Current Nutrition Reports

, Volume 3, Issue 3, pp 289–297

Diet during Pregnancy and Gestational Weight Gain

Prenatal, Neonatal, and Maternal Nutrition (DK Tobias and M-F Hivert, Section Editors)

Abstract

Excessive gestational weight gain is associated with a number of health complications for both the mother and offspring. Trends across developed countries indicate an increase in gestational weight gain and a substantial number of women exceeding the recommended amount. Dietary interventions during pregnancy represent an opportunity to minimize excessive weight gain during the gestational period and improve perinatal and postpartum health. Several randomized trials and observational epidemiologic studies have evaluated aspects of maternal diet, such as the macronutrient composition, individual foods and beverages, overall dietary patterns, and caloric restriction with gestational weight gain. This review provides an overview of the current evidence to support the development of pregnancy dietary recommendations for the prevention of excessive gestational weight gain.

Keywords

Pregnancy Gestational weight gain Diet Nutrition Carbohydrate quality Dietary patterns Weight gain Dietary interventions 

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Park JE, Park S, Daily JW, Kim SH. Low gestational weight gain improves infant and maternal pregnancy outcomes in overweight and obese Korean women with gestational diabetes mellitus. Gynecol Endocrinol. 2011;27(10):775–81.PubMedCrossRefGoogle Scholar
  2. 2.
    Herring SJ, Oken E, Rifas-Shiman SL, Rich-Edwards JW, Stuebe AM, Kleinman KP, et al. Weight gain in pregnancy and risk of maternal hyperglycemia. Am J Obstet Gynecol. 2009;201(1):61 e1–7.CrossRefGoogle Scholar
  3. 3.
    Tovar A, Must A, Bermudez OI, Hyatt RR, Chasan-Taber L. The impact of gestational weight gain and diet on abnormal glucose tolerance during pregnancy in Hispanic women. Matern Child Health J. 2009;13(4):520–30.PubMedCentralPubMedCrossRefGoogle Scholar
  4. 4.
    Carreno CA, Clifton RG, Hauth JC, Myatt L, Roberts JM, Spong CY, et al. Excessive early gestational weight gain and risk of gestational diabetes mellitus in nulliparous women. Obstet Gynecol. 2012;119(6):1227–33.PubMedCentralPubMedCrossRefGoogle Scholar
  5. 5.
    Hedderson MM, Gunderson EP, Ferrara A. Gestational weight gain and risk of gestational diabetes mellitus. Obstet Gynecol. 2010;115(3):597–604.PubMedCentralPubMedCrossRefGoogle Scholar
  6. 6.
    Liu Z, Ao D, Yang H, Wang Y. Gestational weight gain and risk of gestational diabetes mellitus among Chinese women. Chin Med J (Engl). 2014;127(7):1255–60.Google Scholar
  7. 7.
    Donnelley EL, Raynes-Greenow CH, Turner RM, Carberry AE, Jeffery HE. Antenatal predictors and body composition of large-for-gestational-age newborns: perinatal health outcomes. J Perinatol. 2014;1–7. doi:10.1038/jp.2014.90.
  8. 8.•
    Kim SY, Sharma AJ, Sappenfield W, Wilson HG, Salihu HM. Association of maternal body mass index, excessive weight gain, and gestational diabetes mellitus with large-for-gestational-age births. Obstet Gynecol. 2014;123(4):737–44. Gestational weight gain was the single most important predictor of large-for gestational age (LGA) babies in this cohort; 33-38 % of LGA babies could be attributed to excessive gestaional weight gain, more than than gestational diabetes or prepregnacny overweight and obesity. PubMedCrossRefGoogle Scholar
  9. 9.
    Margerison Zilko CE, Rehkopf D, Abrams B. Association of maternal gestational weight gain with short- and long-term maternal and child health outcomes. Am J Obstet Gynecol. 2010;202(6):574 e1–8.CrossRefGoogle Scholar
  10. 10.
