Gestational weight gain as a risk factor for pregnancy and delivery complications

Gestational weight gain may affect the health of a woman and her child in the short and long term. Both inadequate and excessive weight gain are associated with several adverse pregnancy and delivery outcomes for the mother and fetus. However, optimal ranges of weight gain during pregnancy remain unclear and insufficiently studied for all categories of pregestational body mass index. This review aimed to examine the relationship between ranges of gestational weight gain and the risk of adverse maternal and fetal outcomes. It also aimed to assess the specific features of gestational weight gain based on pregestational body mass index and which strategies can optimize it. The source search was conducted in eLibrary.Ru, PubMed, Medline, Crossref, and Google Scholar databases from 2009 to 2025 using the following keywords: “гестационная прибавка веса” (gestational weight gain), “осложнения беременности” (pregnancy complications), “ожирение” (obesity), “гестационный сахарный диабет” (gestational diabetes mellitus), and “макросомия” (macrosomia). Preference was given to data from randomized controlled trials, systematic reviews, and meta-analyses. Pregestational body mass index is a crucial predictor of favorable pregnancy outcomes. Therefore, it should be considered the primary target for preventing pregnancy and delivery complications associated with excessive body weight and obesity. Inadequate and excessive gestational weight gain are linked to an increased risk of adverse pregnancy and delivery outcomes for the mother (e.g., gestational hypertension, gestational diabetes mellitus, preterm birth, complicated labor, and increased risk of cesarean section) and fetus (e.g., growth disorders, prematurity, and birth trauma). Currently, no unified protocol exists for managing patients with weight changes during preconception care and pregnancy. This is further complicated by regional factors (e.g., place of residence, dietary traditions, and cultural differences) and individual factors (e.g., influence of the immediate social environment, constitutional characteristics, and childhood and adolescent conditions). Population-level studies examining the causes and consequences of variations in gestational weight gain should be continued as they are critical for decreasing maternal and perinatal morbidity and mortality.