research on weight gain during pregnancy

• Practice Bulletin
• Clinical Practice Guideline
• Committee Statement
• Committee Opinion
• Clinical Consensus
• Practice Advisory
• Obstetric Care Consensus
• ACOG Endorsed
• Technology Assessment
• Task Force Report
• Clinical Practice Update
• Clinical Updates
• Obstetrics & Gynecology
• Patient Education Materials
• For Patients
• Breast Neoplasms
• Delivery of Health Care
• Fetal Alcohol Spectrum Disorders
• Genetic Testing
• Gynecologic Surgical Procedures
• Menstruation Disturbances
• Obstetric Labor
• Obstetric Surgical Procedures
• Pregnancy Complications
• Reproductive Physiological Phenomena
• Clinical Guidance

Weight Gain During Pregnancy

• Committee Opinion CO
• Number 548
• January 2013

Overweight Women

Obese women, conclusions and recommendations.

• Search page Search Page Close
• Resources Resources Close

By reading this page you agree to ACOG's Terms and Conditions.  Read terms

Number 548 (Reaffirmed 2023)

Committee on Obstetric Practice

This document reflects emerging clinical and scientific advances as of the date issued and is subject to change. The information should not be construed as dictating an exclusive course of treatment or procedure to be followed.

ABSTRACT: The updated guidelines by the Institute of Medicine regarding gestational weight gain provide clinicians with a basis for practice. Health care providers who care for pregnant women should determine a woman’s body mass index at the initial prenatal visit and counsel her regarding the benefits of appropriate weight gain, nutrition and exercise, and, especially, the need to limit excessive weight gain to achieve best pregnancy outcomes. Individualized care and clinical judgment are necessary in the management of the overweight or obese woman who is gaining (or wishes to gain) less weight than recommended but has an appropriately growing fetus.

The amount of weight gained during pregnancy can affect the immediate and future health of a woman and her infant. The population demographics of women who become pregnant have changed dramatically over the past decade; more women are overweight or obese at conception. Evidence supports associations between excessive gestational weight gain and increased birth weight and postpartum weight retention but also between inadequate weight gain and decreased birth weight 1 . Gestational weight gain recommendations aim to optimize outcomes for the woman and the infant. In 2009, the Institute of Medicine (IOM) published revised gestational weight gain guidelines that are based on prepregnancy body mass index (BMI) ranges for underweight, normal weight, overweight, and obese women recommended by the World Health Organization and are independent of age, parity, smoking history, race, and ethnic background Table 1 2 . Other changes include the removal of the previous recommendations for special populations and the addition of weight gain guidelines for women with twin gestations. For twin pregnancy, the IOM recommends a gestational weight gain of 16.8–24.5 kg (37–54 lb) for women of normal weight, 14.1–22.7 kg (31–50 lb) for overweight women, and 11.3–19.1 kg (25–42 lb) for obese women. The IOM guidelines recognize that data are insufficient to determine the amount of weight women with multifetal (triplet and higher order) gestations should gain.

The updated IOM recommendations have met with controversial reactions from some physicians who believe that the weight gain targets are too high, especially for overweight and obese women. Also, these perceived high weight gain targets do not address concerns regarding postpartum weight retention. In addition, concerns have been raised that the guidelines do not differentiate degrees of obesity, especially for morbidly obese women.

The IOM guidelines recommend a total weight gain of 6.8–11.3 kg (15–25 lb) for overweight women (BMI of 25–29.9; BMI is calculated as weight in kilograms divided by height in meters squared). Gestational weight gain below the IOM recommendations among overweight pregnant women does not appear to have a negative effect on fetal growth or neonatal outcomes. In several studies, overweight women who gained 2.7–6.4 kg (6–14 lb) had similar fetal growth, perinatal and neonatal outcomes, and less postpartum weight retention as overweight women who gained weight within the currently recommended IOM range 3 4 5 6 7 8 . For the overweight pregnant woman who is gaining less than the recommended amount but has an appropriately growing fetus, no evidence exists that encouraging increased weight gain to conform with the current IOM guidelines will improve maternal or fetal outcomes.

The IOM recommendations define obesity as a BMI of 30 or greater and do not differentiate between Class I obesity (BMI of 30–34.9), Class II obesity (BMI of 35–39.9), and Class III obesity (BMI of 40 or greater) 2 . Given the limited data by class, the IOM recommendation for weight gain is 5–9.1 kg (11–20 lb) for all obese women. The gestational weight gain guidelines attempt to balance the risks of having large-for-gestational-age infants, small-for-gestational-age infants, and preterm births and postpartum weight retention. Citing a lack of sufficient data regarding short-term and long-term maternal and newborn outcomes, authors of the IOM report did not recommend lower targets for women with more severe degrees of obesity 9 . The results of observational studies continue to provide mixed results.

The results of several large population-based cohort studies published after the release of the IOM guidelines suggested no harm in setting more restrictive weight gain limitations 8 10 . One systematic review found that overweight and obese women who gain less weight than the ranges recommended by the IOM do not have an increased risk of having a low birth weight infant 1 . Conversely, other researchers have reported that even the IOM guidelines may be too restrictive for severely obese women and may be associated with increased rates of preterm births, small-for-gestational-age infants, and perinatal mortality when compared with women with a similar BMI who gain an average amount of weight during pregnancy 11 . From the results of these and more recent studies, it appears that the relationships between maternal obesity class, gestational weight gain, and maternal and newborn outcomes are complex.