    Sen S, Carpenter AH, Hochstadt J, Huddleston JY, Kustanovich V, Reynolds AA, et al. Nutrition, weight gain and eating behavior in pregnancy: a review of experimental evidence for long-term effects on the risk of obesity in offspring. Physiol Behav. 2012;107(1):138–45.PubMedCrossRefGoogle Scholar
  11. 11.
    Viswanathan M, Siega-Riz AM, Moos MK, Deierlein A, Mumford S, Knaack J, et al. Outcomes of maternal weight gain. Evid Rep Technol Assess (Full Rep). 2008;168:1–223.Google Scholar
  12. 12.
    Graham LE, Brunner Huber LR, Thompson ME, Ersek JL. Does amount of weight gain during pregnancy modify the association between obesity and cesarean section delivery? Birth. 2014;41(1):93–9.PubMedCrossRefGoogle Scholar
  13. 13.
    Abrams B, Altman SL, Pickett KE. Pregnancy weight gain: still controversial. Am J Clin Nutr. 2000;71(5 Suppl):1233S–41.PubMedGoogle Scholar
  14. 14.
    Fraser A, Tilling K, Macdonald-Wallis C, Hughes R, Sattar N, Nelson SM, et al. Associations of gestational weight gain with maternal body mass index, waist circumference, and blood pressure measured 16 y after pregnancy: the Avon Longitudinal Study of Parents and Children (ALSPAC). Am J Clin Nutr. 2011;93(6):1285–92.PubMedCentralPubMedCrossRefGoogle Scholar
  15. 15.
    Siega-Riz AM, Viswanathan M, Moos MK, Deierlein A, Mumford S, Knaack J, et al. A systematic review of outcomes of maternal weight gain according to the Institute of Medicine recommendations: birthweight, fetal growth, and postpartum weight retention. Am J Obstet Gynecol. 2009;201(4):339 e1–14.CrossRefGoogle Scholar
  16. 16.
    Mannan M, Doi SA, Mamun AA. Association between weight gain during pregnancy and postpartum weight retention and obesity: a bias-adjusted meta-analysis. Nutr Rev. 2013;71(6):343–52.PubMedCrossRefGoogle Scholar
  17. 17.•
    Sridhar SB, Darbinian J, Ehrlich SF, Markman MA, Gunderson EP, Ferrara A, et al. Maternal gestational weight gain and offspring risk for childhood overweight or obesity. Am J Obstet Gynecol. 2014. Women who exceeded IOM guidelines for gestational weight gain had a nearly 50 % greater risk of having a child (ages 2-5 years of age) who was overweight or obese. This outcome was independent of several potential confounders including maternal characteristics and postpartum lifetyle.Google Scholar
  18. 18.
    Ensenauer R, Chmitorz A, Riedel C, Fenske N, Hauner H, Nennstiel-Ratzel U, et al. Effects of suboptimal or excessive gestational weight gain on childhood overweight and abdominal adiposity: results from a retrospective cohort study. Int J Obes (Lond). 2013;37(4):505–12.CrossRefGoogle Scholar
  19. 19.
    Dello Russo M, Ahrens W, De Vriendt T, Marild S, Molnar D, Moreno LA, et al. Gestational weight gain and adiposity, fat distribution, metabolic profile, and blood pressure in offspring: the IDEFICS project. Int J Obes (Lond). 2013;37(7):914–9.CrossRefGoogle Scholar
  20. 20.
    Hull HR, Thornton JC, Ji Y, Paley C, Rosenn B, Mathews P, et al. Higher infant body fat with excessive gestational weight gain in overweight women. Am J Obstet Gynecol. 2011;205(3):211 e1–7.CrossRefGoogle Scholar
  21. 21.
    Rasmussen KM, Yaktine AL, editors. Weight gain during pregnancy: reexamining the guidelines. Washington (DC); 2009.Google Scholar
  22. 22.
    Campbell F, Johnson M, Messina J, Guillaume L, Goyder E. Behavioural interventions for weight management in pregnancy: a systematic review of quantitative and qualitative data. BMC Public Health. 2011;11:491.PubMedCentralPubMedCrossRefGoogle Scholar
  23. 23.
    Muktabhant B, Lumbiganon P, Ngamjarus C, Dowswell T. Interventions for preventing excessive weight gain during pregnancy. Cochrane Database Syst Rev. 2012;4, CD007145.PubMedGoogle Scholar
  24. 24.
    Skouteris H, Hartley-Clark L, McCabe M, Milgrom J, Kent B, Herring SJ, et al. Preventing excessive gestational weight gain: a systematic review of interventions. Obes Rev. 2010;11(11):757–68.PubMedCrossRefGoogle Scholar
