Few Pregnant Women Stay in Recommended Range for Weight Gain

Diana Swift

November 06, 2015

Just 32.1% of pregnant women who delivered in the United States in 2012 and 2013 had a gestational weight gain (GWG) within the range recommended by the Institute of Medicine, according to a report published in the November 5 issue of the Morbidity and Mortality Week Report.

Although about one in five women gained inadequate weight, opening the door to low-birthweight babies, close to half gained too many pounds, highlighting the need for prenatal interventions.

"The high prevalence of excessive GWG, which varies by state and prepregnancy [body mass index], is of concern because excessive GWG increases the risk for macrosomia, postpartum weight retention, and obesity in mothers and possibly children," write Nicholas P. Deputy, MPH, a research fellow in the Centers for Disease Control and Prevention's Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, Georgia, and colleagues.

Earlier this year, Deputy and fellow researchers reported that 20.9% of US pregnant women gained less than the recommended amount of weight, 32.0% the appropriate amount, and 47.2% more than the recommended amount, but that study did not examine prevalence by state.

In the current report, they estimate the state-specific prevalence of GWG below, within, and above Institute of Medicine recommendations (referred to as inadequate, appropriate, and excessive, respectively). To do this, they analyzed 2013 birth data for US resident women who delivered full-term (37 - 41 weeks' gestation) singleton infants from 43 jurisdictions (41 states, New York City, and the District of Columbia) that used the 2003 revised birth certificate, which collects maternal height, prepregnancy weight, and delivery weight.

In addition, they studied 2012 data from the Pregnancy Risk Assessment Monitoring System for five states that had not yet adopted the 2003 birth certificate.

The ranges for GWG recommended by the Institute of Medicine are 28 to 40 pounds for underweight women, 25 to 35 pounds for women of normal weight, 15 to 25 pounds for overweight women, and 11 to 20 pounds for obese women.

The prevalence of the three GWG categories across the states included in the study ranged from 12.6% to 25.5% inadequate, 26.2% to 39.0% appropriate, and 38.2% to 54.7% excessive. The prevalence of inadequate GWG was 20% or higher in 20 states and New York City; the prevalence of excessive GWG was 50% or higher in 17 states.

Topping the excessive list were Alaska and Iowa, with about 55% of mothers-to-be gaining too much weight. Arkansas and New Jersey had the highest proportions of appropriate GWG, at 38% and 39%, respectively, whereas in Georgia and Wisconsin, about a quarter of mothers had inadequate GWG.

In stratification by prepregnancy body mass index categories, the variations by state persisted, and overweight women had the highest prevalence of excessive GWG in nearly every state.

The study authors call for intensified, multifaceted strategies to increase the proportion of women who achieve appropriate GWG, in the interest of maternal and child health.

They point out that only during the second and third trimesters do most women need to consume an additional 340 to 450 calories per day to support the metabolic demands of pregnancy. Strategies to promote appropriate GWG might include setting daily calorie goals and doing 150 minutes per week of moderate-intensity physical activity such as brisk walking. Routine self-monitoring of weight gain should begin early in pregnancy and continue between prenatal care visits so that inadequate or excessive GWG can be identified when small, corrective steps can be taken, the authors advise.

Morb Mortal Wkly Rep. 2015;64:1215-1220. Full text

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