Background: Associations between pregnancy weight gain and adverse outcomes may be spurious due to confounding by factors not typically measured in cohort studies. We determined the extent to which the addition of detailed behavioral, psychosocial, and environmental measurements to commonly available covariates improved control of confounding. Methods: We used data from a prospective U.S. pregnancy cohort study (2010‒2013, n=8978). We calculated two propensity scores for low and high pregnancy weight gain (vs. adequate gain) using 11 standard confounders (e.g., age, education). We examined the balance of characteristics between weight gain groups before and after propensity score matching. We used negative binomial regression to estimate the association between weight gain and small- and large-for-gestational-age birth, preterm birth, and unplanned Cesarean delivery, controlling for propensity score. To this model we then added 17 detailed behavioral, psychosocial, and environmental measurements ('fully adjusted'). We calculated the risk ratio due to confounding as the ratio of the standard confounder-adjusted risk ratio to the fully adjusted risk ratio. Results: There were minimal imbalances between weight gain groups in detailed measures after matching for a propensity score of standard covariates. Accordingly, the inclusion of detailed covariates had minimal impact on estimated associations between low or high pregnancy weight gain and adverse pregnancy outcomes: risk ratios due to confounding were null for all outcomes (e.g., 1.1 [95% CI: 1.0, 1.1] for low weight gain and preterm birth). Conclusions: Adjustment for detailed behavioral, psychosocial, and environmental measurements had minimal impact on estimated associations between pregnancy weight gain and adverse perinatal outcomes. Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
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