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5 Total Amount and Pattern of Weight Gain: Physiologic and Maternal Determinants
Pages 96-120

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From page 96...
... NORMS FOR TOTAL GAIN, RATE OF GAIN, ANI) COMPOSITION OF GAIN Pattern and Amount of Gain In 1971, Hytten and Leitch established physiologic norms for total weight gain, the rate of gain in the last half of pregnancy, and the rate of gain associated with the best reproductive performance.
From page 97...
... Hytten and Leitch emphasized, however, that considerable variation of this pattern is consistent with good pregnancy outcomes. The lowest incidence of preeclampsia, low birth weight, and perinatal death was associated with gaining 0.45 kgAveek during the last 20 weeks of pregnancy.
From page 98...
... In addition to increases in uterine and mammary tissue mass, there is an expansion of maternal blood volume, extracellular fluid, fat stores, and possibly other tissues. In laboratory animals, an increase in liver and intestinal mucosal mass during gestation is evident, but there is no evidence that these tissues increase in pregnant women.
From page 99...
... A reported positive relationship between the increased total body water and infant birth weight (Hytten, 1980b) suggests that water accumulation is beneficial.
From page 100...
... (1986) , mean weight gains were higher at each gestational period.
From page 102...
... constructed a graph of the weight gain pattern of 80 pregnant girls aged 19 or less. The slope of the rate of gain for the adolescents was described as steeper than that for adult pregnant women.
From page 103...
... 103 o U: t Cry =4 Cal Cal of .s Ct ~ ~ -o ~ o Ct o o ;^ ·= U: ~ ,~ C: 3 Ct ~ o Ct ~ Cal or US ..
From page 105...
... A slowing of weight gain or a slight weight loss has been consistently reported as women approached term (Cummings, 1934; Kuo, 1941; Robinson et al., 1943; Scott and Benjamin, 1948~. Few investigators have evaluated weight gain during the first trimester in detail.
From page 106...
... Brown et al., 1986 (197~1982 8 4 2 o / /// To/ At/ q : / 1 1 1 1 1 1 1 1 1 1 i' // 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40 Week of Gestation FIGURE 5-5 Pattern of maternal weight gain shown by the six studies in Figure 5-4 that focused on well-nounshed women in Europe and the United States who had uncomplicated pregnancies. that maternal gain averaged 2 kg (4.5 lb)
From page 107...
... per week These ranges pertain to normal pregnancies of women with various maternal ages, heights, and prepregnancy weights for height. ADJUSTMENTS IN INTAKE AND UTILIZATION OF ENERGY SOURCES DURING PREGNANCY To estimate the energy cost for weight gain during pregnancy, the theoretical energy need (approximately 85,000 kcal)
From page 108...
... Adjustments in fat utilization occur between meals to provide for maternal energy needs while conserving glucose and amino acids for fetal fuel and synthesis of maternal and fetal lean tissue. MATERNAL DETERMINANTS OF THE PATTERN AND AMOUNT OF WEIGHT GAIN As mentioned earlier, gestational weight gain differs widely among healthy women delivering single, full-term infants, partly because of differences in maternal characteristics such as prepregnancy weight-for-height status, age, parity, ethnic origin, socioeconomic status, substance abuse, and physical activity level.
From page 109...
... presented the distribution of total weight gains according to four BMI groups: <19.8, 19.8 to 26.0, 26.1 to 29.0 and >29.0, i.e., low, moderate, high, and very high weight for height. The subcommittee located 10 reports published between 1970 and 1989 on the relationship between maternal prepregnancy weight-for-height status and weight gain (see Table 5-3~.
From page 110...
... a Standards varied among the studies. Weight-for-height tables from Metropolitan Life Insurance Company (1959)
From page 111...
... , and coefficients of variation of gain for women with normal prepregnancy weights ranged from 31 to 63%. This degree of variation in gain after controlling for differences in maternal body size shows that maternal prepregnanc,, weight-for-height status accounts for only a small part of the variation in weight gain.
From page 112...
... designed to determine whether there is an independent effect of maternal height on total weight gain. In this study, data from the 1980 NNS were analyzed by using multiple linear regression techniques to control for BMI, age and parity, education level, alcohol use, ethnic origin, and cigarette smoking; a significant effect of height on weight gain was observed.
From page 113...
... After controlling for the effects of prepregnancy weight, marital status, education, and age combined with parity, white women still gained about 0.5 kg more than black women did. The gestational period of white women tended to be about 0.5 week longer than that of black women, but this difference only partly explained the higher gains of the white women.
From page 114...
... This finding, plus the observation that 12- to 13-year-old Peruvian mothers gained less weight (Frisancho et al., 1983) , suggests that the weight gains of very young adolescents (<2 years after menarche)
From page 115...
... In a study of 204 alcohol abusers and 11,123 alcohol nonabusers (Sokol et al., 1980) , no differences were found in maternal prepregnancy weight, height, or gestational weight gain between the two groups.
From page 116...
... Mean weight gain was similar for women in all educational groups, but compared with mothers with 13 or more years of education, the risk of low weight gain was 50% higher among mothers with <12 years of education and 25% higher among those with 12 years of education. Work or Physical Activity Studies on the effect of heavy work or physical activity on weight gain should be interpreted with caution, because high energy expenditure can be offset by increases in energy intake so that energy balance is maintained.
From page 117...
... Hormonal adjustments that induce changes in the efficiency of fuel use for tissue synthesis are possible, but actual measurements of the energy cost for fat or lean tissue synthesis in pregnant women have not been made. Differences in the physiologic response to pregnancy may account for much of the diversity in gains, but certain maternal factors, e.g., high prepregnancy weight for height, short stature, black or Southeast Asian background, very young age (<2 years after menarche)
From page 118...
... These women should receive additional nutritional counseling to ensure an adequate weight gain during pregnancy. · No evidence was found to suggest that work outside the home or regular physical activity increases the risk of low weight gains during pregnancy.
From page 119...
... 1984. Prepregnancy weights and weight gains related to birth weights of infants born to overweight women.
From page 120...
... 1986. Birth weight, Apgar scores, labor and delivery complications and prenatal characteristics of Southeast Asian adolescents and older mothers.


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