WASHINGTON -- A growing amount of scientific evidence indicates that how much weight women gain during pregnancy and their starting weight at conception can affect their health and that of their babies, says a new report from the Institute of Medicine and the National Research Council.  The report recommends new pregnancy weight gain guidelines for American women that aim to balance the benefits and risks associated with pregnancy weight change.  Noting that entering pregnancy with a normal body mass index (BMI) as well as gaining within the recommended levels during gestation are the best ways to minimize the risks, the report calls for increased diet and exercise counseling and programs to help women attain a normal BMI. The new guidelines update recommendations the Institute of Medicine made in 1990 and reflect changing U.S. demographics, particularly the surge in the number of Americans who are overweight or obese.  Healthy American women at a normal weight for their height (BMI of 18.5 to 24.9) should gain 25 to 35 pounds during pregnancy, the new guidelines state.  Underweight women (BMI less than 18.5) should gain more, 28 to 40 pounds, and overweight women (BMI of 25 to 29.9) should gain less, 15 to 25 pounds.  These ranges match the 1990 guidelines, but the report also specifies a new range for obese women (BMI greater than 30) that limits their gain to 11 to 20 pounds.  BMI is based on a person's weight and height; for example, a 5-foot-6-inch woman weighing between 115 and 154 pounds has a normal BMI.  
The ranges for each BMI category reflect that many factors besides maternal weight and gestational weight gain affect outcomes and the reality that healthy babies are born to women across a spectrum of pregnancy weight changes.  Studies consistently show that gaining within the guidelines lowers health risks for mothers and children, though this does not mean that every woman who exceeds or falls short of the guidelines or that the babies born to these women will have problems. "This report gives women and their health care providers an evidence-based answer to the question of how much weight women should gain during pregnancy," said Kathleen M. Rasmussen, professor of nutrition, division of nutritional sciences, Cornell University, Ithaca, N.Y., and chair of the committee that wrote the report.  "We call on health professionals to adopt these guidelines and help women follow them so that mothers and their children will have the best health outcomes possible." Expectant mothers and their care providers need to balance the benefits of pregnancy weight gain for the fetus with the risks of too much or too little increase, which can result in consequences for both mothers and children.  For mothers, the ramifications of excess weight gain include increased chances of retaining extra pounds after birth or needing a Caesarean section; for children the risks include being born preterm or larger than normal with extra fat.  Each of these consequences increases the chances for subsequent health problems -- such as heart disease and diabetes in the case of extra weight, and impaired development in the case of premature birth.  At the same time, adding too few pounds during pregnancy increases risks for stunted fetal growth and preterm delivery.  The report focuses on weight changes during pregnancy, but it also notes that women's weight at conception affects infants and mothers, too.  Nearly two-thirds of U.S. women of childbearing age are overweight or obese.  To minimize the risks, women should aim to conceive while at a normal BMI and gain within the guidelines during pregnancy, the committee concluded.  Helping women achieve these goals will require health care providers to increase the counseling they give their patients on weight, diet, and exercise.  This counseling should occur not just during pregnancy, but well before women plan to conceive, given that many should lose weight to begin pregnancy closer to or at a normal BMI.  Women's doctors should record their patients' weight, height, and BMI as a routine practice prior to conception, throughout pregnancy, and in the post-partum period.  Prenatal care providers and expectant mothers should work together to set pregnancy weight gain goals based on the guidelines and other factors relevant to each patient's individual needs.  Guidelines do no good if women do not know about them and care providers do not follow and promote them.  