Improving Compliance to IOM Recommendations

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In 2000, Abrams et al. [72] conducted a systematic review of available observational data published between 1990 and 1997 on weight gain and maternal and fetal outcomes. Not surprising, this review showed that pregnancy weight gain within the IOM recommended range was associated with the best outcome for both mothers and infants. However, this review also found that most women were noncompliant with these guidelines; many women were gaining excessive amounts of weight. Researchers speculated many reasons for these findings, including environmental temptations, inactivity, and prepregnancy restrictive dieting. They also reported that many women were not given appropriate targets for weight gain. The Women and Infants Starting Healthy study also found that from pregnant women studied in the San Francisco Bay area (excluding women with preterm birth, multiple gestation, or maternal diabetes), 50% of obese women were given advice by their physician to overgain, 35% of underweight women were given advice to undergain, and 87% of women with normal weight were given advice to gain an appropriate amount of weight [73]. The proportion of women who received no advice at all was 33%. This suggests that some providers are not aware of BMI-specific weight gain guidelines and may be advising all women to gain within the same range. Greater public health efforts should be made to ensure that all clinicians and pregnant women are educated on appropriate weight gain targets in pregnancy. In clinical practice, pre-pregnancy BMI should be ideally recorded at the first visit in the first trimester, followed by regular monitoring of gestational weight gain throughout pregnancy. An appropriate care plan should be developed and implemented should rate of weight gain veer significantly from established guidelines.

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