Among severely obese women with weight loss or restricted weight gain during pregnancy, the possible risk of having small-for-gestational-age infants contrasts with possible benefits, such as a decrease in rates of cesarean delivery, a risk of having large-for-gestational-age infants, and postpartum weight retention 10 12 13 . For an obese pregnant woman who is gaining less weight than recommended but has an appropriately growing fetus, no evidence exists that encouraging increased weight gain to conform with the updated IOM guidelines will improve maternal or fetal outcomes. For more information, see the American College of Obstetricians and Gynecologists’ Committee Opinion No. 549, “Obesity in Pregnancy” 14 .

The IOM gestational weight gain guidelines provide clinicians with a basis for practice. Health care providers who care for pregnant women should determine a woman’s BMI at the initial prenatal visit (an online BMI calculator is available at http://www.nhlbisupport.com/bmi . It is important to discuss appropriate weight gain, diet, and exercise at the initial visit and periodically throughout the pregnancy. Individualized care and clinical judgment are necessary in the management of the overweight or obese woman who is gaining (or wishes to gain) less weight than recommended but has an appropriately growing fetus. Balancing the risks of fetal growth (in the large-for-gestational-age fetus and the small-for-gestational-age fetus), obstetric complications, and maternal weight retention is essential but will remain challenging until research provides evidence to further refine the recommendations for gestational weight gain, especially among women with high degrees of obesity.

• Siega-Riz AM, Viswanathan M, Moos MK, Deierlein A, Mumford S, Knaack J, et al. A systematic review of outcomes of maternal weight gain according to the Institute of Medicine recommendations: birthweight, fetal growth, and postpartum weight retention. Am J Obstet Gynecol 2009;201:339.e1–14. [ PubMed ] [ Full Text ] Article Locations: Article Location Article Location
• Institute of Medicine. Weight gain during pregnancy: reexamining the guidelines . Washington, DC: National Academies Press; 2009. Article Locations: Article Location Article Location
• Schieve LA, Cogswell ME, Scanlon KS. An empiric evaluation of the Institute of Medicine’s pregnancy weight gain guidelines by race. Obstet Gynecol 1998;91:878–84. [ PubMed ] [ Obstetrics & Gynecology ] Article Locations: Article Location
• Langford A, Joshu C, Chang JJ, Myles T, Leet T. Does gestational weight gain affect the risk of adverse maternal and infant outcomes in overweight women? Matern Child Health J 2011;15:860–5. [ PubMed ] [ Full Text ] Article Locations: Article Location
• Nohr EA, Vaeth M, Baker JL, Sorensen TI, Olsen J, Rasmussen KM. Combined associations of prepregnancy body mass index and gestational weight gain with the outcome of pregnancy [published erratum appears in Am J Clin Nutr 2008;88:1705]. Am J Clin Nutr 2008;87:1750–9. [ PubMed ] [ Full Text ] Article Locations: Article Location
• Cedergren M. Effects of gestational weight gain and body mass index on obstetric outcome in Sweden. Int J Gynaecol Obstet 2006;93:269–74. [ PubMed ] [ Full Text ] Article Locations: Article Location
• Oken E, Kleinman KP, Belfort MB, Hammitt JK, Gillman MW. Associations of gestational weight gain with short- and longer-term maternal and child health outcomes. Am J Epidemiol 2009;170:173–80. [ PubMed ] [ Full Text ] Article Locations: Article Location
• Beyerlein A, Schiessl B, Lack N, vonKries R. Optimal gestational weight gain ranges for the avoidance of adverse birth weight outcomes: a novel approach. Am J Clin Nutr 2009;90:1552–8. [ PubMed ] [ Full Text ] Article Locations: Article Location Article Location
• Rasmussen KM, Abrams B, Bodnar LM, Butte NF, Catalano PM, Maria Siega-Riz A. Recommendations for weight gain during pregnancy in the context of the obesity epidemic. Obstet Gynecol 2010;116:1191–5. [ PubMed ] [ Obstetrics & Gynecology ] Article Locations: Article Location
• Bodnar LM, Siega-Riz AM, Simhan HN, Himes KP, Abrams B. Severe obesity, gestational weight gain, and adverse birth outcomes. Am J Clin Nutr 2010;91:1642–8. [ PubMed ] [ Full Text ] Article Locations: Article Location Article Location
• Beyerlein A, Lack N, vonKries R. Within-population average ranges compared with Institute of Medicine recommendations for gestational weight gain. Obstet Gynecol 2010;116:1111–8. [ PubMed ] [ Obstetrics & Gynecology ] Article Locations: Article Location
• Blomberg M. Maternal and neonatal outcomes among obese women with weight gain below the new Institute of Medicine recommendations. Obstet Gynecol 2011;117: 1065–70. [ PubMed ] [ Obstetrics & Gynecology ] Article Locations: Article Location
• Potti S, Sliwinski CS, Jain NJ, Dandolu V. Obstetric outcomes in normal weight and obese women in relation to gestational weight gain: comparison between Institute of Medicine guidelines and Cedergren criteria. Am J Perinatol 2010;27:415–20. [ PubMed ] [ Full Text ] Article Locations: Article Location
• Obesity in pregnancy. Committee Opinion No. 549. American College of Obstetricians and Gynecologists. Obstet Gynecol 2013;121:213–7. [ Obstetrics & Gynecology ] Article Locations: Article Location

Copyright January 2013 by the American College of Obstetricians and Gynecologists, 409 12th Street, SW, PO Box 96920, Washington, DC 20090-6920. All rights reserved.

