Weight Gain During Pregnancy: Reexamining the Guidelines

Since the 1990 IOM guidelines for gestational weight gain (GWG) were released, the demographic profile of American women of childbearing age has become more diverse and an increasing proportion of them are overweight or obese. The 1990 guidelines were designed to minimize infant mortality, but their consequences for women were not evaluated. The IOM/NRC has just released a report that includes guidelines for GWG that are based on a consideration of the health consequences for both infants and their mothers. The conceptual framework used to develop new guidelines was based on current public health models. For the first time, the guidelines are based on WHO/NHLBI categories for body mass index and include a GWG range for obese women. The report calls for improvements in surveillance of GWG and postpartum weight retention and adoption of the revised birth certificate by all states to support this surveillance. In addition, the report recommends that professional societies endorse or adopt these guidelines, that they be publicized to women and that women follow them. The report also calls on women to begin pregnancy at a health weight. To help women achieve this goal as well as a GWG within the guidelines, the report calls for additional preconceptional care and also for prenatal care providers to offer women counseling, such as guidance on dietary intake and physical activity, that is tailored to their life circumstances. Full implementation of the report's recommendations would require a radical change in the care provided to American women of childbearing age.