Background
Methods
ADVANCE Clinical Research Network
Derivation of the PROMISE cohort
Identification of pregnancies
Inclusion and exclusion criteria
Data linkages
Linkage of parent and child clinical data
Birth record linkage
GIS data linkage
Study variables
Anthropometry of the birthing person
Pregnancy and child outcomes
Covariates
Statistical analysis
Study population characteristics
Frequency and timing of GWG data collection
Results
Derivation of the study cohort
Sociodemographic and baseline characteristics
Excluded (n = 12,667) | Included (n = 77,599) | |
---|---|---|
Age at delivery [mean (SD)] | 27.0 (6.3) | 27.9 (6.1) |
Age at delivery [n (%)] | ||
< 20 years | 1427 (11.3) | 6208 ( 8.0) |
20 to < 25 years | 3633 (28.7) | 18,915 (24.4) |
25 to < 30 years | 3329 (26.3) | 22,198 (28.6) |
30 to < 35 years | 2535 (20.0) | 17,979 (23.2) |
35 to < 40 years | 1350 (10.7) | 9811 (12.6) |
40 + years | 393 ( 3.1) | 2488 ( 3.2) |
Race and ethnicity | ||
NH-White | 2732 (21.6) | 17,617 (22.7) |
NH-Black | 1962 (15.5) | 9419 (12.1) |
NH-Asian | 562 ( 4.4) | 3286 ( 4.2) |
NH-Native HI/PI | 186 ( 1.5) | 408 ( 0.5) |
NH AI/AN | 51 ( 0.4) | 349 ( 0.4) |
NH-other | 111 ( 0.9) | 641 ( 0.8) |
Hispanic | 6620 (52.3) | 43,876 (56.5) |
Unknown | 443 ( 3.5) | 2003 ( 2.6) |
Preferred spoken language | ||
English | 7061 (55.7) | 42,710 (55.0) |
Spanish | 4378 (34.6) | 29,338 (37.8) |
Other | 1213 ( 9.6) | 5511 ( 7.1) |
Unknown | 15 ( 0.1) | 40 ( 0.1) |
Region | ||
OR | 3716 (29.3) | 21,089 (27.2) |
CA | 3798 (30.0) | 29,885 (38.5) |
WA | 1556 (12.3) | 4900 ( 6.3) |
Other | 3586 (28.3) | 21,677 (27.9) |
Unknown | 11 ( 0.1) | 48 ( 0.1) |
Income as a percent of FPL | ||
0–50% | 4537 (35.8) | 23,006 (29.6) |
> 50–100% | 2399 (18.9) | 18,062 (23.3) |
> 100–200% | 1923 (15.3) | 15,299 (19.7) |
> 200% | 549 ( 4.3) | 4539 ( 5.8) |
Unknown | 3249 (25.6) | 16,693 (21.5) |
Insurance status | ||
Uninsured | 1364 (10.8) | 5864 ( 7.6) |
Public | 9224 (72.8) | 63,816 (82.2) |
Private | 584 ( 4.6) | 7392 ( 9.5) |
Unknown | 1495 (11.8) | 527 ( 0.7) |
Tobacco use (pre-pregnancy to early pregnancy) | ||
Current | 327 ( 2.6) | 6750 ( 8.7) |
Former | 202 ( 1.6) | 6163 ( 7.9) |
Never | 1111 ( 8.8) | 37,646 (48.5) |
Unknown | 11,027 (87.1) | 27,040 (34.8) |
Tobacco use (mid-late pregnancy) | ||
Current | 936 ( 7.4) | 5663 ( 7.3) |
Former | 1206 ( 9.5) | 9630 (12.4) |
Never | 5698 (45.0) | 51,182 (66.0) |
Unknown | 4827 (38.1) | 11,124 (14.3) |
Gestational age at first pregnancy encounter (weeks) | ||
< 6 weeks | 1051 ( 8.3) | 20,772 (26.8) |
6 to < 9 weeks | 570 ( 4.5) | 24,451 (31.5) |
9 to < 14 weeks | 179 ( 1.4) | 19,908 (25.7) |
14 to < 28 weeks | 7609 (60.1) | 10,020 (12.9) |
28 + weeks | 3258 (25.7) | 2448 ( 3.2) |
Total number of pregnancy encounters in the second and third trimester | ||
0 | 1695 (13.4) | 11 ( 0.0) |
1–2 | 193 ( 1.5) | 4776 ( 6.2) |
3–5 | 3950 (31.2) | 9438 (12.2) |
6–10 | 5173 (40.8) | 34,240 (44.1) |
11–15 | 1536 (12.1) | 25,633 (33.0) |
16 + | 120 ( 0.9) | 3501 ( 4.5) |
