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Within-Population Average Ranges Compared With Institute of Medicine Recommendations for Gestational Weight Gain

Beyerlein, Andreas PhD; Lack, Nicholas PhD; von Kries, Rüdiger MD

doi: 10.1097/AOG.0b013e3181f1ad8b
Original Research

OBJECTIVE: To compare the risk for pregnancy outcomes by gestational weight gain with the Institute of Medicine criteria and empirically established average ranges of gestational weight gain.

METHODS: In a population-based data set comprising 678,560 singleton deliveries in Bavarian obstetric units from 2000 to 2007, we calculated the prevalence of adverse short-term pregnancy outcomes within the gestational weight-gain ranges recommended by the Institute of Medicine. We then compared these for gestational weight gain within data-based interquartile ranges (25th to 75th percentile) and interdecile ranges (10th to 90th percentile) of gestational weight gain by maternal weight category (underweight, normal weight, overweight, and obese).

RESULTS: In underweight and normal-weight mothers, adherence to Institute of Medicine criteria was significantly associated with fewer preterm deliveries and small-for-gestational-age births (prevalence [95% confidence interval] for preterm delivery in normal-weight women: 5.33 [5.23-5.43] within Institute of Medicine criteria compared with 5.45 [5.36-5.54] in interquartile range). Overweight and obese mothers gaining weight within the Institute of Medicine recommendations had less preeclampsia and nonelective caesarean deliveries but had higher risks for gestational diabetes, small-for-gestational-age births, preterm delivery, and perinatal mortality compared with gestational weight gain within the respective interquartile ranges and interdecile ranges (prevalence for preterm delivery in overweight women: 8.14% [7.87-8.42] within Institute of Medicine criteria compared with 5.77% [5.60-5.93] in interquartile range).

CONCLUSION: Although underweight and normal-weight women should be encouraged to aim for a gestational weight gain according to Institute of Medicine guidelines, different gestational weight gain recommendations in overweight and obese women might lessen some adverse short-term pregnancy outcomes.


Although underweight and normal-weight women should be encouraged to aim for gestational weight gain according to Institute of Medicine guidelines, different recommendations might be appropriate for overweight and obese women. SUPPLEMENTAL DIGITAL CONTENT IS AVAILABLE IN THE TEXT.

From the Institute of Social Paediatrics and Adolescent Medicine, Ludwig-Maximilians University of Munich, Munich, Germany; and the Bayerische Arbeitsgemeinschaft für Qualitätssicherung (Bavarian Working Group on Clinical Quality Assessment), Munich, Germany.

See related article on page 1191.

Supplementary tables are available for this article as Appendix 1 and Appendix 2, available online at and

Supported by the project “Perinatal Prevention of Obesity Development” (PEPO) and the “Deutsche Forschungsgemeinschaft,” grant KR 1926/3-1. PEPO is part of the German obesity network funded by the German Federal Ministry of education and research.

Corresponding author: Andreas Beyerlein, Ludwig-Maximilians University of Munich, Institute of Social Paediatrics & Adolescent Medicine, Division of Epidemiology, Heiglhofstr. 63, 81377 Munich, Germany; e-mail:

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

© 2010 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.