• Leila Cheikh Ismail, Deborah C Bishop, Ruyan Pang, Eric O Ohuma, Gilberto Kac, Barbara Abrams, Kathleen Rasmussen, Fernando C Barros, Jane E Hirst, Ann Lambert, Aris T Papageorghiou, William Stones, Yasmin A Jaffer, Douglas G Altman, J Alison Noble, Maria Rosa Giolito, Michael G Gravett, Manorama Purwar, Stephen H Kennedy, Zulfiqar A Bhutta, and José Villar.
• Nuffield Department of Obstetrics & Gynaecology and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK leila.cheikhismail@obs-gyn.ox.ac.uk.
• BMJ. 2016 Jan 1; 352: i555.

ObjectiveTo describe patterns in maternal gestational weight gain (GWG) in healthy pregnancies with good maternal and perinatal outcomes.DesignProspective longitudinal observational study.SettingEight geographically diverse urban regions in Brazil, China, India, Italy, Kenya, Oman, United Kingdom, and United States, April 2009 to March 2014.ParticipantsHealthy, well nourished, and educated women enrolled in the Fetal Growth Longitudinal Study component of the INTERGROWTH-21(st) Project, who had a body mass index (BMI) of 18.50-24.99 in the first trimester of pregnancy.Main Outcome MeasuresMaternal weight measured with standardised methods and identical equipment every five weeks (plus/minus one week) from the first antenatal visit (<14 weeks' gestation) to delivery. After confirmation that data from the study sites could be pooled, a multilevel, linear regression analysis accounting for repeated measures, adjusted for gestational age, was applied to produce the GWG values.Results13,108 pregnant women at <14 weeks' gestation were screened, and 4607 met the eligibility criteria, provided consent, and were enrolled. The variance within sites (59.6%) was six times higher than the variance between sites (9.6%). The mean GWGs were 1.64 kg, 2.86 kg, 2.86 kg, 2.59 kg, and 2.56 kg for the gestational age windows 14-18(+6) weeks, 19-23(+6) weeks, 24-28(+6) weeks, 29-33(+6) weeks, and 34-40(+0) weeks, respectively. Total mean weight gain at 40 weeks' gestation was 13.7 (SD 4.5) kg for 3097 eligible women with a normal BMI in the first trimester. Of all the weight measurements, 71.7% (10,639/14,846) and 94.9% (14,085/14,846) fell within the expected 1 SD and 2 SD thresholds, respectively. Data were used to determine fitted 3rd, 10th, 25th, 50th, 75th, 90th, and 97th smoothed GWG centiles by exact week of gestation, with equations for the mean and standard deviation to calculate any desired centiles according to gestational age in exact weeks.ConclusionsWeight gain in pregnancy is similar across the eight populations studied. Therefore, the standards generated in this study of healthy, well nourished women may be used to guide recommendations on optimal gestational weight gain worldwide.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

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