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Article: Pregnancy Weight Gain Guidelines in the US - a Historical Overview Back to article | View all comments

Author: Debbie Miller, RN | October 12, 2010

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October 14, 2010 12:14 PM
Debbie Miller, RN's avatar

Thank you, Aroon.  Your additions are timely and accurate.  I appreciate the clarifications because, as you say, there are other special needs that should be considered.  Also, BMI is not a perfect measurement of fat percentage and when calculated merely by weight and height can be somewhat inaccurate.  The entire clinical picture, including age, race, ethnicity, stature and muscle mass must be considered.  A woman who is fit, even though her BMI may be on the high side, may be at less risk than someone who is in a “normal” BMI range but who does get adequate exercise.  Multiple gestation also demands special attention and these cases have often been treated the same as singletons except with regard to the delivery method and potential for prematurity.  Vitamins and nutritional status have not always been appropriately adjusted.  I recommend the book, When You’re Expecting Twins, Triplets or Quads by Barbara Luke and Tamara Eberlein.  The adjusted nutritional recommendations, based on evidence-based research, are addressed in this text and with multiple gestation pregnancies on the rise this is a timely and important matter for consideration.

I also appreciate your comments regarding the decreasing age of menarche and high rate of teen pregnancy with accompanying judgment in this population.  There is certainly an element of negativity that often is conveyed, likely interfering with patient-provider relations and compliance. Developmentally they are also at risk for behaviors that could be harmful in pregnancy including poor judgment, substance use, immaturity and poor nutrition.  These patients would, as you said, feel especially vulnerable if they are also obese, or perhaps suffering from an eating disorder.  This would be a high risk situation for many reasons, including a increased likelihood of depression in both the antepartum and postpartum period.  These young women also require special consideration and attention because of the additional challenges they will face as young parents (or relinquishing mothers) in addition to the physical and emotional demands of pregnancy.  Sensitivity must be paramount and referrals for adjunct care might be essential to a good outcome.  These challenges could even be a subject for another entire blog discussion.

Thank you for your thoughtful and relevant reminders of the need for individualized health care. People do not always fit into neat little charts and it is important to remember the art as well as the science involved.  Confusion is often the result of conflicting data, changing recommendations and media reports.

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October 14, 2010 03:08 AM
M. Aroon Kamath, M.D.'s avatar

Thank you Debbie for your prompt response and for answering my queries. As an almost lay person in these matters, I do come across concerns raised in media about the decreasing age of menarche, rising prevalence of obesity in children and persisting concerns regarding teenage pregnancies, patterns of weight gain in pregnant teenagers and so on. In the course of your blog you have stressed on the importance of being sensitive to the feelings of an obese patient and then go on to say that “often she feels ignored or judged”. That got me thinking whether there could be other special categories who may also feel ignored or judged. The one category that came to my mind was that of the pregnant adolescents who are obese as well. They have to contend with being pregnant aside from the fact that they are obese.

The updated 2009 recommendations by the Institute of Medicine (IOM) and the National Research Council do indeed confirm what you have said, by recommending that “teenagers who are pregnant should use the adult BMI categories to determine their weight gain range until more research is done to determine whether special categories are needed for them.” [1].

Elsewhere, it is mentioned that the 2009 IOM recommendations also address some special populations: This report goes on to say that “Some special populations are addressed in the IOM committee’s report. Women of short stature are recommended to gain at the lower end of the range for their prepregnant BMI. Pregnant adolescents may typically safely follow the new guidelines for adult BMI cutoff levels, though younger adolescents often need to gain more to improve birth outcomes. Racial or ethnic groups should follow the new recommendations in general, but more research is needed in this area.  Women carrying twins are offered the following recommendations: normal weight women should gain 37 – 54 pounds, overweight women 31-50 pounds and obese women, 25-42 pounds at term.” [2] 

Disparities in such reports from different sources unfortunately results in confusion in the lay public.

1. http://www.iom.edu/~/media/Files/Report

2. http://www.ksre.k-state.edu/humannutrition/nutritionnews/pregweightguidel.pdf

 

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October 13, 2010 04:33 PM
Debbie Miller, RN's avatar

Hello Aroon,
Thank you for your kind comments.  In my study I have found nothing to suggest that adolescent recommendations should vary from adult women.  BMI appears to be the most important factor and pregnant adolescents more often are on the lower end (normal or underweight) than the adults.  There is one study of black primapara teens (Rochester School of Nursing, 2008) which showed that those who gained more than the amount recommended by the IOM were 4.6 times more likely to be obese 6 and 9 years after giving birth.  So, it appears that the same risk factors are involved with all women who gain too much.  Another study suggests that nutritional status following pregnancy in adolescence is not adversely affected by the pregnancy and agrees that BMI concerns are equal among all the women.  The latter study was a cohort study among Latin American women, reported in 2009.  Do you have other thoughts on this? 

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October 12, 2010 01:55 PM
M. Aroon Kamath, M.D.'s avatar

Hello Debbie,
It was a pleasure reading through your blog, written in such simplistic, easily readable and understandable fashion. You would agree that adolescent pregnancies and their outcomes still remain a concern despite the various programs and resources directed towards addressing teen pregnancy prevention and improving adolescent preconception health. I am curious to know if the Institute of Medicine and the National Research Council in June 2009 recommended anything in particular with regard to total pregnancy weight gain in pregnant adolescents. Also, have there been any recent recommendations regarding the optimal way of assessing the body habitus of these individuals. Does one go by calculated BMI as in the adults or is there an alternative?

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