Guideline for Pregnancy Weight Gain Offers Targets for Obese Women
Authors: Bridget M. Kuehn
Journal: JAMA (2009)

ANEW GUIDELINE FROM THE INSTItute of Medicine (IOM) emphasizes that physicians should advise patients on the appropriate amount of weight gain during pregnancy. It also tweaks previous recommendations for pregnancy weight gain to account for greater numbers of mothers who are obese or pregnant with twins. The target ranges for weight gain for underweight, normal weight, and overweightwomensetby theorganization in 1990remainunchangedinthenewguideline.However, thedocument’sbodymass index (BMI) ranges for each weight category were slightly changed to conform to thoseusedby theWorldHealthOrganization rather than those derived from the Metropolitan Life Insurance tables used for the previous guideline. More notably, the guideline lowers the minimum recommended weight gain for women who are obese, from the 6.8 kg recommended in 1990 to 5 kg. It also for the first time suggests an upper weight gain limit for these women of 9 kg. Recommendationsarealsooffered forweight gain during twin gestations. Kathleen M. Rasmussen, ScD, chair of the IOM committee that created the updated guideline and professor of nutrition at Cornell University in Ithaca, NY, explained that the population of pregnant women has changed substantially since 1990. Today, more women are overweight or obese when they begin their pregnancy and more of them are conceiving at older ages. In addition, a greater proportion of pregnancies are occurring among women from minority groups and a greater proportion of women are gaining amounts of weight during pregnancy that fall above or below the previous IOM guideline. The 1990 guideline focused on creating targets for pregnancy weight gain that would improve such fetal outcomes as reducing low birth weight and preterm birth, both of which are associated with insufficient weight gain during pregnancy. But the new guideline seeks to balance the health of the mother and child, Rasmussen explained. Women who begin pregnancy overweight or obese are at higher risk of hypertension, preeclampsia, and diabetes during pregnancy and are also at greater risk of cesarean delivery. The committee also considered thepotential long-termhealth consequences for women who gain excessive weight during pregnancy and retain it after parturition. To improve pregnancy outcomes and boostwomen’shealth, thenewguideline recommends that physicians counsel women to achieve a healthy weight beforeconception.Clinicianstreatingpregnant women also should offer advice aboutweightgainduringpregnancy,discuss proper nutrition and exercise, and refer patients to nutritionists or exercise specialists when appropriate. Rasmussen also emphasized that physicians should take an individualized approach. Women who might have poor diets or engage in minimal exercise may require special attention, she said. After delivery, to help women return to a normal weight, physicians should counsel womenabout losing theweight theyhave gained during pregnancy, she said. Noting that currently available data on gestational weight gain are insufficient, the committee called on federal and state agencies to routinely collect related information and called for more research on the impact of weight gain on pregnancy outcomes and women’s health, including studies that break out various BMI categories. Thecommittee’s recommendations for weight gain for women who are obese have already proven controversial. Naomi E. Stotland, MD, an assistant professor in the department of obstetrics, gynecology, and reproductive sciences at the University of California, San Francisco, who was not involved in the cre-