Underweight (< 18.5) | Normal (18.5 to < 25) | Overweight (25 to < 30) | Obesity Class I (30 to < 35) | Obesity Class II (35 to < 40) | Obesity Class III (40 +) | |
---|---|---|---|---|---|---|
N | 1658 | 26,262 | 24,310 | 14,673 | 6536 | 4160 |
Age at delivery [mean (SD)] | 24.7 (5.4) | 26.7 (6.0) | 28.3 (6.1) | 29.0 (6.1) | 28.7 (5.9) | 28.9 (5.6) |
Age at delivery [%] | ||||||
< 20 years | 16.8 | 11.7 | 7.0 | 5.1 | 4.7 | 2.9 |
20 to < 25 years | 36.9 | 28.1 | 22.8 | 20.8 | 21.9 | 21.5 |
25 to < 30 years | 27.0 | 28.3 | 28.6 | 28.2 | 29.6 | 31.4 |
30 to < 35 years | 13.9 | 20.4 | 24.5 | 25.1 | 25.5 | 26.5 |
35 to < 40 years | 4.4 | 9.4 | 13.7 | 16.2 | 14.4 | 14.6 |
40 + years | 1.0 | 2.1 | 3.5 | 4.7 | 3.9 | 3.2 |
Race and ethnicity | ||||||
NH-White | 30.2 | 29.0 | 19.0 | 17.3 | 20.3 | 24.4 |
NH-Black | 17.5 | 11.4 | 10.8 | 12.2 | 14.6 | 18.8 |
NH-Asian | 12.8 | 7.0 | 3.3 | 2.0 | 1.3 | 0.8 |
NH-Native HI/PI | <1
| 0.3 | 0.4 | 0.7 | 1.0 | 1.1 |
NH AI/AN | <1
| 0.4 | 0.4 | 0.5 | 0.7 | 1.1 |
NH-other | 1.7 | 0.9 | 0.6 | 0.7 | 1.1 | 1.2 |
Hispanic | 33.6 | 47.7 | 63.1 | 64.6 | 58.8 | 50.7 |
Unknown | 3.4 | 3.2 | 2.4 | 2.0 | 2.3 | 2.0 |
Preferred spoken language | ||||||
English | 69.2 | 59.0 | 47.7 | 50.1 | 62.0 | 73.5 |
Spanish | 16.7 | 31.4 | 45.5 | 44.5 | 33.9 | 24.1 |
Other | 13.9 | 9.5 | 6.7 | 5.4 | 3.9 | 2.3 |
Unknown | <1 | 0.1 | 0.0 | 0.0 | 0.1 | 0.0 |
Region | ||||||
OR | 26.1 | 27.8 | 27.1 | 27.0 | 26.8 | 25.6 |
CA | 33.6 | 38.9 | 39.4 | 38.5 | 37.2 | 35.1 |
WA | 6.9 | 6.2 | 6.1 | 6.1 | 6.8 | 8.0 |
Other | 33.4 | 27.1 | 27.3 | 28.3 | 29.2 | 31.2 |
Unknown | <1
| 0.1 | 0.0 | 0.1 | 0.0 | 0.0 |
Income as a percent of FPL | ||||||
0–50% | 38.8 | 30.6 | 28.0 | 28.4 | 30.5 | 33.1 |
> 50–100% | 18.8 | 20.0 | 24.8 | 26.3 | 24.9 | 23.4 |
> 100–200% | 15.1 | 18.9 | 20.6 | 20.4 | 20.2 | 18.8 |
> 200% | 5.5 | 6.8 | 5.5 | 5.4 | 5.1 | 4.8 |
Unknown | 21.7 | 23.8 | 21.1 | 19.5 | 19.4 | 20.0 |
Insurance status | ||||||
Uninsured | 6.9 | 8.1 | 7.9 | 7.0 | 6.6 | 5.6 |
Public | 83.8 | 79.3 | 82.8 | 84.4 | 84.6 | 85.6 |
Private | 8.4 | 12.0 | 8.6 | 7.8 | 8.1 | 8.2 |
Unknown | <1
| 0.6 | 0.7 | 0.7 | 0.7 | 0.7 |
Tobacco use (pre-pregnancy to early pregnancy) | ||||||
Current | 13.4 | 9.0 | 7.1 | 7.9 | 10.7 | 13.6 |
Former | 6.2 | 8.0 | 7.1 | 7.4 | 9.5 | 12.3 |
Never | 38.1 | 44.4 | 51.5 | 52.6 | 49.3 | 45.1 |
Unknown | 42.3 | 38.5 | 34.2 | 32.1 | 30.5 | 29.0 |
Tobacco use (mid-late pregnancy) | ||||||
Current | 14.1 | 8.1 | 6.0 | 5.9 | 8.4 | 10.0 |
Former | 12.3 | 12.8 | 10.7 | 11.7 | 14.8 | 19.0 |
Never | 57.7 | 63.7 | 68.8 | 69.0 | 64.2 | 58.6 |
Unknown | 15.9 | 15.4 | 14.5 | 13.4 | 12.6 | 12.4 |
Gestational age at first pregnancy encounter (weeks) | ||||||
< 6 weeks | 23.3 | 24.2 | 26.7 | 29.0 | 29.9 | 32.1 |
6 to < 9 weeks | 29.2 | 30.5 | 32.3 | 31.8 | 32.5 | 32.0 |
9 to < 14 weeks | 23.9 | 26.6 | 25.9 | 25.4 | 23.9 | 22.6 |
14 to < 28 weeks | 18.0 | 14.7 | 12.3 | 11.5 | 11.4 | 10.7 |
28 + weeks | 5.6 | 4.1 | 2.7 | 2.4 | 2.3 | 2.5 |