Studies published after the 1990 guidelines were released found that a high proportion of women were either given no advice on how much weight to gain or were advised to gain outside of their recommended range.  The committee called on medical professional societies, federal health agencies, and other influential groups to adopt the new guidelines and help educate women on their importance for achieving healthy outcomes for their children and themselves. The guidelines are intended for American women, the report notes.  They may be applicable to women in other developed countries, but they are not intended for use in areas of the world where women are substantially shorter or thinner than American women or where adequate obstetric services are not available. The study was sponsored by the U.S. Department of Health and Human Services' Health Resources Services Administration, Centers for Disease Control and Prevention, National Institutes of Health (National Institute of Child Health and Development, National Institute of Diabetes and Digestive and Kidney Diseases, and Division of Nutrition Research Coordination), HHS Office of Women's Health, and the HHS Office of Disease Prevention and Health Promotion; and the March of Dimes.  Additional support was provided by the HHS Office of Minority Health (National Minority AIDS Council).  The National Academy of Sciences, National Academy of Engineering, Institute of Medicine, and National Research Council make up the National Academies.  They are private, nonprofit institutions that provide science, technology, and health policy advice under a congressional charter.  A committee roster follows.                                                                                                                                                                                                                      Copies of WEIGHT GAIN DURING PREGNANCY: REEXAMINING THE GUIDELINES are available from the National Academies Press; tel. 202-334-3313 or 1-800-624-6242 or on the Internet at HTTP://WWW.NAP.EDU/.   NATIONAL RESEARCH COUNCILDivision of Behavioral and Social Sciences and EducationBoard on Children, Youth, and Families
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INSTITUTE OF MEDICINEBoard on Children, Youth, and FamiliesFood and Nutrition Board COMMITTEE TO REEXAMINE IOM PREGNANCY WEIGHT GUIDELINES KATHLEEN M. RASMUSSEN, SC.D. (CHAIR)ProfessorDivision of Nutritional SciencesCornell UniversityIthaca, N.Y. BARBARA ABRAMS, DR. P.H., R.D.Professor of Epidemiology, Maternal and Child Health, and Public Health NutritionSchool of Public HealthUniversity of CaliforniaBerkeley LISA M. BODNAR, PH.D., M.P.H., R.D.Assistant ProfessorDepartment of EpidemiologyGraduate School of Public HealthUniversity of PittsburghPittsburgh CLAUDE BOUCHARD, PH.D.Executive Director, andGeorge A. Bray Chair in NutritionPennington Biomedical Research CenterBaton Rouge, La. NANCY F. BUTTE, PH.D.Professor of PediatricsChildren's Nutrition Research CenterBaylor College of MedicineHouston PATRICK M. CATALANO, M.D., F.A.C.O.G.ChairDepartment of Reproductive BiologyMetroHealth Medical CenterCase Western Reserve UniversityCleveland MATTHEW GILLMAN, M.D., S.M.Associate ProfessorDepartment of Ambulatory Care and PreventionHarvard Pilgrim Health CareHarvard Medical SchoolBoston FERNANDO A. GUERRA, M.D., M.P.H.*Director of HealthSan Antonio Metropolitan Health DistrictSan Antonio, Texas PAULA JOHNSON, M.D., M.P.H.Executive DirectorConnors Center for Women's HealthBrigham and Women's HospitalBoston MICHAEL C. LU. M.D., M.P.H., M.S.Associate Professor of Obstetrics and GynecologySchool of MedicineUniversity of CaliforniaLos Angeles
ELIZABETH R. MCANARNEY, M.D.*Professor and Chair EmeritaDepartment of PediatricsSchool of Medicine and DentistryUniversity of RochesterRochester, N.Y. RAFAEL PEREZ-ESCAMILLA, PH.D.Professor of Nutritional Sciences, andDirectorCenter for Eliminating Health
DisparitiesUniversity of ConnecticutStorrs, Conn. DAVID A. SAVITZ, PH.D.*Charles W. Bluhdorn Professor of Community and Preventive Medicine, andDirector of Epidemiology, Biostatistics, and Disease PreventionMount Sinai School of MedicineNew York City ANNA MARIA SIEGA-RIZ, PH.D.Associate ProfessorDepartment of Maternal and Child HealthSchool of Public HealthUniversity of North CarolinaChapel Hill STAFF ANN L. YAKTINE, PH.D.Study Director                                                                       * Member, Institute of Medicine