New Guidelines for US Women for Weight Gain in Pregnancy

[KnoxvilleDoula]

Packing on too many pounds during pregnancy

By LAURAN NEERGAARD, AP Medical Writer Lauran Neergaard, Ap Medical Writer 1 hr 59 mins ago

WASHINGTON - Eating for two? New guidelines are setting how much weight women should gain during pregnancy - surprisingly little if they're already overweight.

The most important message: Get to a healthy weight before you conceive, says the Institute of Medicine in the first national recommendations on pregnancy weight since 1990. It's healthiest for the mother - less chance of pregnancy-related high blood pressure or diabetes, or the need for a C-section - and it's best for the baby, too. Babies born to overweight mothers have a greater risk of premature birth or of later becoming overweight themselves, among other concerns.

Meeting the guidelines could be a tall order, considering that about 55 percent of women of childbearing age are overweight, that preconception care isn't that common and about half of pregnancies are unplanned.

Once a woman's pregnant, the guidelines issued Thursday aren't too different from what obstetricians already recommend, although about half of women don't follow that advice today.

Among the new recommendations:

_A normal-weight woman, as measured by BMI or body mass index, should gain between 25 and 35 pounds during pregnancy. A normal BMI, a measure of weight for height, is between 18.5 and 24.9.

_An overweight woman - BMI 25 to 29.9 - should gain 15 to 25 pounds during pregnancy.

_For the first time, the guidelines set a standard for obese women - BMI of 30 or higher: 11 to 20 pounds.

_An underweight woman - BMI less than 18.5 - should gain 28 to 40 pounds.

What if a mom-to-be has gained too much? On average, overweight and obese women already are gaining five more pounds than the upper limit.

But pregnancy is not a time to lose weight, stressed guidelines co-author Dr. Anna Maria Siega-Riz of the University of North Carolina, Chapel Hill.

"It's not, 'Hey you gained enough, now you need to stop,'" Siega-Riz said. "Let's take stock of where you're at and start gaining correctly."

Indeed, underweight and normal-weight mothers should put on a pound a week for proper fetal growth in the second and third trimesters, the guidelines say. The overweight and obese need about half a pound a week.

Hopping on the scale during prenatal checkups makes for a sensitive moment, especially in a culture that cherishes the stereotype of late-night ice cream-and-pickles snacks.

Implementing the guidelines may take a move "to change the whole culture about pregnancy" and eating, Siega-Riz said. She noted that in studies of the overweight, "most of these women will tell you that they've never been told how much weight to gain."

The guidelines call for increased nutrition and exercise counseling during pregnancy, saying doctors or midwives may need to consult a dietitian to tailor a woman's care no matter her starting weight. Also, providers should discuss whether a woman plans to breastfeed, which not only is optimal for the baby but helps the new mother shed pounds, too.

"It's really a teachable moment," said guidelines co-author Dr. Patrick Catalano, obstetrics chairman at Ohio's Case Western Reserve University. "When women are pregnant, they may be more accepting" of weight discussions "because it's also in the best interest of their babies."

Obstetricians, who have struggled with how to advise heavier women as U.S. obesity rates have soared over the past two decades, welcomed the guidelines - especially the recognition that babies born too large tend to grow into overweight children at risk for their own health problems. Not too many years ago it was rare to see a 9-pound, or larger, newborn.

"Pregnant women should not be eating for two," said Dr. Ellen J. Landsberger, who specializes in high-risk pregnancies at New York's Montefiore Medical Center. "You want a healthy baby? On both ends, you have to eat the right amount."

But is it realistic for obese women to gain as little as 11 pounds?

"We think it's possible. We also think it will be a challenge," said Cornell University nutrition specialist Dr. Kathleen Rasmussen, who chaired the Institute of Medicine committee.

In the Bronx, Nyree Paten illustrates that challenge: She had been putting on weight for three years and discovered she was pregnant at her peak, just over 300 pounds, seriously obese even for someone 6 feet tall. Her doctor diagnosed diabetes at her first prenatal checkup. Landsberger found Paten, 35, a nutritionist and prescribed insulin for the diabetes. Paten said she's gained only about 2 pounds by week 24, while regular ultrasounds show her baby is growing well.

"Thank God I've been doing good," says Paten, who feels more energetic because she's eating better. So is her 8-year-old son. First to go: sugary sodas and juices in favor of water.

"It's all about knowing and being educated on how to eat," adds Paten, who's lined up the nutritionist to help her lose weight once her baby is born.

The guidelines say women expecting twins can gain more: 37 to 54 pounds for a normal-weight woman, 31 to 50 pounds for the overweight, 25 to 42 pounds for the obese. There's not enough information to set recommendations for triplets or more.

The institute stressed that the guidelines are aimed at U.S. women, not for parts of the world with different nutritional and obstetric needs.

[RanaAurora]

May. 28, 2009 at 7:51 PM

I wasn't aware these were new guidelines?  These are what I read 5 years ago, except the high-end amount for underweight women is higher on this one.

[KnoxvilleDoula]

May. 28, 2009 at 7:52 PM

What is new about it is for the obese women gaining maybe only 11 pounds.

(Original Poster)

[adulation]

May. 28, 2009 at 7:57 PM

hmm i didn't know this was new either.  i had already read several times that very overweight women should only gain between 10-15 lbs during pregnancy.

anyway,  i think it's is reasonable.  to me it's just saying to work to maintain your weight during pregnancy.  yes, it's so easy to let yourself go, but you definitely don't have to.

i could've easily gained 35 pounds or more during my pregnancy.. almost did!  but i worked enough to maintain a recommended weight gain [i gained 29 lbs] and it was not easy!

[Mommygoose]

May. 28, 2009 at 8:21 PM

That will be my goal during this next pregnancy. I did "ok" with DD and have gotten back down to pre-DD weight. Now lets just hope the test shows positive in the morning!!!!

[KnoxvilleDoula]

May. 28, 2009 at 9:12 PM

*baby dust* mommygoose!

(Original Poster)

[MythicMMM]

May. 29, 2009 at 8:33 PM

BMI is a bunch of BS as far as I am concerned. I gained a lot of muscle while doing hard constant physical labor for 5 years and have always been "over weight" according to the BMI since then, even though I was (and still am) pretty cut up. ~showes off my guns~ lol.