Recommendations for weight gain during pregnancy

Guidelines for weight gain during pregnancy aim to promote adequate, but not excessive, weight gain for optimal fetal development. Weight gain is highly correlated with infant birth weight making optimal weight gain during pregnancy important to fetal outcomes [1]. For a thorough discussion of optimal weight gain for pregnancy, the reader is referred to Chap. 2, "Optimal Weight Gain," in Part 1 of this book. In brief, the Institute of Medicine (IOM) developed guidelines for maternal weight gain based on aggregate data examining fetal outcomes and associated maternal conditions [1]. These guidelines, adapted by both the American College of Obstetrics and Gynecology (ACOG) and the American Dietetic Association (ADA), use maternal body mass index (BMI, kg/m2) prior to conception (Tables 13.1, 13.2) as a starting point for recommended weight gain during pregnancy [1-4]. Although these guidelines are available to women during pregnancy, educational programs regarding how to follow these guidelines appear to be lacking as evidenced by several studies documenting that only 30-40% of American women meet the IOM guidelines for weight gain [1, 3].

Table 13.1

ACOG Guidelines for Weight Gain during Pregnancy [1]

Condition prior to pregnancy

Weight gain guideline (lb)

Underweight Normal weight

Overweight Obese

28-40 (12.7-18.2 kg) 25-35 (11.4-16 kg) 15-25 (6.8-11.4) 15 (6.8 kg)

Twins/triplets

Table 13.2

ADA Position Paper: Guidelines for Weight Gain during Pregnancy

Body mass index (BMI) Recommended weight gain Weight gain/week after 12 weeks

Table 13.2

ADA Position Paper: Guidelines for Weight Gain during Pregnancy

Body mass index (BMI) Recommended weight gain Weight gain/week after 12 weeks

BMI <19.8

12.5-18 kg (28-40 lb)

0.5 kg (1 lb)

BMI 19.8-26

11.5-16 kg (25-35 lb)

0.4 kg (0.9 lb)

BMI > 26-29

7-11.5 kg (15-25 lb)

0.3 kg (0.7 lb)

BMI > 29

At least 7 kg (15 lb)

Twin pregnancy

15.9-20.4 kg (34-45 lb)

0.7 kg (1.5 lb)

Triplet pregnancy

Overall gain of 22.7 kg (50 lb)

While managing a healthy weight throughout pregnancy may be a challenge for many women, it is important for women to embrace the fact that they are pregnant and need to gain weight in order to ensure having a healthy baby. Weight reduction during pregnancy is discouraged and has been associated with neuropsychological abnormalities and low birth weight in the infant [2]. Conversely, excess weight gain can place women at higher risk for complications. Women should not use pregnancy as an excuse to eat excessively.

Although diet is a key component to weight maintenance, exercise, rest, and lifestyle are also highly important. During pregnancy, women should strive to eat a varied diet that encompasses all of the nutrients essential for fetal development. This varied diet should be well balanced and not too high or low in any one of the macronutrients.

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