Discordance between concern and guideline-defined gestational weight gain status: a multicentre cross-sectional study of pregnant women

Concern about gaining too much weight may not correspond to guideline-defined excessive gestational weight gain (GWG) and may instead reflect body-related experiences. We assessed concordance between concern and excessive GWG and associations of concern, weight-related body esteem, and recent exercise with GWG categories. This multicentre cross-sectional study included 685 pregnant women in Poland. GWG was calculated from self-reported pre-pregnancy and current weight and classified according to pre-pregnancy body mass index and gestational week using Institute of Medicine/National Research Council recommendations. Weight-related body esteem was assessed using the 10-item Weight Concern subscale of the Body Esteem Scale. Agreement was quantified using Cohen’s kappa. Adjusted multinomial logistic regression compared inadequate and excessive GWG with adequate GWG. GWG was classified as inadequate in 17.7%, adequate in 34.7%, and excessive in 47.6% of participants. Agreement between concern and excessive GWG was very weak (κ = 0.077, 95% confidence interval [CI] 0.003–0.152). Sensitivity was 47.5% and specificity 60.2%, indicating classification close to chance and limited stand-alone value; 52.5% of women with excessive GWG reported no concern. In the adjusted multinomial model ( n = 682), concern was associated with neither inadequate nor excessive GWG; for excessive versus adequate GWG, the odds ratio (OR) was 1.00 (95% CI 0.69–1.47). Higher weight-related body esteem (OR = 0.82 per 5-point increase, 95% CI 0.71–0.94) and more frequent exercise (OR = 0.77 per response-category increase, 95% CI 0.67–0.88) were associated with lower odds of excessive versus adequate GWG. Neither was associated with inadequate versus adequate GWG. In a separate adjusted model, higher body esteem was associated with lower odds of concern (OR = 0.66 per 5-point increase, 95% CI 0.58–0.75), whereas excessive GWG was not. Concern about gaining too much weight was not a reliable indicator of guideline-defined excessive GWG. More positive weight-related body esteem and more frequent recent exercise were associated with lower odds of excessive gain, whereas concern was associated with body esteem but not with GWG status. These findings suggest that guideline-based GWG monitoring and assessment of body-related concerns provide complementary information in antenatal care.