ISSN 1074-861X

Weight gain during pregnancy. Committee Opinion No. 548. American College of Obstetricians and Gynecologists. Obstet Gynecol 2013;121:210–2.

Figures & Tables

Table 1. Institute of Medicine Weight Gain Recommendations for Pregnancy

request permissions

Please Confirm

Bulk pricing was not found for item. Please try reloading page.

For additional quantities, please contact [email protected] or call toll-free from U.S.: (800) 762-2264 or (240) 547-2156 (Monday through Friday, 8:30 a.m. to 5 p.m. ET)

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

• View all journals
• Explore content
• About the journal
• Publish with us
• Sign up for alerts
• Population Study Article
• Open access
• Published: 03 August 2021

Assessment of pregnancy dietary intake and association with maternal and neonatal outcomes

• Jole Costanza 1 ,
• Margherita Camanni 1 ,
• Maria Maddalena Ferrari 2 ,
• Valentina De Cosmi 3 , 4 ,
• Silvia Tabano 5 , 6 ,
• Laura Fontana 1 , 6 ,
• Tatjana Radaelli 2 ,
• Giulia Privitera 2 ,
• Daniela Alberico 2 ,
• Patrizia Colapietro 6 ,
• Silvia Motta 1 ,
• Silvia Sirchia 7 ,
• Tamara Stampalija 8 , 9 ,
• Chiara Tabasso 4 , 10 ,
• Paola Roggero 4 , 10 ,
• Fabio Parazzini 2 , 4 ,
• Fabio Mosca 4 , 10 ,
• Enrico Ferrazzi 2 , 4 ,
• Silvano Bosari 11 ,
• Monica Miozzo 1 , 7 &
• Carlo Agostoni 3 , 4  

Pediatric Research volume  91 ,  pages 1890–1896 ( 2022 ) Cite this article

4956 Accesses

5 Citations

Metrics details

Maternal dietary habits are contributors of maternal and fetal health; however, available data are heterogeneous and not conclusive.

Nutrient intake during pregnancy was assessed in 503 women with uncomplicated pregnancies, using the validated Food Frequency Questionnaire developed by the European Prospective Investigation into Cancer and Nutrition (EPIC-FFQ).

In all, 68% of women had a normal body mass index at the beginning of pregnancy, and 83% of newborns had an appropriate weight for gestational age. Maternal pre-pregnancy body mass index (BMI), gestational weight gain (GWG), and placental weight were independently correlated with birth weight. GWG was not related to the pre-pregnancy BMI. EPIC-FFQ evaluation showed that 30% of women adhered to the European Food Safety Authority (EFSA) ranges for macronutrient intake. In most pregnant women (98.1%), consumption of water was below recommendations. Comparing women with intakes within EFSA ranges for macronutrients with those who did not, no differences were found in BMI, GWG, and neonatal or placental weight. Neither maternal nor neonatal parameters were associated with the maternal dietary profiles.

Conclusions

In our population, maternal pre-pregnancy BMI, GWG, and placental weight are determinants of birth weight percentile, while no association was found with maternal nutrition. Future studies should explore associations through all infancy.

Maternal anthropometrics and nutrition status may affect offspring birth weight.

In 503 healthy women, maternal pre-pregnancy body mass index (BMI), gestational weight gain (GWG), and placental weight were independently correlated to neonatal birth weight. GWG was not related to the pre-pregnancy BMI. In all, 30% of women respected the EFSA ranges for macronutrients. Neither maternal nor neonatal parameters were associated with maternal dietary profiles considered in this study.

Maternal pre-pregnancy BMI, GWG, and placental weight are determinants of neonatal birth weight percentile, while a connection with maternal nutrition profiles was not found.

Similar content being viewed by others

Relationship between the quality of the pregnant woman’s diet and birth weight: a prospective cohort study

Maternal pre-pregnancy overweight and gestational diabetes and dietary intakes among young adult offspring

Prenatal adherence to the Mediterranean diet decreases the risk of having a small-for-gestational-age baby, ECLIPSES study

Introduction.

Maternal dietary habits are lifestyle-related contributors of maternal and fetal health, impacting pre-pregnancy body mass index (BMI), maternal gestational weight gain (GWG), and fetal growth. 1 Furthermore, according to the hypothesis of Developmental Origins of Health and Disease, nutritional exposure and the subsequent metabolic programming that occurs in utero may also influence offspring physiology and metabolism later in life. 2 Both undernutrition and overnutrition during pregnancy have been associated with clinical complications including hypertensive disorders of pregnancy and gestational diabetes, which can lead to adverse neonatal and infant conditions, such as abnormal birth weight, anatomic and functional neurodevelopmental conditions, and adulthood cardiovascular disorders. 3 , 4 , 5 , 6 Birth weight could be a predictor of offspring health and placental weight identified as a determinant of intrauterine growth. In turn, placental weight is related to maternal conditions. 7 , 8

