Excessive Gestational Weight Gain Associated with Higher Risk of Cesarean Delivery across Body Mass Index Categories in the United States - 10/08/25

Doi : 10.1016/j.jogoh.2025.103010

Pearl A. MCELFISH ^1,^2,^⁎ , Nicola L. HAWLEY ³, Aaron R. CALDWELL ^2,⁴, James P. SELIG ^2,⁴, Donya WATSON ^5,⁶, Enrique GOMEZ-POMAR ^5,⁷, Jennifer A. ANDERSEN ^1,², Shashank KRALETI ⁵, Lanita WHITE ⁸, Don E. WILLIS ^1,², Krista LANGSTON ², Nirvana MANNING ⁵, Jennifer A. CALLAGHAN-KORU ^1,², Austin PORTER ^9,¹⁰, Clare C. BROWN ⁹
¹ College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48^th St., Springdale, AR 72762, USA
² Institute for Community Health Innovation, University of Arkansas for Medical Sciences Northwest, 2708 S. 48^th St., Springdale, AR 72762, USA
³ Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College St., New Haven, CT 06510, USA
⁴ Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR 72762, USA
⁵ College of Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR 72205, USA
⁶ South Arkansas Regional Hospital, 706 W. Grove St., El Dorado, AR 71730, USA
⁷ Neonatology, St Bernards Regional Medical Center, 225 E. Washington Ave., Jonesboro, AR 72401, USA
⁸ Community Health Centers of Arkansas, 706 W. 4th St., North Little Rock, AR 72114, USA
⁹ Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR 72205, USA
¹⁰ Arkansas Department of Health, 4815 W. Markham St., Little Rock, AR 72205, USA

^⁎Corresponding author: Pearl A. McElfish, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR 72762, USAUniversity of Arkansas for Medical Sciences Northwest2708 S. 48th St.SpringdaleAR72762USA

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ABSTRACT

Objectives

This research investigated associations between rate of gestational weight gain (GWG; “below recommended rate,” “within recommended rate,” and “exceeding recommended rate”) and increased risk of cesarean delivery for women across a range of body mass index (BMI) categories (underweight, normal, overweight, obesity classes I, II, and III).

Study Design

We used vital records data from the National Center for Health Statistics to include nulliparous, singleton term births with cephalic presentation (n=7,891,653) to women who gave birth in the US from 2014 through 2022. We evaluated the association of GWG on mode of birth (cesarean vs. vaginal delivery) using multivariable linear probability (categorical GWG) and generalized additive (continuous GWG) models.

Results

Approximately 26% of births were by cesarean delivery and 65% exceeded the recommended rate of GWG. Risk of cesarean delivery increased as BMI increased, and those in pre-pregnancy BMI above normal categories had higher risk of cesarean delivery. Excessive GWG (EGWG) increased the risk of cesarean delivery for all women, but the effect was more pronounced in those with a higher pre-pregnancy BMI. Among women whose BMI was underweight or normal, GWG had a J-shaped relationship with cesarean delivery risk, while women whose pre-pregnancy BMI was categorized as overweight or obese demonstrated a relatively linear increase in risk with any GWG.

Conclusions

Findings provide valuable insights on EGWG and increased risk of cesarean delivery for women across BMI categories. Additional efforts are needed at both the patient and provider level to reduce EGWG and the risk of cesarean delivery.

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Keywords : maternal mortality, gestational weight gain, excessive gestational weight gain, cesarean delivery, body mass index

Plan

Continuous Analysis of GWG and Visualization

COMMENT

Principal Findings

Results in the Context of What is Known

Clinical Implications

Research Implications

Strengths and Limitations

Conclusions

Author Contributions

CONDENSATION
Tweetable Statement: Researchers find excessive gestational weight gain is associated with higher risk of cesarean delivery for all body mass index categories.