Excerpt

Sponsors asked the IOM's Food and Nutrition Board and the Division of Behavioral and Social Sciences and Education Board on Children, Youth, and Families to review and update the IOM (1990) recommendations for weight gain during pregnancy and recommend ways to encourage their adoption through consumer education, strategies to assist practitioners, and public health strategies.

The committee was asked to address the following tasks: 1. Review evidence on the relationship between weight gain patterns before, during, and after pregnancy and maternal and child health outcomes, with particular attention to the prevalence of maternal obesity racial/ethnic and age differences, components of GWG, and implications of weight during pregnancy on postpartum weight retention, maternal and child obesity, and later child health. 2. Within a life-stage framework consider factors in relation to GWG that are associated with maternal health outcomes such as lactation performance, postpartum weight retention, cardiovascular disease, metabolic processes including glucose and insulin-related issues, and risk of other chronic diseases; for infants and children, in addition to low birth weight, consider early developmental impacts and obesity-related consequences (e.g., mental health, diabetes). 3. Recommend revisions to the existing guidelines, where necessary, including the need for specific pregnancy weight guidelines for underweight, normal weight, and overweight and obese women and adolescents and women carrying twins or higher-order multiples. 4. Consider a range of approaches to promote appropriate weight gain, including: individual (behavior), psychosocial, community, health care, and health systems; timing and components of interventions; and ways to enhance awareness and adoption of the guidelines, including interdisciplinary approaches, consumer education to men and women, strategies to assist practitioners to use the guidelines, and public health strategies. 5. Identify gaps in knowledge and recommend research priorities.