Maternal dietary exposure can be monitored through GWG and pre-pregnancy BMI. A number of negative pregnancy outcomes have been linked with high and low GWG; however, limited evidence is available on the impact of optimal GWG on pregnancy outcomes. 9 , 10 According to the Institute of Medicine (IOM) recommendations, 11 GWG should be progressive and proportional to pre-pregnancy BMI. Controlling dietary intake during pregnancy allows sufficient provision of energy to the growing fetus, while keeping GWG within recommended ranges. The main energy source during gestation should be carbohydrates, which should account for 45–60% of total daily energy intake (EI), with sugar consumption within 10% of total carbohydrate intake. Fat should comprise around 30% EI, with protein contributing the remaining portion of energy. 12 Overall EI should be adjusted for age and level of physical activity. 13

Despite the recognized role of nutrition in pregnancy on maternal and offspring outcomes, available data are heterogeneous, mainly because of differences in study designs, dietary intake measurements, environmental confounders, and the large variability of maternal dietary habits.

Aims of the present study were to explore the macronutrient and daily EIs of European women, compare the results with the European Food Safety Authority (EFSA) recommendations and investigate the relationship between maternal nutritional status and neonatal anthropometric outcomes.

To this aim, we have conducted a survey on a cohort of European pregnant women at term with cultural and lifestyle habits consistent with the Mediterranean diet. Dietary intake was evaluated using a Food Frequency Questionnaire, developed by the European Prospective Investigation into Cancer and Nutrition questionnaire (EPIC-FFQ). 14

Materials and methods

Pregnant women were enrolled at the Obstetric Unit “L. Mangiagalli” at Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, from September 2016, up to March 2019. Cases were selected according to the following inclusion criteria: (1) Caucasian European ancestry, (2) singleton spontaneous pregnancy delivered at ≥37 weeks of gestation, and (3) absence of fetal abnormalities. We excluded women affected by chronic diseases and/or gestational complications, such as gestational diabetes, hypertensive disorders, and/or fetal growth restrictions. The study protocol was approved by Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico Milano Area B Ethical Committee (reference ID number 2487-588ter (28.04.2015), and written informed consent was obtained from each woman. The enrolled women for this study belong to a more comprehensive project aimed at creating the first Italian biobank of maternal and fetal biological material from >2000 healthy pregnancies. Within the project, we will explore the Barker’s hypothesis by investigating the maternal nutrition, the fetal–placental epigenetic profile, and transcriptome patterns related to birth weight and maternal weight gain.

Herein we investigated the nutrition habits during pregnancy in a large cohort of European women. The study was designed in collaboration with clinicians, midwives, nutrition experts, and geneticists to find evidence to respond to anxiety in pregnant women about the possible consequences of their diet on newborn weight, their own health, and that of their babies.

Data collection

Participants were enrolled at the time of hospitalization for delivery and included both cesarean section and vaginal deliveries. Maternal data, comprising anthropometric parameters (height and weight before and at the end of pregnancy), obstetric history, and clinical characteristics of the pregnancies, were obtained from medical records. Maternal nutritional habits were recorded through the EPIC-FFQ questionnaire. At the time of delivery, mode of delivery, gestational age, neonatal weight, and placental weight were recorded.

Dietary assessment

To evaluate nutritional habits, a printed copy of the FFQ developed by the EPIC study (EPIC-FFQ) was given to participants. 14 EPIC is a multicentric prospective cohort study investigating the relationship between diet, cancer, and other chronic diseases in over half a million participants across different European countries. 15 , 16 The EPIC study was conceived by the International Agency for Research on Cancer, part of the World Health Organization, and was funded by the “Europe Against Cancer” program of the European Commission and other non-profit institutions. The questionnaire is composed of 260 multiple-choice questions supported by pictures. 14 The EPIC-FFQ was not specifically designed to assess nutrition and/or dietary habits in pregnancy, but it has already been used by Flynn et al. in an adapted version for the UK population to assess dietary pattern in obese pregnant women. 17 , 18 Each survey was processed through the licensed software EPIC (patented by Fondazione IRCCS Istituto Nazionale dei Tumori), allowing the conversion of nutritional habits into nutrient quantities per day (expressed in grams). The women filled in the EPIC-FFQ during their hospitalization for delivery. They were asked to report the nutritional habits from the first trimester up to delivery, indicating possible changes compared to their pre-pregnancy habits. The questionnaires were designed to protect respondent anonymity and to improve the reliability and accuracy of feedback, as well as to increase response rates. Macronutrient energy ratios were calculated using a formula that multiplies fat/protein/carbohydrate quantity (expressed in grams) by a standard coefficient for each macronutrient (kcal/g = 9 for fat, 4 for protein, and 3.75 for carbohydrate), according to Atwater. 19 The results were adjusted for total daily calories. As a result, overall EI and the percentage of calories derived from carbohydrate, fat, and protein were obtained.

Data analysis

Categorical or ordinal variables are presented as frequency (%) and continuous variables as means (standard deviation) if normally distributed, and medians (interquartile range) if not. Differences between groups were evaluated with t test for normally distributed variables. A one-way analysis of variance was used to evaluate differences between three or more independent groups. Correlation between birth weight and placental weight was tested with Pearson’s correlation coefficient ( r ). K -means clustering was performed to define dietary profiles according to macronutrient ratios. Statistical analysis and graph generation was performed in R 20 with p  < 0.05 considered statistically significant.

