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Weight Gain Recommendations in Pregnancy and the Obesity Epidemic

Artal, Raul MD; Lockwood, Charles J. MD; Brown, Haywood L. MD

doi: 10.1097/AOG.0b013e3181c51908
Current Commentary

Excessive gestational weight gain and obesity have been recognized as independent risk factors for maternal and fetal complications of pregnancy with significant lifelong consequences. These associations call into question the recently released Institute of Medicine (IOM) gestational weight gain recommendations, particularly for obese women. The IOM recommendation of a single standard of weight gain for all obesity classes is also of concern, because higher body mass index levels are associated with more severe pregnancy complications, such as preeclampsia and gestational diabetes. The IOM recommendations retained the 1990 focus on the theoretical association between poor gestational weight gain and low birth weight (LBW). Low gestational weight gain may often be a consequence and not the cause of LBW, and there is a lack of evidence in developed countries that dietary supplementation increases birth weight. Current obstetric practice allows for accurate and timely diagnosis of and intervention for LBW. We submit that gestational weight gain recommendations should be more individualized especially for obese women. Obese pregnant women should not be precluded from partaking in healthy lifestyle modifications in pregnancy that include physical activities, modified, judicious diets, and limited weight gain.

The association between excessive gestational weight gain and short-term and long-term comorbidities calls into question the Institute of Medicine recommendations.

From the Department of Obstetrics, Gynecology and Women's Health, Saint Louis University School of Medicine, St. Louis, Missouri; Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut; and Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina.

Corresponding author: Raul Artal, MD, Saint Louis University School of Medicine, 6420 Clayton Road, Suite 290, St. Louis, MO 63117; e-mail:

Financial Disclosure: The authors did not report any potential conflicts of interest.

© 2010 by The American College of Obstetricians and Gynecologists.