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: 4.37). 01/2010; 115(1):152-5. DOI: 10.1097/AOG.0b013e3181c51908
Source: PubMed

ABSTRACT 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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    ABSTRACT: We aimed to examine whether women who adhered to Institute of Medicine (IOM) guidelines for gestational weight gain (GWG) had improved perinatal outcomes. This is a population-based retrospective cohort study of nulliparous women with term singleton vertex births in the United States from 2011 through 2012. Women with medical or obstetric complications were excluded. Prepregnancy body mass index was calculated using reported weight and height. Women were categorized into 4 groups based on GWG and prepregnancy body mass index: (1) weight gain less than, (2) weight gain within, (3) weight gain 1-19 lb in excess of, and (4) weight gain ≥20 lb in excess of the IOM guidelines. The χ(2) test and multivariable logistic regression analysis were used for statistical comparisons. Compared to women who had GWG within the IOM guidelines, women with excessive weight gain, particularly ≥20 lb, were more likely to have adverse maternal outcomes (preeclampsia: adjusted odds ratio [aOR], 2.78; 95% confidence interval [CI], 2.82-2.93; eclampsia: aOR, 2.51; 95% CI, 2.27-2.78; cesarean: aOR, 2.1; 95% CI, 2.14-2.19), blood transfusion (aOR, 1.22; 95% CI, 1.11-1.33), and neonatal outcomes (5-minute Apgar <4: aOR, 1.22; 95% CI, 1.14-1.31; ventilation use >6 hours: aOR, 1.24; 95% CI, 1.15-1.33; seizure: aOR, 1.53; 95% CI, 1.24-1.89). Women who gained less than IOM guidelines had lower risks of hypertensive disorders of pregnancy and obstetric interventions but were more likely to have small-for-gestational-age neonates (aOR, 1.55; 95% CI, 1.52-1.59). Women whose GWG is in excess of IOM guidelines have higher risk of adverse maternal and neonatal outcomes, particularly in women with ≥20 lb excess weight gain above guidelines while women who had weight gain below the IOM guidelines were less likely to have maternal morbidity but had higher odds of small for gestational age. Copyright © 2015 Elsevier Inc. All rights reserved.
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    ABSTRACT: Objective Reference charts for classifying and monitoring pregnancy weight gain in severely obese women do not exist. The goal was to construct pregnancy weight-gain-for-gestational-age z-score charts for overweight and obese mothers, stratified by severity of obesity.Methods Serial weight gain measurements were abstracted from 1047, 1202, 1267, and 730 overweight, class I, II, and III obese women, respectively, delivering uncomplicated term pregnancies at Magee-Womens Hospital in Pittsburgh, PA. Multi-level linear regression models were used to express serial weight gain measurements as a function of gestational age.ResultsThere were a median [interquartile range] of 11 [9-12] and 11 [9-13] serial weight measurements for overweight and obese (class I, II, and III) women, respectively. The rate of weight gain was minimal until 15-20 weeks and then increased in a slow, linear manner until term. The slope of weight gain flattened as pre-pregnancy BMI increased. Charts were created describing the mean, standard deviation, and select percentiles of weight gain in class I, II, and III obese and overweight pregnancies.Conclusions These charts are an innovative tool for studying the association between gestational weight gain and adverse pregnancy outcomes.
    Obesity 03/2015; 23(3). DOI:10.1002/oby.21011 · 4.39 Impact Factor
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    ABSTRACT: A systematic review was conducted to determine the risk of adverse pregnancy outcomes with gestational weight gain (GWG) below the 2009 Institute of Medicine guidelines compared with within the guidelines in obese women. MEDLINE, Embase, Cochrane Register, CINHAL and Web of Science were searched from 1 January 2009 to 31 July 2014. Quality was assessed using a modified Newcastle–Ottawa scale. Three primary outcomes were included: preterm birth, small for gestational age (SGA) and large for gestational age (LGA). Eighteen cohort studies were included. GWG below the guidelines had higher odds of preterm birth (adjusted odds ratio [AOR] 1.46; 95% confidence interval [CI] 1.07–2.00) and SGA (AOR 1.24; 95% CI 1.13–1.36) and lower odds of LGA (AOR 0.77; 95% CI 0.73–0.81) than GWG within the guidelines. Across the three obesity classes, the odds of SGA and LGA did not show any notable gradient and remained unexplored for preterm birth. Decreased odds were noted for macrosomia (AOR 0.64; 95% CI 0.54–0.77), gestational hypertension (AOR, 0.70; 95% CI 0.53–0.93), pre-eclampsia (AOR 0.90; 95% CI 0.82–0.99) and caesarean (AOR 0.87; 95% CI 0.82–0.92). GWG below the guidelines cannot be routinely recommended but might occasionally be individualized for certain women, with caution, taking into account other known risk factors.
    Obesity Reviews 02/2015; 16(3). DOI:10.1111/obr.12238 · 7.86 Impact Factor