Gestational weight gain: an ounce of prevention is still worth a pound of cure

Abstract

Gestational weight gain (GWG) is an important factor in the antenatal management of pregnancy. Most obstetrics professional societies [1–5] address the issue of appropriate weight gain during pregnancy. Recommendations for GWG, however, have varied over the years, often without the benefit of sound scientific evidence, ranging from encouraging pregnant women to ‘eat for two’, to recommending minimal weight gain to prevent complications of pregnancy. In 1990 the Institute of Medicine (IOM) of the National Academy of Science in the United States convened a committee to recommend dietary intake and specific GWG recommendations with the goal of delivery of a healthy full-term infant of appropriate size [6]. The 1990 IOM committee noted that there was a positive relationship of both pre-pregnancy maternal weight and GWG with birthweight. Their recommendations were in part a response to the increased risk of the perinatal morbidity and mortality of infants with low birthweight related to poor GWG. The committee report advised an average GWG of 9.1–11.4 kg and advised against the then-current practice of limiting GWG to 4.5–6.4 kg. In 2009, in part because of the increase in numbers of overweight and/or obese people in the population and the lack of specific GWG guidelines for obese women (the 1990 committee recommended target for women with a BMI >29.0 was at least 6.8 kg), the IOM convened a committee to reexamine the GWG guidelines [7]. The results of the report were published in 2009 based on the evidence available at that time (see Table 1). A further goal was to recommend support for researchers to conduct studies on the determinants and impact of GWG, and pattern of weight gain on maternal and child outcomes. This, in the context of the Developmental Origins of Health and Disease (DOHaD) hypothesis, has led to a substantial increase in the number of publications on GWG and impact on pregnancy outcomes over the last decade. Table 1 IOM 2009 gestational weight gain recommendations