  25. 25.••
    Tanentsapf I, Heitmann BL, Adegboye AR. Systematic review of clinical trials on dietary interventions to prevent excessive weight gain during pregnancy among normal weight, overweight and obese women. BMC Pregnancy Childbirth. 2011;11:81. This review meta-analyzed ten dietary intervention trials and found lower gestational weight gain and less post-partum weight retention at 6 months among women in the intervention groups versus control groups. Most of the interventions included other lifestyle changes such as physcial activity. PubMedCentralPubMedCrossRefGoogle Scholar
  26. 26.
    Thangaratinam S, Rogozinska E, Jolly K, Glinkowski S, Duda W, Borowiack E, et al. Interventions to reduce or prevent obesity in pregnant women: a systematic review. Health Technol Assess. 2012;16(31):iii–iv. 1-191.PubMedGoogle Scholar
  27. 27.
    Fogelholm M, Anderssen S, Gunnarsdottir I, Lahti-Koski M. Dietary macronutrients and food consumption as determinants of long-term weight change in adult populations: a systematic literature review. Food Nutr Res. 2012;56:19103.Google Scholar
  28. 28.
    Sacks FM, Bray GA, Carey VJ, Smith SR, Ryan DH, Anton SD, et al. Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates. N Engl J Med. 2009;360(9):859–73.PubMedCentralPubMedCrossRefGoogle Scholar
  29. 29.
    Hooper L, Abdelhamid A, Moore HJ, Douthwaite W, Skeaff CM, Summerbell CD. Effect of reducing total fat intake on body weight: systematic review and meta-analysis of randomised controlled trials and cohort studies. BMJ. 2012;345:e7666.PubMedCentralPubMedCrossRefGoogle Scholar
  30. 30.
    Hession M, Rolland C, Kulkarni U, Wise A, Broom J. Systematic review of randomized controlled trials of low-carbohydrate vs. low-fat/low-calorie diets in the management of obesity and its comorbidities. Obes Rev. 2009;10(1):36–50.PubMedCrossRefGoogle Scholar
  31. 31.
    Rhodes ET, Pawlak DB, Takoudes TC, Ebbeling CB, Feldman HA, Lovesky MM, et al. Effects of a low-glycemic load diet in overweight and obese pregnant women: a pilot randomized controlled trial. Am J Clin Nutr. 2010;92(6):1306–15.PubMedCentralPubMedCrossRefGoogle Scholar
  32. 32.
    Uusitalo U, Arkkola T, Ovaskainen ML, Kronberg-Kippila C, Kenward MG, Veijola R, et al. Unhealthy dietary patterns are associated with weight gain during pregnancy among Finnish women. Public Health Nutr. 2009;12(12):2392–9.PubMedCrossRefGoogle Scholar
  33. 33.
    Stuebe AM, Oken E, Gillman MW. Associations of diet and physical activity during pregnancy with risk for excessive gestational weight gain. Am J Obstet Gynecol. 2009;201(1):58 e1–8.CrossRefGoogle Scholar
  34. 34.
    Althuizen E, van Poppel MN, Seidell JC, van Mechelen W. Correlates of absolute and excessive weight gain during pregnancy. J Womens Health (Larchmt). 2009;18(10):1559–66.CrossRefGoogle Scholar
  35. 35.
    Lagiou P, Tamimi RM, Mucci LA, Adami HO, Hsieh CC, Trichopoulos D. Diet during pregnancy in relation to maternal weight gain and birth size. Eur J Clin Nutr. 2004;58(2):231–7.PubMedCrossRefGoogle Scholar
  36. 36.
    Shin D, Bianchi L, Chung H, Weatherspoon L, Song WO. Is gestational weight gain associated with diet quality during pregnancy? Matern Child Health J. 2013. doi:10.1007/s10995-013-1383-x.
  37. 37.
    Jenkins DJ, Wolever TM, Taylor RH, Barker H, Fielden H, Baldwin JM, et al. Glycemic index of foods: a physiological basis for carbohydrate exchange. Am J Clin Nutr. 1981;34(3):362–6.PubMedGoogle Scholar
  38. 38.
    Moses RG, Luebcke M, Davis WS, Coleman KJ, Tapsell LC, Petocz P, et al. Effect of a low-glycemic-index diet during pregnancy on obstetric outcomes. Am J Clin Nutr. 2006;84(4):807–12.PubMedGoogle Scholar
  39. 39.••
