One size does not fit all: Examining ethnicity in gestational weight gain guidelines

Abstract

Pregnancy-related metrics vary by race/ethnicity, yet most gestational weight gain (GWG) guidelines are ethnicity-blind. We estimated small-for-gestational age (SGA) risk in a Japanese population, examining GWG adequacy categorized by Institute of Medicine (IOM) and Japanese guidelines in male (N  = 192) and female (N = 191) full-term singleton infants. For predicting SGA, IOM guidelines had high sensitivity ( ≥ 0.75), but low specificity ( ≤ 0.25); Japanese guidelines had high specificity ( ≥ 0.80) but low sensitivity ( ≤ 0.50). GWG guidelines’ implicit notions of Caucasian–Americans as optimal may lead to ‘One Size Fits All’ recommendations that can obscure important biocultural factors contributing to maternal child health outcomes.

Acknowledgments

We thank the women and children who generously shared their maternal child health handbooks and made this research possible. We gratefully acknowledge the cooperation and assistance of staff from the National Institute of Health and Nutrition; 佐久総合病院 (Saku Central Hospital) and 小海町 (Koumimachi); and the Boards of Education and the staff of the elementary and middle schools of Yachiho, Koumi and Kitamaki. We thank S. Watanabe for design and research coordination assistance, M. Kaihoku for research coordination and data entry, K. Maizuru for data entry, M. Griffin and S. Noazin for extensive data clean-up and preliminary analyses, Y. Ito for consultation about the use of Japanese anthropometric indicators and for data cleaning, and J. Yang for editorial assistance. Data and an earlier version of this manuscript were presented at the American Public Health Association annual meeting in 2016 and at the American Anthropological Association annual meeting in 2017. MM conceived and planned the study, collected the data, performed some analyses, consulted on final analyses, drafted and revised the manuscript. GY conducted data cleaning, all final statistical analyses, and revised the methods and results sections. DAS and PS consulted on final analyses and revised the manuscript. All authors edited the manuscript for intellectual content and provided critical comments on the manuscript.

Disclosure statement

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Additional information

Funding

This work was supported by the Wenner-Gren Foundation for Anthropological Research under Grant #7902; intramural funding from the National Institute of Health and Nutrition (Tokyo, Japan); the University of Delaware General University Research Fund under Grant #12A00454; and the Johns Hopkins Population Center under Grant #R24HD042854 (via National Institutes of Health NICHD).