecol 2010; 35 (1): 48–53.
Brewer CJ, Balen AH . The adverse effects of obesity on conception and implantation. Reproduction 2010; 140: 347–364.
Lederman SA, Paxton A . Maternal reporting of prepregnancy weight and birth outcome: consistency and completeness compared with the clinical records. Matern Child Health J 1998; 2: 123–126.
Rowland ML . Self-reported weight and height. Am J Clin Nutr 1990; 52: 1125–1133.
Stevens-Simon C, Roghmann KJ, McAnarney ER . Relationship of self-reported prepregnant weight and weight gain during pregnancy to maternal body habitus and age. J Am Diet Assoc 1992; 92: 85–87.
Martin JA, Hamilton BE, Sutton PD, Ventura SJ, Menacker F, Munson ML . Births: final data for 2002. Natl Vital Stat Rep 2003; 52: 1–113.
Tsai AG, Wadden TA . Systematic review: an evaluation of major commercial weight loss programs in the United States. Ann Intern Med 2005; 142: 56–66.
Olson CM, Strawderman MS, Reed RG . Efficacy of an intervention to prevent excessive gestational weight gain. Am J Obstet Gyn 2004; 191: 530–536.
Polley BA, Wing RR, Sims CJ . Randomized controlled trial to prevent excessive weight gain in pregnant women. Int J Obes 2002; 26: 1494–1502.
Acknowledgements
Financial support was provided by KL2RR024994.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no conflict of interest.
Additional information
This article was presented at the Society for Maternal-Fetal Medicine 2008 Annual Meeting and the Southern Society for Pediatric Research 2009 Annual Meeting.
Rights and permissions
About this article
Cite this article
Halloran, D., Cheng, Y., Wall, T. et al. Effect of maternal weight on postterm delivery. J Perinatol 32, 85–90 (2012). https://doi.org/10.1038/jp.2011.63
Received:
Revised:
Accepted:
Published:
Issue date:
DOI: https://doi.org/10.1038/jp.2011.63
Keywords
This article is cited by
-
Association between gestational weight gain and preterm birth and post-term birth: a longitudinal study from the National Vital Statistics System database
BMC Pediatrics (2023)
-
Pre-term and post-term births: predictors and implications on neonatal mortality in Northern Ethiopia
BMC Nursing (2016)
-
The Association of Maternal Pre-pregnancy Body Mass Index with Breastfeeding Initiation
Maternal and Child Health Journal (2013)