Initially, the dataset was composed by >800 women who adhered to this project; however, in order to have a homogeneous and eligible dataset, we further filtered out the population reaching the final number of 503 pregnancies. Data quality controls were indeed carried out to exclude biased entries (e.g., randomly drafted), uncompleted questionnaires (>30/260 blank answers), and those showing unlikely daily caloric intakes (<1000 kcal/day or >3500 kcal/day).

Infant growth charts developed by Bertino et al. (INeS) 21 were used for birth weight classification. Three newborn groups were identified based on weight percentile considering weeks of gestation: (1) SGA (small for gestational age), ≤10th percentile; (2) AGA (appropriate for gestational age), >10th and <90th percentile; (3) LGA (large for gestational age), ≥90th percentile. 22 , 23

Maternal weights were stratified on the basis of GWG and pre-pregnancy BMI, with women classified as underweight (BMI < 18.5 kg/m 2 ), normal weight (BMI ≥ 18.5 and <25 kg/m 2 ), overweight (BMI ≥ 25 and <30 kg/m 2 ), and obese (BMI ≥ 30 kg/m 2 ). 11 According to IOM recommended ranges, GWG is progressive and proportional to pre-pregnancy BMI: in underweight women the recommended GWG range is 12.5–18 kg, in normal weight women 11.5–16 kg, in overweight women 7–11.5 kg, and in obese women 5–9 kg. 11

Clinical information about each pregnancy was entered into a comprehensive database and a unique identification code was assigned to ensure privacy.

On the whole, the final dataset consists of 503 women, 474 Italian and 29 from other European countries. Clinical data are reported in Table  1 .

The cohort was mainly composed of women in the normal range for prenatal BMI (73.3%) and AGA newborns were delivered in 83% of cases.

Gestational age, mode of delivery, and neonatal weight were similar considering primiparous vs. multiparous women.

Clinical outcomes

The relationships between maternal anthropometric parameters (pre-pregnancy BMI and GWG) and primary neonatal outcomes (newborn birth weight percentile and placental weight) were evaluated at the time of delivery. 24 , 25 Neonatal birth weight and placental weight showed a significant positive correlation ( r  = 0.54, r 2  = 0.3, p  < 0.05; Fig.  S1 ). When stratified by neonatal birth weight percentile groups (i.e., SGA, AGA, and LGA), there were significant differences in maternal pre-pregnancy BMI between groups (Fig.  1a ). There were also significant differences in maternal GWG between SGA newborns and the other newborn classes (Fig.  1 ). Overall, birth weight percentile increases in parallel with GWG and pre-pregnancy BMI.

Pre-pregnancy maternal BMI ( a ) and gestational weight gain (GWG) ( b ) boxplot distributions in small for gestational age (SGA), appropriate for gestational age (AGA), and large for gestational age (LGA) neonatal groups. c Pair-wise t test results analyzing differences in pre-pregnancy BMI and GWG between SGA, AGA, and LGA birth weight categories.

When categorized by maternal BMI, there was a higher proportion of SGA offspring from mothers with a low maternal BMI compared to other BMI categories (18% SGA in underweight women vs. 5 and 2.6% in normal weight and overweight women, respectively). There were no SGA infants born to obese mothers, who gave birth to a larger proportion of LGA infants (25%) than mothers with a lower BMI (Fig.  S2 ).

Analysis of relative risk (RR) showed that women with a normal BMI had a lower risk of delivering SGA and LGA offspring than women in lower and higher BMI categories, respectively. The RR of a SGA birth was significant (RR = 0.27, 95% confidence interval (CI) 0.13–0.57) in normal weight compared with underweight women and the RR of a LGA newborn was not significant (RR = 0.7, 95% CI 0.34–1.38) in normal weight compared with overweight/obese women.

Additional analyses were performed to evaluate the relationships among placental weight, pre-pregnancy BMI, and GWG, revealing that placental weight correlated to pre-pregnancy BMI and GWG (Fig.  S3 ).

Although both maternal BMI and GWG differed according to newborn weight percentile categories, maternal GWG was not different between pre-pregnancy BMI categories ( p  = 0.44; Fig.  S4 ).

To evaluate maternal anthropometric and GWG, the study population were compared with the IOM guidelines. 11 This comparison showed that 78% of underweight and 64% of normal weight women gained insufficient weight during pregnancy (minimum recommended thresholds 11.5 and 12.5 kg, respectively). By contrast, among obese women 58% gained more weight than the maximum recommended threshold and 25% had appropriate GWG. Most overweight women showed GWG within the recommended range (43%), while mothers with low and high GWG were equally distributed outside the lower and upper limits.

Nutritional data

Daily caloric and macronutrient intake.

Maternal energy requirements may vary depending on several factors, including the trimester of gestation and the level of physical activity. Since information about the physical activity levels were not available, previously reported 26 intakes based on moderate physical activity were used as reference range (between 1800 and 2400 kcal/day). For nutrition evaluation, EI, macronutrients, fiber, and water were considered.

The mean EI in our cohort was 2108.4 ± 519.7 kcal/day. When the daily caloric intake was compared with the SIGO guidelines, 26 27.2% of women consumed more calories than the recommended range, 29.8% consumed less, and 43% were within the recommended range (Table  2 ).

