Pregnancy Weight Gain Recommendations

In 1970, the US National Academy of Sciences published guidelines for weight gain during pregnancy in the report, Maternal Nutrition and the Course of Pregnancy. The recommended pregnancy gain was 24 lb (10.9 kg), with a range of 10-25 lb (9.1-11.4 kg). The report advised health care providers and pregnant women not to restrict weight gain—a practice that had been fairly widespread during the previous decade in order to reduce the perceived risks of labor complications, preeclampsia, and excess weight retention postpartum. In fact, many obstetricians had been recommending gains of only 15-20 lb (6.8-9.1 kg).

Even with the more generous recommendations set in 1970, by the 1980s it had become clear that average gains of women in the United States far exceeded these guidelines. An analysis of data from the National Natality Survey in 1980 showed the average pregnancy weight gain to be 29 lb (13.2 kg), and by the time of the National Maternal Infant Health Survey in 1988 the average had increased to 32 lb (14.5 kg). The range of gain was very wide, from no gain to more than 75 lb (34.1 kg).

Based on this realization, in 1990 the weight gain recommendations were revised completely by a committee established by the Institute of Medicine (IOM) of the National Academy of Sciences. Existing data from a national survey were analyzed to determine the weight gain that was compatible with a normal pregnancy outcome. The latter was defined as the infant being born full term and of normal birth weight and the absence of pregnancy or delivery complications. It became apparent from these analyses that maternal weight-for-height at conception, expressed as body mass index (BMI; weight in kilograms and height in meters squared), was an important predictor of actual weight gain. Thin women (with a low BMI) gained more weight than fatter women. Different weight gain recommendations were therefore developed for women entering pregnancy with different BMIs (Table 1). For thinner women (BMI <19.8 or <90% of ideal body weight), recommended gains are 28-40 lb (12.7-18.2 kg); for women with a normal BMI (19.8-25.9), gain should be 25-35 lb (11.4-15.9 kg) or 1 lb (0.45 kg) per week; and for overweight women (BMI >29.0 or >135% ideal body weight), gain should be at least 15 lb (6.8 kg) or 0.7lb (0.32 kg) per week. New weight gain grids were constructed that showed the

Table 1 Recommendations for pregnancy weight gain by body mass index (BMI) at conception

BMI category

Recommended total gain

Kilograms

Pounds

Low (BMI <19.8)

12.8-18.G

28-4G

Normal (BMI >19.8-26.0)

11.5-16.G

25-35

High (BMI >26.0-29.0)

7.G-11.5

15-25

Obese (BMI >29.0)

<6.G

<13

Modified from Institute of Medicine, Committee on Nutritional Status during Pregnancy and Lactation (1990) Nutrition During Pregnancy. Weight Gain. Nutrient Supplements. Food and Nutrition Board. Washington, DC: National Academy Press.

Modified from Institute of Medicine, Committee on Nutritional Status during Pregnancy and Lactation (1990) Nutrition During Pregnancy. Weight Gain. Nutrient Supplements. Food and Nutrition Board. Washington, DC: National Academy Press.

recommended gains over the course of pregnancy for each BMI group (Figure 1), enabling the adequacy of weight gain to be tracked for individual women. To use the chart, women's height and weight should be measured as near to the time of conception as possible (because pregnancy causes a temporary reduction in height) and used to obtain their BMI from a table. The US recommendations are deemed to be appropriate for women in developed countries worldwide.

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