Weight Gain During Pregnancy Reexamining the Guidelines (2009) / Chapter Skim
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Department of Health and Human Services Health Resources and Services Administration; Centers for Disease Control and Prevention Division of Nutrition and Physical Activity and Obesity; National Institutes of Health Eunice Kennedy Shriver National Institute of Child Health and Human Development; National Institutes of Health National Insti tute of Diabetes and Digestive and Kidney Diseases; U.S. Department of Health and Human Services Office on Women's Health; U.S.
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Specifically, the committee was asked to review evidence on relationships between weight gain patterns before, during, and after pregnancy and maternal and child health outcomes; consider factors within a life-stage framework associated with outcomes such as lactation performance, postpartum weight retention, and cardiovascular and other chronic diseases; and recommend revisions to existing guidelines where necessary. Finally, the committee was asked to recommend ways to encourage the adoption of the weight gain guidelines through consumer education, strategies to assist practitioners, and public health strategies.
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The committee was unable to identify evidence sufficient to continue to support a modification of GWG guidelines for women of short stature. Although women of short stature had an increased risk of emergency cesarean delivery, this risk was not modified by GWG.
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Inasmuch as the committee was unable to conduct the same kind of analysis for women with twins as it did for women with singletons, the committee offers the following provisional guidelines: normal weight women should gain 17-25 kg (37-54 pounds) , overweight women, 14-23 kg (31-50 pounds)
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Research Recommendation S-1: The committee recommends that the National Institutes of Health and other relevant agencies should provide support to researchers to conduct studies in large and diverse populations of women to understand how dietary intake, physical activity, dieting practices, food insecurity and, more broadly, the social, cultural, and environmental context affect GWG. In developing its recommendations, the committee identified a set of consequences for the short- or long-term health of the mother and the child that are potentially causally related to GWG.
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WEIGHT GAIN DURING PREGNANCY SOCIAL/BUILT/NATURAL AND LIFE-STAGE ENVIRONMENT Societal/Institutional: media, culture and acculturation, health services, policy Environmental: altitude, environmental toxicants, natural and man-made disasters Neighborhood/Community: access to healthy foods, opportunities for physical activity Interpersonal/Family: family violence, marital status, partner and family support MATERNAL FACTORS Genetic characteristics Developmental programming Epigenetics Sociodemographic, e.g., age, race or ethnicity, socioeconomic status, food insecurity Anthropometric and Physiological, e.g., prepregnancy BMI, hormonal milieu, basal metabolic rate Medical, e.g., pre-existing morbidities, hyperemesis gravidarum, anorexia nervosa and bulimia nervosa, bariatric surgery, multiple births Psychological, e.g., depression, stress, social support, attitude toward weight gain Behavioral, e.g., dietary intake, physical activity, substance abuse, unintended pregnancy ENERGY BALANCE/NUTRIENT Food, energy, nutrient intake TOTAL AND OVERALL PATTERN OF GESTATIONAL WEIGHT GAIN Fetus Mother Fetal growth Fat-free mass -Fat-free mass Fat mass Placenta -Fat mass Amniotic fluid NEONATAL OUTCOME PREGNANCY AND BIRTH OUTCOME Stillbirth Consequences during pregnancy Birth defects Consequences at delivery Infant mortality Maternal mortality Fetal growth Preterm birth LONG-TERM CONSEQUENCES POSTPARTUM OUTCOMES Neonatal body composition Lactation Infant weight gain Weight retention Breastfeeding Postpartum depression Obesity Long-term consequences Neurodevelopment Allergy/Asthma Cancer indicates possible modification of effect indicated by arrow on which it abuts indicates possible causal influences FIGURE S-1 Schematic summary of potential determinants and consequences for gestational weight gain. SOURCE: Modified from IOM, 1990.
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Research Recommendation S-2: The committee recommends that the National Institutes of Health and other relevant agencies should provide support to researchers to conduct studies in all classes of obese women, stratified by the severity of obesity, on the determinants and impact of GWG, pattern of weight gain, and its composition on maternal and child outcomes. Key Finding S-5: There are only limited data available with which to link GWG to health outcomes of mothers and children that occur after the neonatal period.
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, parity, racial/ethnic group, socioeconomic status, co-morbidities, and maternal/paternal/fetal genotype. Research Recommendation S-6: The committee recommends that the National Institutes of Health and other relevant agencies should provide support to researchers to conduct observational and experimental studies to assess the impact of variation in GWG on a range of child outcomes, including duration of gestation and weight and body composition at birth, and neurodevelopment, obesity and related outcomes, and asthma later in childhood.
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Action Recommendation S-3: The committee recommends that appropriate federal, state, and local agencies as well as health care providers should inform women of the importance of conceiving at a normal BMI and that all those who provide health care or related services to women of childbearing age should include preconceptional counseling in their care. Second, a higher proportion of American women should limit their GWG to the range specified in these guidelines for their prepregnant BMI.
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In addition, special attention should be given to low-income and minority women, who are at risk of being overweight or obese at the time of conception, consuming diets of lower nutritional value, and of performing less recreational physical activity. Action Recommendation S-5: To assist women to gain within the guidelines, the committee recommends that those who provide prenatal care to women should offer them counseling, such as guidance on dietary intake and physical activity, that is tailored to their life circumstances.
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• Offering services, such as counseling on diet and physical activ ity, to all pregnant women to help them achieve the guidelines on GWG contained in this report. This may also reduce their obstetric risk, reduce postpartum weight retention, improve their long-term health, normalize infant birth weight, and offer an additional tool to help to reduce childhood obesity.
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2006. Recommendations to improve preconception health and health care -- United States.
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