Analysis of nutritional data showed that 89.5% of women respected EFSA protein range derived from a massive European survey, 27 and only 12 women (8.3%) consumed less protein (Table  2 ) while the vegetable to animal protein ratio was 1:2. Around 63% of women exceeded the EFSA range for fat intake, with a vegetable to animal fat ratio of 1:1. Finally, the mean carbohydrate intake of pregnant women was within the recommended range, with 334 women (66.4%) consuming the recommended daily levels of carbohydrate.

The average intake of dietary fiber in our cohort was slightly lower than EFSA recommendation, at 23 ± 7.6 g consumed vs. 25 g recommended (Table  2 ). Additionally, the average consumption of water was 1152 ± 391 mL/day, about half of the recommended amounts (2300 mL/day) 28 (Fig.  S5 ).

To investigate associations between maternal diet and neonatal outcomes, women were divided into two groups: (1) those following EFSA recommendations for all macronutrients and (2) those who fell outside EFSA guidelines for all three macronutrients (fat, protein, and carbohydrate), to maximize possible differences at the two extremes, even considering the possible unbalance of numbers. These subsets included 151 (30%) and 11 women (2%), respectively (Table  S1 ).

No differences were found between the two groups in terms of newborn and placental weight at birth, pre-pregnancy BMI, and GWG. However, a mild difference in birth weight was found, since women within EFSA references had children with a mean birth weight of 3355 g, while women out of EFSA references for all the three macronutrients had children with a mean birth weight of 3053 g, but the variability in this smaller group should be also accounted for.

We also evaluated birth weight values in two groups, based on “lower” vs. “higher” intakes of fat as for the cutoff of 35% indicated by EFSA recommendations and no difference has been found ( p  = 0.37, t test).

Finally, k -means clustering was carried out, which defined four dietary profiles according to macronutrient ratios ( k  = 4) expressed in percentage according to Atwater formula, as reported in the “Materials and methods” section. 19 The groups were mainly distinguished by fat and carbohydrate intakes. Group 1 (depicted in red in Fig.  2 ) included 175 women who had a high intake of carbohydrate (45–55% EI) and a normal contribution of fat (30–40% EI). Group 2 (orange) included 103 women who showed a high level of carbohydrate intake (55–65% EI) with a lower level of fat intake (22–35% EI). In addition, 58 mothers in Group 3 (light green) had a percentage of carbohydrate lower than recommended (30–40% EI) and a higher portion of fat (40–53% EI). Finally, 167 women in Group 4 (dark green) consumed a higher proportion of carbohydrate (40–48% EI) and fat (35–45% EI) than recommended. All groups fall within EFSA range for proteins, but Group 2 in particular is characterized by a relatively low protein intake (13.6% ± 1.8% EI), while in Group 3 the contribution of protein was higher (17.3% ± 2.5 EI). Neither maternal nor neonatal outcomes (pre-pregnancy BMI, GWG, newborn weight, placental weight) showed associations with these dietary profiles.

In red (group 1) high carbohydrate (45–55%) and normal fat (30–40%); in orange (group 2) very high carbohydrate (55–65%) and low fat (22–35%); in light green (group 3) low carbohydrate (30–40%) and very high fat (40–53%); in dark green (group 4) high carbohydrate (40–48%) and high fat (35–45%). Neonatal and maternal parameters are reported on lateral bar: birth weight percentile (BW percentile), maternal pre-pregnancy BMI, gestational weight gain (GWG), energy intake. K -means groups are also reported. Top-right legend reports neonatal, maternal, and nutritional categories: for birth weight percentile, infants are categorized into large for gestational age (LGA), appropriate for gestational age (AGA), small for gestational age (SGA); for maternal pre-pregnancy BMI, women are divided into underweight (BMI < 18.5 kg/m 2 ), normal weight (18.5 ≤ BMI < 25 kg/m 2 ), overweight (25 ≤ BMI < 30 kg/m 2 ), and obese (BMI ≥ 30 kg/m 2 ); for gestational weight gain (GWG), women are divided into low GWG (GWG < 7 kg), high GWG (GWG > 13 kg), and normal GWG (7 ≤ GWG ≤ 13 kg); energy intakes are divided into three categories: low energy (energy < 1200 kcal/day), normal energy (1200 ≤ energy < 2500 kcal/day), and high energy (energy > 2500 kcal/day).

This study aimed to characterize dietary habits in healthy pregnant women and investigate how these related to maternal anthropometric parameters and neonatal outcomes (represented by neonatal and placental weight at birth). Neonatal outcomes have been suggested as proxy of future health status at population levels.

Neonatal and placental weight were positively correlated, with a direct association with maternal pre-pregnancy BMI and GWG, respectively. The prevalence of SGA neonates was higher in the subgroup of underweight mothers, while the prevalence of LGA neonates was higher in obese mothers. However, in the obese group, GWG was not higher than the other pre-pregnancy BMI categories. In agreement with other studies, 29 , 30 , 31 our data show that excessive maternal GWG resulted in a greater proportion of LGA offspring than mothers with a lower GWG. However, in contrast to previous studies, 32 , 33 , 34 we found that the relationship between GWG and offspring weight was independent of pre-pregnancy BMI.

