Weight Gain During Pregnancy Reexamining the Guidelines (2009) / Chapter Skim
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1 Setting the Stage for Revising Pregnancy Weight Guidelines: Conceptual Framework
1 Setting the Stage for Revising Pregnancy Weight Guidelines: Conceptual Framework
Pages 13-24
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From page 13... ...
, developed from concern about high neonatal and infant mortality rates in the United States compared to other developed countries. In that report, the Committee on Maternal Nutrition recognized the positive relationship between gestational weight gain (GWG)
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From page 14... ...
Notably, the population of U.S. women of childbearing age has become more diverse; and prepregnancy BMI and excess GWG have increased across all population groups, particularly among minority groups who are already at risk for poor maternal and child health outcomes (Yeh and Shelton, 2005; Kim et al., 2007)
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From page 15... ...
Although low birth weight remains a significant concern during pregnancy, new health concerns have emerged. These include the greater prevalence of women who are overweight or obese entering pregnancy, which puts them at high risk for pregnancy complications.
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From page 16... ...
The purpose of this workshop was to review trends in maternal weight; explore emerging research findings related to the complex relationship of the biological, behavioral, psychological, and social interactions that affect maternal and pregnancy weight on maternal and child health outcomes; and discuss interventions. The following specific questions were addressed by the workshop: • What research and databases describe the distribution of maternal weight (prior to, during, and after pregnancy)
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From page 17... ...
Review evidence on the relationship between weight gain patterns before, during, and after pregnancy and maternal and child health outcomes, with particular attention to the prevalence of maternal obesity racial/ethnic and age differences, components of GWG, and implications of weight during pregnancy on postpartum weight retention, maternal and child obesity, and later child health.
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From page 18... ...
, psychosocial, community, health care, and health systems; • timing and components of interventions; and • ways to enhance awareness and adoption of the guidelines, including interdisciplinary approaches, consumer education to men and women, strategies to assist practitioners to use the guidelines, and public health strategies.
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From page 19... ...
. Moreover, the safety and effectiveness of a set of guidelines is a function of many factors, including adoption and use of the guidelines by the health care team, acceptance and actual use of the guidelines by their target audience, barriers the target audience might experience in achieving the guidelines and, finally, whether those who actually meet the guidelines have better outcomes.
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From page 20... ...
20 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 1-1 Schematic summary of potential determinants and consequences for gestational weight gain. SOURCE: Modified from IOM, 1990.
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From page 21... ...
Chapter 5 focuses on maternal outcomes and Chapter 6 on offspring outcomes. The conceptual framework upon which the committee based its deliberations draws attention not just to outcomes in the perinatal and postpartum periods but also to those that occur much later in the lives of mothers and their children.
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From page 22... ...
Workshop Report. Committee on the Impact of Pregnancy Weight on Maternal and Child Health.
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From page 23... ...
2005. Increasing prepregnancy body mass index: analysis of trends and contributing variables.
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