Total number of pregnancy encounters in the second and third trimester | ||||||
0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 |
1–2 | 7.4 | 5.7 | 5.9 | 6.2 | 7.1 | 8.8 |
3–5 | 14.2 | 12.4 | 11.4 | 11.8 | 12.7 | 14.7 |
6–10 | 48.0 | 46.1 | 44.0 | 42.7 | 42.0 | 39.5 |
11–15 | 27.4 | 32.5 | 34.2 | 33.7 | 32.5 | 30.4 |
16 + | 3.0 | 3.3 | 4.6 | 5.5 | 5.7 | 6.5 |
Longitudinal data characteristics
Maternal pre-pregnancy BMI classification | |||||||
---|---|---|---|---|---|---|---|
Total | Underweight | Normal weight | Overweight | Obesity Class I | Obesity Class II | Obesity Class III | |
Total number of pregnancies | 77,599 | 1658 | 26,262 | 24,310 | 14,673 | 6536 | 4160 |
Days between last observed weight measure and delivery date [median (10th, 90th %ile)] | 5 (1, 46) | 5 (1, 50) | 5 (1, 43) | 5 (1, 43) | 5 (1, 46) | 6 (1, 53) | 6 (1, 63) |
Pregnancies with last observed weight measure within 2 weeks of the delivery date (%) | 78.0 | 75.1 | 79.4 | 78.5 | 77.3 | 75.6 | 73.0 |
Number of valid weight measures [median (10th, 90th %ile)] | |||||||
First trimester | 2 (0, 5) | 2 (0, 4) | 2 (0, 4) | 2 (0, 5) | 2 (0, 5) | 2 (0, 5) | 2 (0, 5) |
Second trimester | 4 (1, 6) | 3 (1, 5) | 3 (1, 5) | 4 (1, 6) | 4 (1, 6) | 4 (1, 6) | 4 (1, 6) |
Third trimester | 6 (1, 9) | 5 (1, 9) | 6 (1, 9) | 6 (1, 9) | 6 (1, 9) | 6 (1, 9) | 5 (0, 9) |
Pregnancies with 2 + valid weight measures in each trimester (%) | |||||||
First trimester | 68.0 | 60.2 | 64.7 | 69.3 | 70.5 | 70.4 | 71.6 |
Second trimester | 88.2 | 84.3 | 87.4 | 89.1 | 89.0 | 88.1 | 86.8 |
Third trimester | 88.0 | 85.9 | 88.9 | 88.6 | 88.0 | 86.1 | 82.5 |
Pregnancies with 2 + valid weight measures, at least one week apart, in each trimester (%) | |||||||
First trimester | 63.9 | 55.9 | 60.3 | 65.3 | 66.5 | 66.7 | 67.6 |
Second trimester | 87.2 | 82.9 | 86.3 | 88.2 | 88.2 | 87.3 | 85.8 |
Third trimester | 88.0 | 85.1 | 88.3 | 88.0 | 87.3 | 85.5 | 81.9 |
Gestational weight gain
Maternal pre-pregnancy BMI classification | ||||||||
---|---|---|---|---|---|---|---|---|
N | Total | Underweight | Normal weight | Overweight | Obesity Class I | Obesity Class II | Obesity Class III | |
Total GWG (kg)a | 56,503 | 11.85 (6.49) | 14.80 (5.25) | 14.10 (5.48) | 11.95 (6.04) | 9.93 (6.48) | 8.57 (7.03) | 6.88 (7.92) |
Total GWG (adherence to IOM/NAM recommendations)a (%) | ||||||||
< recommendations | 56,503 | 25.7 | 35.3 | 30.8 | 18.6 | 21.0 | 30.7 | 41.8 |
Within recommendations | 56,503 | 31.7 | 43.2 | 36.4 | 31.2 | 27.4 | 26.0 | 22.0 |
> recommendations | 56,503 | 42.6 | 21.5 | 32.8 | 50.2 | 51.6 | 43.3 | 36.1 |
First trimester (kg/week)b | 49,569 | 0.003 (0.45) | 0.16 (0.41) | 0.07 (0.41) | 0.00 (0.43) | -0.05 (0.46) | -0.08 (0.49) | -0.12 (0.56) |
Second trimester (kg/week)b | 67,708 | 0.46 (0.30) | 0.57 (0.26) | 0.55 (0.27) | 0.48 (0.28) | 0.39 (0.29) | 0.33 (0.30) | 0.25 (0.36) |
Third trimester (kg/week)b | 67,822 | 0.51 (0.34) | 0.54 (0.31) | 0.55 (0.30) | 0.51 (0.32) | 0.48 (0.34) | 0.46 (0.40) | 0.45 (0.48) |