A recent meta-analysis of the association of GWG with maternal and infant outcomes analyzed data of >1 million pregnant women and showed that 47% of women have greater GWG and 23% lower GWG, than IOM recommendations. 35 Likewise, in our study, women did not lie within the IOM ranges for GWG. The majority of underweight and normal weight women did not reach the minimum GWG recommended (78 and 64%, respectively), while >50% obese women gained more weight than the maximum recommended GWG. Additionally, our results showed no differences in GWG and EIs between women stratified into four groups according to pre-pregnancy BMI.

The daily caloric and macronutrient intake of mothers have been investigated through the EPIC questionnaire. The repartition between macronutrients emphasized the heterogeneous dietary intakes in the sampled population. In all, 30% of the sampled population reported dietary intakes in line with all EFSA recommendations. During pregnancy, requirements of water and fiber increase, due to increased uterus weight and reduced bowel motility resulting from higher levels of progesterone. 36 However, our data on water and fiber consumption showed that women did not reach the minimum recommended intake for either dietary component. Our results fit with the macronutrient distributions obtained from the EPIC-FFQ in another recent study even though involving a different larger Italian sample. 37

We have also observed that maternal and neonatal outcomes (pre-pregnancy BMI, GWG, newborn weight, placental weight) were not different when mothers with different dietary profiles were compared. Since follow-up data were not available, our observations are limited to the parameters at birth. Therefore, we cannot exclude the possibility that maternal dietary habits before and during pregnancy might impact on later postnatal outcomes, such as growth and/or developmental achievements.

Our study has both strengths and limitations. A relatively large, homogeneous sample was used from a single institution and a validated FFQ was used to assess dietary habits. Although the FFQ is designed to determine eating habits over the last year, participants generally “telescope” their report backward so that their dietary information mostly reflects recent patterns of intake. 38

Possibly, maternal weight should be put under control before, rather than during pregnancy, since optimal GWG ranges may have limited predictive value. 11 This is also confirmed by our results suggesting that maintaining an adequate and controlled weight may represent a benefit for either maternal health or neonatal outcomes (considering birth weight and placenta).

Failure to meet recommendations for energy, protein, and fat found in the present study are in accordance with results reported for macronutrients in a cohort of 200 pregnant women by Diemert et al. 39 and by a systematic review and meta-analysis of data from developed countries. 40 Within this context, recommendations often focus on GWG, rather than on promoting a healthy diet as starting point during pregnancy and before conception. Despite a lack of maternal adherence to recommendations, neonatal anthropometric outcomes were within normal ranges, which may suggest compensatory fetal growth mechanisms, partly at least genetically driven, in face of maternal nutritional inadequacy. We may also speculate that the present dietary recommendation may not be relevant to the healthy local diet. The opportunity of longer-term follow-ups should be once more recommended to account for epigenetic changes and/or mechanisms with later phenotypic expression levels. 41 , 42

Finally, our data cannot be directly compared with data from developing and resource-poor countries, where baseline nutritional intakes are different. For example, Pathirathna et al. studied 141 healthy pregnant women in Sri Lanka, whose dietary habits were measured by a FFQ and the results suggest that women with a total EI below recommendations delivered neonates with significantly lower mean birth weight than women who were above recommendations. 43

In conclusion, we found that maternal pre-pregnancy BMI, GWG, and placental weight were positively correlated with neonatal birth weight. Few women had a GWG within the recommended ranges and, when looking at their nutritional habits, even fewer followed Institutional recommended intakes for energy, macronutrients, fiber, and water. Neither maternal nor neonatal outcomes were associated with the dietary profiles considered in this study. These findings suggest that nutritional counseling should be strongly implemented in pre-conceptional and obstetric clinic. As regards the apparent non-influence of inappropriate diet on newborn weight, we speculate that a longitudinal follow-up of the newborns of this cohort into their infancy could reveal a potential metabolic effect of the intrauterine environment independently from simple weight at birth—a working hypothesis requiring long-term observations in large populations from different settings.

World Health Organization. Good Maternal Nutrition: The Best Start in Life (WHO, 2016).

Barker, D. J., Osmond, C., Winter, P., Margetts, B. & Simmonds, S. J. Weight in infancy and death from ischaemic heart disease. Lancet 334 , 577–580 (1989).

Article   Google Scholar  

Langmia, I. M. et al. Cardiovascular programming during and after diabetic pregnancy: role of placental dysfunction and IUGR. Front. Endocrinol. 10 , 215 (2019).

Vohr, B. R., Davis, E. P., Wanke, C. A. & Krebs, N. F. Neurodevelopment: the impact of nutrition and inflammation during preconception and pregnancy in low-resource settings. Pediatrics 139 , S38–S49 (2017).

Gaillard, R. Maternal obesity during pregnancy and cardiovascular development and disease in the offspring. Eur. J. Epidemiol. 30 , 1141–1152 (2015).

Mamun, A., Mannan, M. & Doi, S. Gestational weight gain in relation to offspring obesity over the life course: a systematic review and bias‐adjusted meta‐analysis. Obes. Rev. 15 , 338–347 (2014).

Article   CAS   Google Scholar  

Strøm‐Roum, E. M., Tanbo, T. G. & Eskild, A. The associations of maternal body mass index with birthweight and placental weight. Does maternal diabetes matter? A population study of 106 191 pregnancies. Acta Obstet. Gynecol. Scand. 95 , 1162–1170 (2016).

