Towards Defining Optimal Gestational Weight Gain
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In 2009, the Institute of Medicine (IOM) Committee to Reexamine Pregnancy Weight Gain Guidelines published updated recommendations on the rate and amount of weight that women should gain during pregnancy. These recommendations were based on a large body of primarily observational literature reporting ranges of total pregnancy weight gain associated with lowest risks of a number of adverse maternal and newborn health outcomes. However, the IOM committee identified many gaps in the evidence to support guidelines for optimal amount and pattern of gain. In this article, the authors outline how recent insights on the role of early pregnancy weight gain, patterns of weight gain, emerging evidence from randomized trials of weight gain interventions, and accounting for the relative importance that women and care-providers place on different maternal and child health outcomes may advance our understanding of optimal pregnancy weight gain and inform the creation of improved pregnancy weight gain guidelines.
KeywordsNutrition in pregnancy Gestational weight gain Reference values Practice guidelines Pregnancy complications Postpartum weight retention Childhood obesity
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Conflict of Interest
Jennifer A. Hutcheon and Emily Oken declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
All studies by both authors involving animal and/or human subjects were performed after approval by the appropriate institutional review boards. When required, written informed consent was obtained from all participants.
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- 1.Institute of Medicine and National Research Council of the National Academies. Weight gain during pregnancy: reexamining the guidelines. Washington, DC: National Academies Press; 2009.Google Scholar
- 2.Viswanathan M, Siega-Riz AM, Moos M-K, et al. Outcomes of maternal weight gain, evidence report/technology assessment No. 168. Rockville, MD: Agency for Healthcare Research and Quality; 2008.Google Scholar
- 9.•Walter JR, Perng W, Kleinman KP, Rifas-Shiman SL, Rich-Edwards JW, Oken E. Associations of trimester-specific gestational weight gain with maternal adiposity and systolic blood pressure at 3 and 7 years postpartum. Am J Obstet Gynecol. 2015;212(4):499. e491-412. This paper included 801 women enrolled during the first trimester of pregnancy in the Boston-area Project Viva cohort. Among normal-weight women, both total and first-trimester gestational weight gain was associated with greater weight change at 3 and 7 years postpartum, but there was not strong evidence of association for either second- or third-trimester gain. First-trimester gain also related to 3-year postpartum weight change in overweight and obese women. Greater total and first-trimester gestational weight gain were associated with larger waist circumference and higher systolic blood pressure but not insulin resistance. These findings suggest that interventions targeting GWG beginning very early in pregnancy may benefit long-term maternal health.Google Scholar
- 14.••Brunner S, Stecher L, Ziebarth S, et al. Excessive gestational weight gain prior to glucose screening and the risk of gestational diabetes: a meta-analysis. Diabetologia. 2015;58(10):2229–37. This meta-analysis included eight studies involving 13,748 participants. The pooled analysis of unadjusted OR yielded a summary OR of 1.40 (95% CI 1.21, 1.61; p < 0.001) for the relationship of excessive weight gain prior to glycemic screening and risk for gestational diabetesmellitus. No evidence was found that the effect of GWG on GDM differs depending on maternal pre-pregnancy BMI category. The implication of this study was that avoiding excessive weight gain in pregnancy prior to the GDM screening test may be a potential strategy to reduce GDM risk.CrossRefPubMedGoogle Scholar
- 15.McGiveron A, Foster S, Pearce J, Taylor MA, McMullen S, Langley-Evans SC. Limiting antenatal weight gain improves maternal health outcomes in severely obese pregnant women: findings of a pragmatic evaluation of a midwife-led intervention. J Hum Nutr Diet : Off J Br Diet Assoc. 2015;28 Suppl 1:29–37.CrossRefGoogle Scholar
- 17.Hui AL, Back L, Ludwig S, et al. Effects of lifestyle intervention on dietary intake, physical activity level, and gestational weight gain in pregnant women with different pre-pregnancy body mass index in a randomized control trial. BMC Pregnancy Childbirth. 2014;14:331.CrossRefPubMedPubMedCentralGoogle Scholar
- 18.••Muktabhant B, Lawrie TA, Lumbiganon P, Laopaiboon M. Diet or exercise, or both, for preventing excessive weight gain in pregnancy. Cochrane Database Syst Rev. 2015;6:CD007145. This was a meta-analysis of randomised controlled trials (RCTs) of diet or exercise, or both, interventions for preventing excessive weight gain in pregnancy. 49 RCTs involving 11,444 women contributed data to quantitative meta-analysis. Diet or exercise, or both, interventions reduced the risk of excessive GWG on average by 20% overall (average risk ratio (RR) 0.80, 95% confidence interval (CI) 0.73 to 0.87). Other benefits may include a lower risk of caesarean delivery, macrosomia, and neonatal respiratory morbidity, particularly for high-risk women receiving combined diet and exercise interventions. Maternal hypertension may also be reduced. Exercise appears to be an important part of controlling weight gain in pregnancy and more research is needed to establish safe guidelines. Most included studies were carried out in developed countries and it is not clear whether these results are widely applicable to lower income settings.PubMedGoogle Scholar
- 22.Gesell SB, Katula JA, Strickland C, Vitolins MZ. Feasibility and initial efficacy evaluation of a community-based cognitive-behavioral lifestyle intervention to prevent excessive weight gain during pregnancy in Latina women. Matern Child Health J. 2015;19(8):1842–52.CrossRefPubMedPubMedCentralGoogle Scholar
- 37.Johansson K, Hutcheon JA, Stephansson O, Cnattingius S. Pregnancy weight gain by gestational age and BMI in Sweden: a population-based cohort study. Am J Clin Nutr. 2015;in press.Google Scholar
- 38.Cheikh-Ismail L. Gestational weight gain standard based on healthy, well-nourished women in the INTERGROWTH-21st Project. Paper presented at: 9th World Congress Developmental Origins of Health and Disease. Cape Town, South Africa; 2015.Google Scholar
- 44.Hawkins SS, Oken E, Gillman MW. Early in the life course: time for obesity prevention. In: Halfon N, Forrest C, Lerner R, Faustman EM, editors. Handbook of life course health development science. : Springer; 2016.Google Scholar
- 45.Oostdam N, Bosmans J, Wouters MG, Eekhoff EM, van Mechelen W, van Poppel MN. Cost-effectiveness of an exercise program during pregnancy to prevent gestational diabetes: results of an economic evaluation alongside a randomised controlled trial. BMC Pregnancy Childbirth. 2012;12:64.CrossRefPubMedPubMedCentralGoogle Scholar
- 47.Ruifrok AE, Rogozinska E, van Poppel MN, et al. Study protocol: differential effects of diet and physical activity based interventions in pregnancy on maternal and fetal outcomes—individual patient data (IPD) meta-analysis and health economic evaluation. Syst Rev. 2014;3:131.CrossRefPubMedPubMedCentralGoogle Scholar