    Moses RG, Casey SA, Quinn EG, Cleary JM, Tapsell LC, Milosavljevic M, et al. Pregnancy and Glycemic Index Outcomes study: effects of low glycemic index compared with conventional dietary advice on selected pregnancy outcomes. Am J Clin Nutr. 2014;99(3):517–23. This randomized trial showed no effect of a low-glycemic index diet on gestational weight gain when compared with another healthy eating diet that did not have a glycemic index component. PubMedCrossRefGoogle Scholar
  40. 40.••
    Perichart-Perera O, Balas-Nakash M, Rodriguez-Cano A, Legorreta-Legorreta J, Parra-Covarrubias A, Vadillo-Ortega F. Low Glycemic Index Carbohydrates versus All Types of Carbohydrates for Treating Diabetes in Pregnancy: A Randomized Clinical Trial to Evaluate the Effect of Glycemic Control. Int J Endocrinol. 2012;296017. This randomized trial showed no effect of a low glycemic index diet on total gestational weight gain when compared with a control diet. The GI intervention group had lower risk of excessive gestational weight gain.Google Scholar
  41. 41.
    McGowan CA, McAuliffe FM. The influence of maternal glycaemia and dietary glycaemic index on pregnancy outcome in healthy mothers. Br J Nutr. 2010;104(2):153–9.PubMedCrossRefGoogle Scholar
  42. 42.
    Deierlein AL, Siega-Riz AM, Herring A. Dietary energy density but not glycemic load is associated with gestational weight gain. Am J Clin Nutr. 2008;88(3):693–9.PubMedCentralPubMedGoogle Scholar
  43. 43.
    Knudsen VK, Heitmann BL, Halldorsson TI, Sorensen TI, Olsen SF. Maternal dietary glycaemic load during pregnancy and gestational weight gain, birth weight and postpartum weight retention: a study within the Danish National Birth Cohort. Br J Nutr. 2013;109(8):1471–8.PubMedCrossRefGoogle Scholar
  44. 44.
    Maple-Brown LJ, Roman NM, Thomas A, Presley LH, Catalano PM. Perinatal factors relating to changes in maternal body fat in late gestation. J Perinatol. 2013;33(12):934–8.PubMedCrossRefGoogle Scholar
  45. 45.
    Mozaffarian D, Hao T, Rimm EB, Willett WC, Hu FB. Changes in diet and lifestyle and long-term weight gain in women and men. N Engl J Med. 2011;364(25):2392–404.PubMedCentralPubMedCrossRefGoogle Scholar
  46. 46.
    Pan A, Malik VS, Hao T, Willett WC, Mozaffarian D, Hu FB. Changes in water and beverage intake and long-term weight changes: results from three prospective cohort studies. Int J Obes (Lond). 2013;37(10):1378–85.CrossRefGoogle Scholar
  47. 47.
    Hu FB. Resolved: there is sufficient scientific evidence that decreasing sugar-sweetened beverage consumption will reduce the prevalence of obesity and obesity-related diseases. Obes Rev. 2013;14(8):606–19.PubMedCrossRefGoogle Scholar
  48. 48.
    Jacques PF, Wang H. Yogurt and weight management. Am J Clin Nutr. 2014;99(5 Suppl):1229S–34.PubMedCrossRefGoogle Scholar
  49. 49.
    Olson CM, Strawderman MS. Modifiable behavioral factors in a biopsychosocial model predict inadequate and excessive gestational weight gain. J Am Diet Assoc. 2003;103(1):48–54.PubMedCrossRefGoogle Scholar
  50. 50.
    Herring SJ, Nelson DB, Davey A, Klotz AA, Dibble LV, Oken E, et al. Determinants of excessive gestational weight gain in urban, low-income women. Womens Health Issues. 2012;22(5):e439–46.PubMedCentralPubMedCrossRefGoogle Scholar
  51. 51.
    Olafsdottir AS, Skuladottir GV, Thorsdottir I, Hauksson A, Steingrimsdottir L. Maternal diet in early and late pregnancy in relation to weight gain. Int J Obes (Lond). 2006;30(3):492–9.CrossRefGoogle Scholar
  52. 52.
    Di Renzo GC, Brillo E, Romanelli M, Porcaro G, Capanna F, Kanninen TT, et al. Potential effects of chocolate on human pregnancy: a randomized controlled trial. J Matern Fetal Neonatal Med. 2012;25(10):1860–7.PubMedCrossRefGoogle Scholar
  53. 53.
