Eat healthy. Exercise regularly. And like the three bears, you won’t be too thin or too fat; you’ll be just right. It sounds easy. But apparently it’s not. The obesity epidemic is spreading (no pun intended) to among others, pregnant women, and the consequences are concerning. According to the Institute of Medicine (IOM), “Women today are heavier; a greater percentage of them are entering pregnancy overweight or obese, and many are gaining too much weight during pregnancy.”   

When you combine being overweight before pregnancy with gaining excessive weight during pregnancy the result is a myriad of poor health outcomes in mothers (hypertension, gestational diabetes, and preeclampsia) and babies (birth defects, especially neural tube defects, birth complications, and infant death).

Given that nearly two decades have passed since the IOM issued its original recommendations, clearly the time had come to reexamine the guidelines.  Dr. Kathleen Rasmussen, Division of Nutritional Services, Cornell University served as Chair of the review committee.

“The earlier guidelines recommended weight gain that would be optimal for the baby. These new guidelines take into account the well-being of the mother as well,” said Rasmussen.  

The new guidelines, which can be found here are similar to the previous guidelines but have two distinct differences. First, the new guidelines are based on World Health Organization BMI (body mass index) categories rather than the Metropolitan Life Insurance Company tables. Second, a weight gain recommendation has been added for women who are obese. In order to accommodate various ages, races, and ethnicities all weight gain guidelines are stated as ranges such as 28-40 pounds for women with a BMI <18.5 (underweight) and 11-20 pounds for women with a BMI of 30 or more (obese). 

The IOM report includes a list of five recommendations for action:

• The Department of Health and Human Services should conduct routine sur­veillance of weight gain during pregnancy and postpartum weight retention on a nationally representative sample of women and report the results by prepregnancy BMI (including all classes of obesity), age, racial/ethnic group, and socioeconomic status.

• All states should adopt the revised version of the birth certificate, which in­cludes fields for maternal prepregnancy weight, height, weight at delivery, and age at the last measured weight. In addition, all states should strive for 100 percent completion of these fields on birth certificates and collaborate to share data, thereby allowing a complete national picture as well as regional snapshots.

• Federal, state, and local agencies, as well as health care providers, should inform women of the importance of conceiving at a normal BMI, and those who provide health care or related services to women of childbearing age should include preconceptional counseling in their care. A higher proportion of American women should limit their weight gain during pregnancy to the range specified in these guidelines for their prepregnant BMI. The first step in assisting women to gain within these guidelines is letting them know the guidelines exist, which will require educating health care providers as well as the women themselves.
  

• Federal agencies, private voluntary organizations, and medical and public health organizations should adopt these new guidelines for weight gain dur­ing pregnancy and publicize them to their members and also to women of childbearing age.

• Those who provide prenatal care to women should offer them counseling, such as guidance on dietary intake and physical activity that is tailored to their life circumstances.

Every woman is different. What works for an expectant teen, may not work for a thirty-something. The challenge for health care providers will be to structure care plans that reflect available resources and real-life circumstances.