![]() ![]() One systematic review found that overweight and obese women who gain less weight than the ranges recommended by the IOM do not have an increased risk of having a low birth weight infant 1. The results of several large population-based cohort studies published after the release of the IOM guidelines suggested no harm in setting more restrictive weight gain limitations 8 10. The results of observational studies continue to provide mixed results. Citing a lack of sufficient data regarding short-term and long-term maternal and newborn outcomes, authors of the IOM report did not recommend lower targets for women with more severe degrees of obesity 9. The gestational weight gain guidelines attempt to balance the risks of having large-for-gestational-age infants, small-for-gestational-age infants, and preterm births and postpartum weight retention. Given the limited data by class, the IOM recommendation for weight gain is 5–9.1 kg (11–20 lb) for all obese women. The IOM recommendations define obesity as a BMI of 30 or greater and do not differentiate between Class I obesity (BMI of 30–34.9), Class II obesity (BMI of 35–39.9), and Class III obesity (BMI of 40 or greater) 2. The IOM guidelines recognize that data are insufficient to determine the amount of weight women with multifetal (triplet and higher order) gestations should gain. For twin pregnancy, the IOM recommends a gestational weight gain of 16.8–24.5 kg (37–54 lb) for women of normal weight, 14.1–22.7 kg (31–50 lb) for overweight women, and 11.3–19.1 kg (25–42 lb) for obese women. Other changes include the removal of the previous recommendations for special populations and the addition of weight gain guidelines for women with twin gestations. ![]() In 2009, the Institute of Medicine (IOM) published revised gestational weight gain guidelines that are based on prepregnancy body mass index (BMI) ranges for underweight, normal weight, overweight, and obese women recommended by the World Health Organization and are independent of age, parity, smoking history, race, and ethnic background Table 1 2. Gestational weight gain recommendations aim to optimize outcomes for the woman and the infant. Evidence supports associations between excessive gestational weight gain and increased birth weight and postpartum weight retention but also between inadequate weight gain and decreased birth weight 1. The population demographics of women who become pregnant have changed dramatically over the past decade more women are overweight or obese at conception. The amount of weight gained during pregnancy can affect the immediate and future health of a woman and her infant. Individualized care and clinical judgment are necessary in the management of the overweight or obese woman who is gaining (or wishes to gain) less weight than recommended but has an appropriately growing fetus. Health care providers who care for pregnant women should determine a woman’s body mass index at the initial prenatal visit and counsel her regarding the benefits of appropriate weight gain, nutrition and exercise, and, especially, the need to limit excessive weight gain to achieve best pregnancy outcomes. ABSTRACT: The updated guidelines by the Institute of Medicine regarding gestational weight gain provide clinicians with a basis for practice.
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