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Author Notes:

See Publication for full list of authors.

Correspondence to Cassandra M. Pickens, Phone: (512) 293-6099, Email: cassandra.pickens@gmail.com

All authors conceived and designed the study.

CJH, DJD, RMS, RLG, HP, GRS, MWV, and BJS collected the data.

CMP analyzed the data.

CMP, CJH, PPH, MRK, MLB, DJD, and RMS interpreted the data.

CMP and CJH drafted the article.

PPH, MRK, MLB, DJD, RMS, RLG, HP, GRS, MWV, and BJS critically revised the article for important content.

All authors read and approved the final version of the manuscript to be published.

The datasets generated and/or analyzed during the current study are publicly available in the National Institute of Child Health and Human Development (NICHD) Data and Specimen Hub (DASH) repository [https://dash.nichd.nih.gov/].

This study was reviewed and approved by the Institutional Review Boards of each of the participating sites (Brown University, Emory University, University of Texas Health Science Center at San Antonio, University of Texas Medical Branch at Galveston, University of Utah) and by the data coordinating center (RTI International) (IRB #: IRB00000764).

Written informed consent was obtained from participants or from their legal guardians (if participants were minors).

Authors declare they have no competing interests.


Research Funding:

Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health

Maternal and Child Health Bureau, Health Resources and Services Administration

Additional stipend support was provided by Laney Graduate School, Emory University.


  • Science & Technology
  • Life Sciences & Biomedicine
  • Obstetrics & Gynecology
  • Fetal death
  • Gestational weight gain
  • Obesity
  • Stillbirth
  • AGE
  • RISK
  • BIAS

The association between gestational weight gain z-score and stillbirth: a case-control study

Journal Title:

BMC Pregnancy and Childbirth


Volume 19, Number 1


, Pages 451-451

Type of Work:

Article | Final Publisher PDF


Background: There is limited information on potentially modifiable risk factors for stillbirth, such as gestational weight gain (GWG). Our purpose was to explore the association between GWG and stillbirth using the GWG z-score. Methods: We analyzed 479 stillbirths and 1601 live births from the Stillbirth Collaborative Research Network case-control study. Women with triplets or monochorionic twins were excluded from analysis. We evaluated the association between GWG z-score (modeled as a restricted cubic spline with knots at the 5th, 50th, and 95th percentiles) and stillbirth using multivariable logistic regression with generalized estimating equations, adjusting for pre - pregnancy body mass index (BMI) and other confounders. In addition, we conducted analyses stratified by pre - pregnancy BMI category (normal weight, overweight, obese). Results: Mean GWG was 18.95 (SD 17.6) lb. among mothers of stillbirths and 30.89 (SD 13.3) lb. among mothers of live births; mean GWG z-score was - 0.39 (SD 1.5) among mothers of cases and - 0.17 (SD 0.9) among control mothers. In adjusted analyses, the odds of stillbirth were elevated for women with very low GWG z-scores (e.g., adjusted odds ratio (aOR) and 95% Confidence Interval (CI) for z-score - 1.5 SD versus 0 SD: 1.52 (1.30, 1.78); aOR (95% CI) for z-score - 2.5 SD versus 0 SD: 2.36 (1.74, 3.20)). Results differed slightly by pre - pregnancy BMI. The odds of stillbirth were slightly elevated among women with overweight BMI and GWG z-scores ≥1 SD (e.g., aOR (95% CI) for z-score of 1.5 SD versus 0 SD: 1.84 (0.97, 3.50)). Conclusions: GWG z-scores below - 1.5 SD are associated with increased odds of stillbirth.

Copyright information:

© 2019 The Author(s).

This is an Open Access work distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/).
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