Gestational weight gain recommendations

Although the need for appropriate weight gain during pregnancy has long been recognized, recommendations for weight gain have changed over the years as new data have become available. The changes in recommended ranges for gestational weight gain are summarized in Table 2.1.

Prior to 1970, it was standard obstetric practice to restrict gestational weight gain to between 18 and 20 lb (8-9 kg) [2]. Overeating was believed to cause large babies and, as a consequence, more difficult deliveries.

In 1970, the Food and Nutrition Board's Committee on Maternal Nutrition [6] recommended a higher gestational weight gain, 20-25 lb (9-11.5 kg). The increase was based on new evidence that low weight gain was related to increased risk of delivering low-birth-weight infants, with those infants at increased risk of mortality and developmental problems. This recommendation was followed by heightened interest in helping pregnant women achieve appropriate weight gain and nutrient intake. For example, the US Department of Agriculture (USDA) established the Special Supplemental Food Program for Women, Infants, and Children (WIC) to provide both food and nutrition education for nutritionally vulnerable women. This change in gestational weight gain recommendation, among other factors such as participation in the WIC program, contributed to an increase in gestational weight gain and fetal growth, as evidenced by an increase in mean birth weight, and a reduction in low birth weights [2].

In 1990, the Food and Nutrition Board of the Institute of Medicine (IOM) [1] recommended gestational weight ranges for women on the basis of their prepregnancy BMI. BMI is calculated by the weight in kilograms divided by the square of height in meters (kg/m2). The recommended total weight gain ranges were 28-40 lb (12.5-18 kg) for women with low BMI (<19.8), 25-35 lb (11.5-16 kg) for women with normal BMI (19.8-26), and 15-25 lb (7-11.5 kg) for women with high BMI (>26-29). It was recommended that young adolescents and African American women should strive for gains at the upper end of the recommended range. Short women (<157 cm)

Table 2.1

Historical Perspective: Total Gestational Weight Gain Recommendations

Recommended total gain

Reference Year (kg) (lb)

Table 2.1

Historical Perspective: Total Gestational Weight Gain Recommendations

Recommended total gain

Reference Year (kg) (lb)

Standard obstetric practice3

Prior to 1970

8-

9

18-

-20

National Research Council,

1970

9-

11.5

20-

-25

Food & Nutrition Board

Committee on Maternal Nutrition

Institute of Medicineb Food

1990

11.5-

-16

25-

-35

& Nutrition Board

World Health Organization

1995

10-

-14

22-

b Recommended total weight gain for pregnant women with normal body mass index (19.8-26)

b Recommended total weight gain for pregnant women with normal body mass index (19.8-26)

should strive for gains at the lower end of the range. The recommended target weight gain for obese women (BMI > 29) was at least 15 lb (6 kg). These ranges were derived from the 1980 US National Natality Survey and based on the observed weight gains of women delivering full-term (39-41 weeks), normal-growth (3-4 kg) infants without complications. Furthermore, the rate of weight gain recommended by the IOM was approximately 1 lb (0.4 kg) per week in the second and third trimesters of pregnancy for women with a normal prepregnancy BMI, slightly more than 1 lb (0.5 kg) per week for underweight women, and 0.66 lb (0.3 kg) per week for overweight women.

A comprehensive review of studies conducted by Abrams [7] showed that gestational weight gains within the IOM's recommended ranges were associated with the best outcome for both infants, in terms of birth weight, and for mothers, in terms of delivery complications and postpartum weight retention.

In 1995, the World Health Organization (WHO) Collaborative Study on Maternal Anthropometry and Pregnancy Outcomes [4] reviewed information on 110,000 births from 20 different countries to define desirable maternal weight gain. The range of gestational weight gain associated with birth weights greater than 3 kg was 22-31 lb (10-14 kg). Comparing the WHO weight ranges with the IOM's recommended weight ranges for women with low and normal prepregnancy BMI, the WHO's ranges are slightly lower than the IOM's ranges (10-14 kg versus 12.5-18 kg [low BMI] and 11.5-16 kg [normal BMI]).

In 2000, the US Department of Health and Human Services released the Healthy People 2010 document, with specific objectives for maternal and infant health [8]. One of these objectives (developmental) refers to increasing the proportion of mothers who achieve a recommended weight gain during their pregnancies. Unfortunately, approximately 50% of women receive no prenatal advice or inappropriate advice regarding gestational weight gain [9]. Cogswell and colleagues [10] found that among those who received advice, 14% were advised to gain less than the recommended weight, while 22% were advised to gain more than recommended. Further, the probability of being advised to gain more than the recommended weight were higher in women with high BMI (>26 kg/m2). When no advice on gestational weight gain was given, pregnant women tended to gain outside the IOM recommendations. Two groups of women who continue to gain less than the recommended level of weight during pregnancy are adolescents and African American women. As a result, they are at particular high risk for having low-birth-weight infants and preterm delivery. On the other hand, women who are overweight or obese are more likely than are women of normal weight to gain more weight than is recommended [11]. Exceeding the recommendations for weight gain was also found to be more likely in low-income women [12]. Outcomes related to excessive gestational weight gain include postpartum weight retention for the mother, future maternal overweight or obesity, and for the infant, childhood overweight/obesity [13]. Future attention should be directed to the relationship of pregnancy body weight gain to body fat gain for the development of dietary and weight gain recommendations.

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