    Malik VS, Pan A, Willett WC, Hu FB. Sugar-sweetened beverages and weight gain in children and adults: a systematic review and meta-analysis. Am J Clin Nutr. 2013;98(4):1084–102.PubMedCrossRefGoogle Scholar
  54. 54.
    Boggs DA, Rosenberg L, Rodriguez-Bernal CL, Palmer JR. Long-term diet quality is associated with lower obesity risk in young African American women with normal BMI at baseline. J Nutr. 2013;143(10):1636–41.PubMedCrossRefGoogle Scholar
  55. 55.
    Funtikova AN, Benitez-Arciniega AA, Gomez SF, Fito M, Elosua R, Schroder H. Mediterranean diet impact on changes in abdominal fat and 10-year incidence of abdominal obesity in a Spanish population. Br J Nutr. 2014;111(8):1481–7.PubMedCrossRefGoogle Scholar
  56. 56.
    Schulze MB, Fung TT, Manson JE, Willett WC, Hu FB. Dietary patterns and changes in body weight in women. Obesity (Silver Spring). 2006;14(8):1444–53.CrossRefGoogle Scholar
  57. 57.
    Hu FB. Dietary pattern analysis: a new direction in nutritional epidemiology. Curr Opin Lipidol. 2002;13(1):3–9.PubMedCrossRefGoogle Scholar
  58. 58.
    Hillesund ER, Bere E, Haugen M, Overby NC. Development of a New Nordic Diet score and its association with gestational weight gain and fetal growth - a study performed in the Norwegian Mother and Child Cohort Study (MoBa). Public Health Nutr. 2014:1-11. doi:10.1017/S1368980014000421.
  59. 59.
    Davis RR, Hofferth SL, Shenassa ED. Gestational weight gain and risk of infant death in the United States. Am J Public Health. 2014;104 Suppl 1:S90–5.PubMedCrossRefGoogle Scholar
  60. 60.
    Dietz PM, Callaghan WM, Cogswell ME, Morrow B, Ferre C, Schieve LA. Combined effects of prepregnancy body mass index and weight gain during pregnancy on the risk of preterm delivery. Epidemiology. 2006;17(2):170–7.PubMedCrossRefGoogle Scholar
  61. 61.
    Poston L. Gestational weight gain: influences on the long-term health of the child. Curr Opin Clin Nutr Metab Care. 2012;15(3):252–7.PubMedCrossRefGoogle Scholar
  62. 62.
    Wolff S, Legarth J, Vangsgaard K, Toubro S, Astrup A. A randomized trial of the effects of dietary counseling on gestational weight gain and glucose metabolism in obese pregnant women. Int J Obes (Lond). 2008;32(3):495–501.CrossRefGoogle Scholar
  63. 63.
    Rae A, Bond D, Evans S, North F, Roberman B, Walters B. A randomised controlled trial of dietary energy restriction in the management of obese women with gestational diabetes. Aust N Z J Obstet Gynaecol. 2000;40(4):416–22.PubMedCrossRefGoogle Scholar
  64. 64.
    Renault KM, Norgaard K, Nilas L, Carlsen EM, Cortes D, Pryds O, et al. The Treatment of Obese Pregnant Women (TOP) study: a randomized controlled trial of the effect of physical activity intervention assessed by pedometer with or without dietary intervention in obese pregnant women. Am J Obstet Gynecol. 2014;210(2):134 e1–9.CrossRefGoogle Scholar
  65. 65.
    Thornton YS, Smarkola C, Kopacz SM, Ishoof SB. Perinatal outcomes in nutritionally monitored obese pregnant women: a randomized clinical trial. J Natl Med Assoc. 2009;101(6):569–77.PubMedGoogle Scholar
  66. 66.
    Di Carlo C, Iannotti G, Sparice S, Chiacchio MP, Greco E, Tommaselli GA, et al. The role of a personalized dietary intervention in managing gestational weight gain: a prospective, controlled study in a low-risk antenatal population. Arch Gynecol Obstet. 2014;289(4):765–70.PubMedCrossRefGoogle Scholar
  67. 67.
    Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials. 1996;17(1):1–12.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Division of Preventive MedicineBrigham and Women’s Hospital and Harvard Medical SchoolBostonUSA
  2. 2.Department of NutritionHarvard School of Public HealthBostonUSA
  3. 3.Eunice Kennedy Shriver National Institute of Child Health and Human DevelopmentBethesdaUSA

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