Contents

• The National Academies
• Committee to Reexamine IOM Pregnancy Weight Guidelines
• Reviewers
• Preface
• Summary
  • GUIDELINES FOR WEIGHT GAIN DURING PREGNANCY
  • DEVELOPMENT OF THE GUIDELINES FOR WEIGHT GAIN DURING PREGNANCY
  • APPROACHES TO ACHIEVING RECOMMENDED WEIGHT GAIN DURING PREGNANCY
  • CONCLUDING REMARKS
  • REFERENCES
• 1. Setting the Stage for Revising Pregnancy Weight Guidelines: Conceptual Framework
  • BACKGROUND
  • RATIONALE FOR REVISING THE GUIDELINES
  • INDICATORS FOR REVISING THE CONCEPTUAL FRAMEWORK OF THE GUIDELINES
  • SETTING THE STAGE FOR REVISING THE GUIDELINES
  • THE COMMITTEE’S TASK
  • CONCEPTUAL FRAMEWORK
  • ORGANIZATION OF THE REPORT
  • REFERENCES
• 2. Descriptive Epidemiology and Trends
  • TRENDS IN MATERNAL WEIGHT AND GESTATIONAL WEIGHT GAIN
  • POSTPARTUM WEIGHT RETENTION
  • SOCIODEMOGRAPHIC CHARACTERISTICS OF MOTHERS
  • PREGNANCY OUTCOMES RELATED TO GESTATIONAL WEIGHT GAIN
  • FINDINGS AND RECOMMENDATIONS
  • REFERENCES
• 3. Composition and Components of Gestational Weight Gain: Physiology and Metabolism
  • TOTAL AND PATTERN OF GESTATIONAL WEIGHT GAIN
  • COMPONENTS OF GESTATIONAL WEIGHT GAIN
  • MATERNAL PHYSIOLOGY
  • FETAL-PLACENTAL PHYSIOLOGY
  • ABNORMAL MATERNAL METABOLISM
  • FINDINGS AND RECOMMENDATIONS
  • REFERENCES
• 4. Determinants of Gestational Weight Gain
  • SOCIETAL/INSTITUTIONAL DETERMINANTS
  • ENVIRONMENTAL DETERMINANTS
  • NEIGHBORHOOD/COMMUNITY DETERMINANTS
  • INTERPERSONAL/FAMILY DETERMINANTS
  • MATERNAL FACTORS
  • VULNERABLE POPULATIONS
  • FINDINGS AND RECOMMENDATIONS
  • REFERENCES
• 5. Consequences of Gestational Weight Gain for the Mother
  • CONCEPTUAL FRAMEWORK: CONSEQUENCES OF GESTATIONAL WEIGHT GAIN FOR THE MOTHER
  • CONSEQUENCES DURING PREGNANCY
  • CONSEQUENCES AT DELIVERY
  • POSTPARTUM CONSEQUENCES
  • LONG-TERM CONSEQUENCES
  • CONCLUDING REMARKS
  • FINDINGS AND RECOMMENDATIONS
  • REFERENCES
• 6. Consequences of Gestational Weight Gain for the Child
  • GENERAL CONCEPTS
  • EFFECTS ON NEONATAL MORBIDITY AND MORTALITY
  • LONG-TERM CONSEQUENCES
  • CONCLUDING REMARKS
  • FINDINGS AND RECOMMENDATIONS
  • REFERENCES
• 7. Determining Optimal Weight Gain
  • INTRODUCTION
  • PRINCIPLES USED TO DEVELOP A STRATEGY
  • PREVIOUS APPROACHES FOR DEVELOPING WEIGHT GAIN RECOMMENDATIONS
  • STRATEGIC APPROACH USED BY THE COMMITTEE IN DEVELOPING ITS RECOMMENDATIONS
  • DEVELOPMENT OF RECOMMENDED WEIGHT-GAIN RANGES
  • DISCUSSION OF THE NEW GUIDELINES
  • FINDINGS AND RECOMMENDATIONS FROM THE COMMITTEE’S ANALYSES
  • REFERENCES
• 8. Approaches to Achieving Recommended Gestational Weight Gain
  • CURRENT CONTEXT FOR CHILDBEARING AND GESTATIONAL WEIGHT GAIN
  • REVIEW OF INTERVENTION STRATEGIES
  • IMPLEMENTATION STRATEGIES FOR NEW GUIDELINES
  • CONCLUDING REMARKS
  • FINDING AND RECOMMENDATIONS
  • REFERENCES
• 9. Open Session and Workshop Agendas
• 10. Committee Member Biographical Sketches
• Appendixes
  • A Acronyms and Abbreviations, Glossary, and Supplemental Information
  • B Supplementary Information on Nutritional Intake
  • C Supplementary Information on Composition and Components of Gestational Weight Gain
  • D Summary of Determinants of Gestational Weight Gain
  • E Results from the Evidence-Based Report on Outcomes of Maternal Weight Gain
  • F Data Tables
  • G Consultant Reports

This study was supported by Contract No. HHSH250200446009I TO HHSH240G5806 between the National Academy of Sciences and U.S. Department of Health and Human Services Health Resources and Services Administration; Contract No. 200-2007-M-21619 between the National Academy of Sciences and Centers for Disease Control and Prevention Division of Nutrition, Physical Activity and Obesity; Contract No. N01-OD-4-2139 TO 192 between the National Academy of Sciences and National Institutes of Health Eunice Kennedy Shriver National Institute of Child Health and Human Development; Contract No. N01-OD-4-2139 TO 192 between the National Academy of Sciences and National Institutes of Health National Institute of Diabetes and Digestive and Kidney Diseases; Contract No. HHSP23300700522P between the National Academy of Sciences and U.S. Department of Health and Human Services Office on Women’s Health; Contract No. HHSP23320070071P between the National Academy of Sciences and U.S. Department of Health and Human Services Office of Disease Prevention and Health Promotion; and Contract No. 21-FY07-576 between the National Academy of Sciences and March of Dimes. Additional support came from U.S. Department of Health and Human Services Office of Minority Health and the National Minority AIDS Council.

Suggested citation:

IOM (Institute of Medicine) and NRC (National Research Council). 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press.

Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project.

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.