limit their weight gain during pregnancy to between 11 and 20 pounds to
safeguard their health and that of their baby, according to newly updated
expert guidelines.
That level of gestational weight gain is about half whats recommended
for normal-weight pregnant women and reflects the concern over the rising
number of obese expectant mothers in the United States.
The new guidelines � the first since 1990 � were issued jointly May
28 by the Institute of Medicine and the National Research Council.
"We looked at a balance of maternal outcomes related to weight gain in
pregnancy and issues related to the outcome for the fetus and neonate,"
explained Dr. Patrick M. Catalano, chairman of obstetrics and gynecology
at Case Western Reserve University and a member of the committee that
wrote the new guidelines.
"There is good evidence that the amount of gestational weight gain for
an obese woman can be related to the risk of needing a cesarean delivery
and retention of weight gain after pregnancy, which puts the woman at
further risk in future pregnancies," Catalano said.
Doctors typically define overweight as a body mass index (BMI) of
between 25 and 30 and obesity as a BMI of 30 and above. BMI is based on
weight and height; for example, a 5-foot-6-inch tall woman weighing
between 115 and 154 pounds would have a BMI in the normal range.
But children born to overweight or obese moms face a rise in risk for
preterm birth or being larger than normal at delivery, with extra fat,
Catalano noted. Babies born large can suffer stuck shoulders and broken
collar bones, experts say, and are prone to overweight or obesity and type
2 diabetes later in life. And an overly large newborn poses risks for the
mother at delivery, including vaginal tearing, bleeding and often the need
for a cesarean section.
Infants born overweight also face higher odds for health problems such
as heart disease and diabetes. Children born prematurely can suffer from
impaired mental and physical development.
On the other end of the spectrum, the report's authors noted, women who
are underweight during their pregnancy raise their babies' odds for
stunted fetal growth and preterm delivery.
So, according to the new guidelines, maintaining a normal body weight
and gaining only the recommended amount of weight during pregnancy is the
best way to lower risks to both mother and child.
Specifically, the guidelines urge that:
Normal-weight women � those with a BMI of 18.5 to 24.9 � should gain
25 to 35 pounds during pregnancy.
Underweight women �those with a BMI less than 18.5 � should gain 28
to 40 pounds during pregnancy.
Overweight women should gain 15 to 25 pounds.
Obese women should gain only 11 to 20 pounds.
The last recommendation marks a change from the 1990 guidelines, which
recommended that obese mothers-to-be gain at least 15 pounds during
pregnancy.
The report's authors were also concerned with the mother's weight at
conception. Almost two-thirds of American women of childbearing age are
overweight and almost one-third are obese, the report notes. The committee
recommended, therefore, that women try to reach a normal BMI before
conception and then gain the appropriate amount of weight during their
pregnancy.
The committee also recommends that doctors provide diet and exercise
counseling to women before conception so that women can achieve a normal
BMI before becoming pregnant. In addition, prenatal care should focus on
keeping weight gain within recommended guidelines.
Putting on excess pounds during pregnancy is becoming common: According
to a study published in November in Obstetrics & Gynecology,
nearly one in five pregnant American women now surpass recommended levels
of weight gain during their pregnancies.
So, following the new guidelines "can be beneficial to both you and the
baby," Catalano said. "The closer to a normal weight that you can be
before you get pregnant is to your advantage and also to your baby's
advantage because we know that your pre-pregnancy weight is a very
important variable for these outcomes as well as the weight gain in
pregnancy."
Dr. Michael Katz, senior vice president for research and global
programs at the March of Dimes, a sponsor of the report, was dubious about
the impact of the new guidelines long term.
"Pregnant women are very concerned about the outcome so they respond to
recommendations, but they don't last very long," Katz said. "Obesity and
overweight is a chronic situation. If a woman is overweight, she should
adjust her weight first, then become pregnant. And one hopes, they would
keep their weight in check subsequently, but that's unlikely."
Losing weight and keeping it off is a lifetime commitment, Katz noted.
Being underweight is also a problem, "but obesity is by far the most
prevalent and most serious problem," he said.
More information
The March of Dimes has more on weight
gain during pregnancy.
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