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Should local references or global standards be used to assess gestational weight gain?

European Journal of Clinical Nutrition volume 77, pages 762–763 (2023)Cite this article

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We read the recent manuscript by Thiruvengadam et al. [1] and the accompanying editorial by Hermanussen [2] with great interest. The study findings provide novel evidence on gestational weight gain patterns and its determinants in India and add to existing evidence on longitudinal weight gain patterns in low- and middle-income countries, previously described in charts from Malawi [3], China [4], and Brazil [5]. However, several methodological aspects related to the construction of gestational weight gain charts and the definition of optimal ranges should be considered before adopting those curves as a reference for monitoring weight gain during prenatal care.

First, the need for local reference charts or local cutoffs for weight gain recommendations warrants discussion. Although the observed distributions of pregnancy weight gain may differ between jurisdictions, this does not imply that the optimal ranges differ. It simply means that some populations may have higher or lower rates of excess/insufficient pregnancy weight gains. Conclusions about the need for a local reference should not be based on differences in the observed distribution of weight gain but rather on differences in the range of weight gain associated with the lowest risks of adverse outcomes. This evidence was lacking in the work by Thiruvengadam et al. [1]. We hypothesize that the relationship between gestational weight gain and adverse outcomes will be the same regardless of the location, i.e., there is no effect modification in the relationship between pregnancy weight gain and adverse outcomes by geographic location [6]. A single global instrument for assessing gestational weight gain has several significant practical advantages from an applied public health perspective: it provides recommendations for jurisdictions that may not have the research capacity to develop their own tool, standardizes care across locations, and enables the use of common dissemination tools. Research comparing the associations between pregnancy weight gain and adverse outcomes across different populations is needed before conclusions are drawn about the need for local vs. global references.

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References

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Funding

TC is a grantee from the Bill and Melinda Gates Foundation, the Brazilian National Research Council (CNPq) and the Brazilian Ministry of Health (grant number 445710/2020-9). JAH holds a Canada Research Chair in Perinatal Population Health. The funders did not play any role in the writing of this letter.

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Authors and Affiliations

  1. Nutritional Epidemiology Observatory, Josué de Castro Nutrition Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil

    Thais Rangel Bousquet Carrilho & Gilberto Kac

  2. Department of Obstetrics and Gynaecology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada

    Jennifer A. Hutcheon

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  1. Thais Rangel Bousquet Carrilho
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  2. Gilberto Kac
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  3. Jennifer A. Hutcheon
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TC wrote the letter with input from JAH and GK. All the authors read and approved the final version and are responsible for its content.

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Correspondence to Thais Rangel Bousquet Carrilho.

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Carrilho, T.R.B., Kac, G. & Hutcheon, J.A. Should local references or global standards be used to assess gestational weight gain?. Eur J Clin Nutr 77, 762–763 (2023). https://doi.org/10.1038/s41430-022-01202-6

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