COMMENTARY

New Recommendations for Weight Gain During Pregnancy

Marilyn W. Edmunds, PhD, CRNP

Disclosures

November 18, 2010

Implementation of the New Institute of Medicine Gestational Weight Gain Guidelines

Siega-Riz A, Deierlein A, Stuebe A
J Midwifery Womens Health. 2010;55:512-519

New Recommendations for Gestational Weight Gain

In May 2009, the Institute of Medicine introduced revised gestational weight gain guidelines[1] that balanced the benefits of and risks for weight gain for both the mother's and newborn's health. A year-long review of research investigating the implications of varying amounts of gestational weight gain on maternal and infant healthcare outcomes formed the basis for these guidelines. Since the original recommendations in 1990, average maternal prepregnancy body mass index (BMI) has been increasing, and many pregnant women are gaining much more than the recommended amount of weight.

The 2009 gestational weight gain guidelines. The 1990 guidelines used maternal pre-pregnancy BMI categories from the Metropolitan Life Insurance Tables. The new guidelines use BMI cut-points from the International Obesity Task Force. These BMIs are 18.5 kg/m2, 25 kg/m2, and 30 kg/m2, representing, respectively, underweight, normal weight, and overweight or obese women. This classification will result in a smaller proportion of women being classified as underweight before pregnancy, and a larger proportion being classified as overweight.

These changes, adopted internationally, should send a "consistent message" to both women and healthcare providers about the importance of weight status in pregnancy. The new guidelines are to be used for adolescents also, unlike earlier classifications that varied with age. The result of this change will be that more pregnant adolescents will be classified as normal weight rather than overweight and they will be advised to gain more weight. This change conforms to previous research showing that higher weight gains for adolescents who may still be growing produces optimal birth outcomes.

Gestational weight gain recommendations. The recommendations for gestational weight gain are as follows:

  • Underweight women should gain 28-40 lb;

  • Normal weight women should gain 25-35 lb;

  • Overweight women should gain 15-25 lbs (this is unchanged from 1990); and

  • Obese women should gain 11-20 lb (this is a new recommendation).

The guidelines also offer recommendations for weight gain on the basis of race, age, and height or when multiple fetuses are involved.

Many women will have difficulty confining their weight gain to these ranges and will require guidance on diet and physical activity if they are to gain the appropriate amount of weight. The important role of healthcare providers in the implementation of the new recommendations is emphasized, and specific guidance for troubleshooting issues that may be encountered when helping women achieve appropriate gestational weight gains is provided.

Viewpoint

For any healthcare provider caring for pregnant women, this is an important article to review. Unlike many articles that discuss the problem and suggest that women will need help, this article focuses on how healthcare providers can work with women before conception, during each trimester of pregnancy, and during the postpartum period. Factors that lead to excessive weight gain are identified for each of these periods, and specific strategies and content are provided to help women avoid unnecessary weight gain. The strategies deal not only with the physiologic processes of pregnancy, diet, and nutrition, but also with the psychological issues that may be related to eating and exercise. Suggestions for how the healthcare provider can consistently work with the mother are practical, realistic, and workable. These suggestions are particularly applicable to the nurse practitioner whose role it is to teach, counsel, and advocate for her patients.

Abstract

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