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Pregnancy Guide Update: Weight Gain

The Institute of Medicine published new pregnancy weight gain guidelines in 2009. The revisions from the 1990 recommendations are minor; but they reflect a major change in thinking.  Previous guidelines intended to protect against low birth weight. The new guidelines intend to protect against obesity.  

Nearly 60% of mothers begin pregnancy either overweight or obese.  And rates of excessive weight gain during pregnancy have increased steadily over the past decade. This is problematic for several reasons. It’s a public health concern, since extra pounds gained during pregnancy predict obesity in children by age three. In addition, extra pregnancy pounds have proved hard to shed, so that women who start pregnancy at normal weight but gain too much, tend to become permanently obese, and to produce children prone to obesity. That means we are programming obesity and its related health risks into future generations, and obesity is one of the greatest future challenges for maternity care.

Here’s the current Key Message from the Beginnings Pregnancy Guide:

Gain Weight. You must gain weight. Plan to gain 25 to 35 pounds. Try to gain more if you are very slim or still growing. Even if you are overweight now, gain at least 15 pounds, or as much as your doctor advises. No dieting!

The message remains accurate since the recommended gestational weight gain ranges remain unchanged:

·  25 to 35 pounds for women beginning pregnancy at normal weight
·  28 to 40 pounds for those who are underweight
·  15 to 25 pounds for overweight women
·  New! 11 to 20 pounds for obese women

Black women, teens, and short women   are included in the new recommendations. Guidelines specific to these groups have been removed.
              
In light of the new guidelines and research findings, in the 2011 Edition of the Pregnancy Guide, the key message will be edited to read as follows:
Gain weight.  Plan to gain 25 to 35 pounds.  If you are very slim, try to gain more (up to 40 pounds). Even if you are overweight now, gain at least 11 pounds. Extra weight gain is very hard to lose after pregnancy, and can cause problems for you and your baby.  Keep track of your weight. Aim for slow steady gain.
              
Recent studies identify barriers to weight gain counseling.  Prenatal care providers report lack of training to calculate appropriate weight gain and to provide counseling on weight management, concern about the sensitivity of the topic, and the perception that counseling is ineffective.  That means health educators, parent educators, case managers, home visitors, WIC counselors, and doulas and others who work with pregnant women need to be prepared to support weight management.

I’m editing and adding content to support you in doing that.  One issue is that the recommendations are based on pre-pregnancy BMI – body mass index.  You can now calculate BMI for yourself or a mom you’re supporting on the Beginnings Guides website. BMI calculator.  

Do you know about an app for cell phones? 
Please share by leaving a Comment

Weight Gain References:

American Dietetic Association (2009). Position of the American Dietetic Association and American Society for Nutrition: Obesity, Reproduction, and Pregnancy Outcomes. 

Journal of the American Dietetic Association (109): 918-927. Josefson  J. The impact of pregnancy nutrition on Offspring Obesity. (2011).

Journal of the American Dietetic Association:  50-52 Margerison Zilco CE, Rehkopf D & Abrams B. (2010). Association of maternal gestational weight gain with short- and long-term maternal and child outcomes. 

American Journal of Obstetrics & Gynecology: 573e2-574e8 Olander EK, Atkinson L, Edmunds JK & French DP. (2011). The views of pre- and post-natal women and health professionals regarding gestational weight gain: An exploratory study. Sexual & Reproductive Healthcare 2: 43-48 Rasmussen KM & Yaktine AL. (Eds.)

Committee to Reexamine IOM Pregnancy Weight Guidelines (2009). Weight Gain During Pregnancy: Reexamining the Guidelines. Institute of Medicine, National Research Council.  Free executive summary available online: http://www.nap.edu/catalog/12584.html Siega-Riz  AM, Deierlein A, & Stuebe A.(2010). Implementation of the New Institute of Medicine Gestational Weight Gain Guidelines.

Journal of Midwifery & Women’s Health 55(6):512-519. Stotland NE, Gilbert P, Bogetz A, Harper CC, Abrams B & Gerbert B. (2010). Preventing Excess Weight Gain in Pregnancy: How do prenatal care providers approach counseling? Journal of Women’s Health 19(4):807-814.



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