Artal R, Lockwood CJ, Brown HL. Weight gain recommendations in pregnancy and the obesity epidemic

Department of Obstetrics, Gynecology and Women's Health, Saint Louis University School of Medicine, St. Louis, Missouri 63117, USA.
Obstetrics and Gynecology (Impact Factor: 5.18). 01/2010; 115(1):152-5. DOI: 10.1097/AOG.0b013e3181c51908
Source: PubMed


Excessive gestational weight gain and obesity have been recognized as independent risk factors for maternal and fetal complications of pregnancy with significant lifelong consequences. These associations call into question the recently released Institute of Medicine (IOM) gestational weight gain recommendations, particularly for obese women. The IOM recommendation of a single standard of weight gain for all obesity classes is also of concern, because higher body mass index levels are associated with more severe pregnancy complications, such as preeclampsia and gestational diabetes. The IOM recommendations retained the 1990 focus on the theoretical association between poor gestational weight gain and low birth weight (LBW). Low gestational weight gain may often be a consequence and not the cause of LBW, and there is a lack of evidence in developed countries that dietary supplementation increases birth weight. Current obstetric practice allows for accurate and timely diagnosis of and intervention for LBW. We submit that gestational weight gain recommendations should be more individualized especially for obese women. Obese pregnant women should not be precluded from partaking in healthy lifestyle modifications in pregnancy that include physical activities, modified, judicious diets, and limited weight gain.

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    • "Reports from these medical bodies take on an alarmist tone and the popular press has picked up on this storyline and regularly disseminates research concerning the purported danger of maternal overweight and obesity to the developing foetus, often in dramatic fashion (see Blackwell 2012; CTVNews 2012; Kirkey 2013). At the same time, debates as to the correct amount of pregnancy weight gain continue, with some arguing that the new IOM guidelines do not go 'far enough' (Artal, Lockwood and Brown 2010; Munz 2011). Although obese bodies are the main focus, all pregnant bodies appear to be a concern (in line with fears of the 'fattening' of western societies, more generally). "
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    ABSTRACT: In this article, we use qualitative methodology to explore how 15 low-income women of diverse sociocultural location construct and experience health and weight gain during pregnancy, as well as how they position themselves in relation to messages pertaining to weight gain, femininity and motherhood that they encounter in their lives. Discussing the findings through a feminist poststructuralist lens, we conclude that the participants are complex, fragmented subjects, interpellated by multiple and at times conflicting subject positions. While the discourse of maternal responsibility (i.e. managing personal behaviours for the baby's health) is very much in evidence in their narratives, embodied experiences of pregnancy, lived experiences of financial constraints and religious beliefs provided some with an alternative discourse and resistant subject position. Participants also had mixed emotions about weight gain; they recognized the need to gain weight in order to have a healthy pregnancy, but weight gain was also not welcome as participants reproduced the dominant discourse of obesity and the discourse of 'feminine' bodily norms. Based on our results, we advocate for change to recent clinical guidelines and social discourses around pregnancy and weight gain, as well as for policies that provide pregnant women with a range of health-promoting resources.
    Nursing Inquiry 12/2013; 21(3). DOI:10.1111/nin.12052 · 1.44 Impact Factor
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    • "A shortcoming of these recommendations is the inability to offer specific guidelines for higher BMIs within the obese category (ie, classes I, II, and III). For instance, it has been proposed that, in cases of super obesity (ie, BMI >40), virtually no gain may serve to limit adverse outcomes.11 Thus, having a single recommendation for the heterogeneous obese population may have led different providers to make recommendations based on the patient population most often presenting for care in their practice and not based on the individual patient risk of excessive gain. "
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    ABSTRACT: There is discord between the recall of maternity care providers and patients when it comes to discussion of gestational weight gain (GWG) and obesity management. Few women report being advised on GWG, physical activity (PA), and nutrition, yet the majority of health care providers report discussing these topics with patients. We evaluated whether various Canadian maternal health care providers can identify appropriate GWG targets for patients with obesity and determine if providers report counseling on GWG, physical activity, and nutrition. A valid and reliable e-survey was created using SurveyMonkey software and distributed by the Society of Obstetricians and Gynaecologists of Canada listserve. A total of 174 health care providers finished the survey. Respondents self-identified as general practitioners, obstetricians, maternal-fetal medicine specialists, midwives, or registered nurses. GWG recommendations between disciplines for all body mass index categories were similar and fell within Health Canada/Institute of Medicine (IOM) guidelines. Of those who answered this question, 110/160 (68.8%) were able to correctly identify the maximum IOM GWG recommended for patients with obesity, yet midwives tended to recommend 0.5-1 kg more GWG (P = 0.05). PA counseling during pregnancy differed between disciplines (P < 0.01), as did nutrition counseling during pregnancy (P < 0.05). In contrast to patient reports, the majority of health care providers document counseling on GWG, PA, and nutrition and appropriately identify GWG limits for obese patients. However, the content and quality of the discourse between patient and provider warrants further investigation.
    International Journal of Women's Health 04/2013; 5(1):629-636. DOI:10.2147/IJWH.S49422
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    • "Perhaps even more striking, in 2006, the British Fertility Society recommended banning fertility treatment to women who are pre-obese and obese, and their European and Canadian counterparts fiercely debated the issue at their respective 2011 annual meetings (Abraham, 2011). Some experts are also of the opinion that modest weight loss during pregnancy can benefit the health of a too-large mother and her fetus (Artal et al., 2010; McKnight et al., 2011). While not dismissing the idea that there may be risks associated with obesity in pregnancy (just as there are risks associated with insufficient gestational weigh gain), in this article we critically examine the SOGC clinical guidelines for obesity in pregnancy, arguing that despite their commitment to objectivity, they are highly problematic as they are based upon questionable scientific evidence and put forth advice that is irrelevant and unhelpful to the vast majority of women. "
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    ABSTRACT: In this article, we critically examine the clinical guidelines for obesity in pregnancy put forth by the Society of Obstetricians and Gynaecologists of Canada (SOGC) that are underpinned by the rules of Evidence-Based Medicine (EBM), a system of ranking knowledge that promises to provide unbiased evidence about the effectiveness of treatments. While the SOGC guidelines are intended to direct health practitioners on 'best practice' as they address pregnancy weight gain with clients in the clinical context, we question their usefulness, arguing that despite their commitment to objectivity, they remain mired in cultural biases that stigmatize large female bodies and associates them to 'unfit' mothers.
    Health 10/2012; 17(4). DOI:10.1177/1363459312460702 · 2.10 Impact Factor
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