The GWG in this study was defined by the difference between the last measured weight (i.e., prenatal weight before delivery) and the pre-pregnancy weight. Then we classified the GWG of each participant into three groups (i.e., below, within and above) according to the IOM recommendations [21], but with the pre-pregnancy BMI stratified by the Chinese recommendation: underweight (BMI < 18.5 kg/m2), normal weight (18.5 ≤ BMI < 24.0 kg/m2), overweight (24.0 ≤ BMI < 28.0 kg/m2) and obese (BMI ≥ 28.0 kg/m2). In the final analysis, we further combined the overweight and obese groups due to their being only a few participants in the obese group. For the outcome variable, we classified the delivery modes into two types in our questionnaire, i.e., vaginal delivery and CS.

A wide range of potential covariates were available for careful consideration of confounding factors. The definitions of those covariates are displayed as follows. They included maternal age in years (< 25, 25–29, 30–35, ≥ 35), ethnicity (Han, minorities), employment before pregnancy (yes, no), personal income per month in Chinese Yuan(< 3000, 3000–4999, 5000–9999, ≥ 10,000), education in schooling years (≤ 12 years, 13–15 years, ≥ 16 years), drinking status before pregnancy (yes or no), smoking status before pregnancy (yes or no), gravidity (1, 2, 3, ≥ 4), parity (primiparous or multiparous), physical activity (MET-h/week), energy intake (kcal/day), anxiety status measured by the SAS score, depression status measured by the SDS score and sleep quality measured by the PSQI score.

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