Roland, M. C. P. et al. Fetal growth versus birthweight: the role of placenta versus other determinants. PLoS ONE 7 , e39324 (2012).

Goldstein, R. F. et al. Gestational weight gain across continents and ethnicity: systematic review and meta-analysis of maternal and infant outcomes in more than one million women. BMC Med. 16 , 153 (2018).

Kominiarek, M. A. & Peaceman, A. M. Gestational weight gain. Am. J. Obstet. Gynecol. 217 , 642–651 (2017).

National Research Council, Institute of Medicine, Food and Nutrition Board, Board on Children, Youth and Families & Committee to Reexamine IOM Pregnancy Weight Guidelines. Weight Gain During Pregnancy: Reexamining the Guidelines (National Academies Press, 2009).

EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA). Scientific opinion on dietary reference values for energy. EFSA J. 11 , 3005 (2013).

Tielemans, M. J. et al. Macronutrient composition and gestational weight gain: a systematic review. Am. J. Clin. Nutr. 103 , 83–99 (2016).

Riboli, E. et al. European Prospective Investigation into Cancer and Nutrition (EPIC): study populations and data collection. Public Health Nutr. 5 , 1113–1124 (2002).

Riboli, E. & Kaaks, R. The EPIC project: rationale and study design. European Prospective Investigation into Cancer and Nutrition. Int. J. Epidemiol. 26 , S6 (1997).

Bingham, S. A. et al. Comparison of dietary assessment methods in nutritional epidemiology: weighed records v. 24 h recalls, food-frequency questionnaires and estimated-diet records. Br. J. Nutr. 72 , 619–643 (1994).

Flynn, A. C. et al. Dietary patterns in obese pregnant women; influence of a behavioral intervention of diet and physical activity in the UPBEAT randomized controlled trial. Int. J. Behav. Nutr. Phys. Act. 13 , 1–12 (2016).

Pisani, P. et al. Relative validity and reproducibility of a food frequency dietary questionnaire for use in the Italian EPIC centres. Int. J. Epidemiol. 26 , S152–S160 (1997).

Miller, D. S. & Judd, P. A. The metabolisable energy value of foods. J. Sci. Food Agric. 35 , 111–116 (1984).

R Core Team. R: A Language and Environment for Statistical Computing (R Foundation for Statistical Computing, 2013).

Bertino, E. et al. Neonatal anthropometric charts: the Italian neonatal study compared with other European studies. J. Pediatr. Gastroenterol. Nutr. 51 , 353–361 (2010).

Hediger, M. L. et al. Growth of infants and young children born small or large for gestational age: findings from the Third National Health and Nutrition Examination Survey. Arch. Pediatr. Adolesc. Med. 152 , 1225–1231 (1998).

Lubchenco, L. O., Hansman, C., Dressler, M. & Boyd, E. Intrauterine growth as estimated from liveborn birth-weight data at 24 to 42 weeks of gestation. Pediatrics 32 , 793–800 (1963).

Taricco, E., Radaelli, T., De Santis, M. N. & Cetin, I. Foetal and placental weights in relation to maternal characteristics in gestational diabetes. Placenta 24 , 343–347 (2003).

Roberts, D. J. & Oliva, E. Clinical significance of placental examination in perinatal medicine. J. Matern. Fetal Neonatal Med. 19 , 255–264 (2006).

Fondazione Confalonieri Ragonese MS, AOGOI, AGUI. Nutrizione in gravidanza e durante l’allattamento.  https://www.sigo.it/wp-content/uploads/2018/06/LG_NutrizioneinGravidanza.pdf (2013).

European Food Safety Authority (EFSA). Dietary reference values for nutrients Summary report. EFSA Supporting Publ. 2017 , e15121 (2017).

Google Scholar  

EFSA Panel on Dietetic Products, Nutrition and Allergies. Scientific opinion on dietary reference values for water. EFSA J. 8 , 1459 (2010).

Eriksson, J. G., Sandboge, S., Salonen, M., Kajantie, E. & Osmond, C. Maternal weight in pregnancy and offspring body composition in late adulthood: findings from the Helsinki Birth Cohort Study (HBCS). Ann. Med. 47 , 94–99 (2015).

Gillman, M. W. et al. Developmental origins of childhood overweight: potential public health impact. Obesity 16 , 1651–1656 (2008).

Morandi, A. et al. Estimation of newborn risk for child or adolescent obesity: lessons from longitudinal birth cohorts. PLoS ONE 7 , e49919 (2012).

Crane, J. M., White, J., Murphy, P., Burrage, L. & Hutchens, D. The effect of gestational weight gain by body mass index on maternal and neonatal outcomes. J. Obstet. Gynaecol. Can. 31 , 28–35 (2009).

Frederick, I. O., Williams, M. A., Sales, A. E., Martin, D. P. & Killien, M. Pre-pregnancy body mass index, gestational weight gain, and other maternal characteristics in relation to infant birth weight. Matern. Child Health J. 12 , 557–567 (2008).

Oken, E., Kleinman, K. P., Belfort, M. B., Hammitt, J. K. & Gillman, M. W. Associations of gestational weight gain with short-and longer-term maternal and child health outcomes. Am. J. Epidemiol. 170 , 173–180 (2009).

Goldstein, R. F. et al. Association of gestational weight gain with maternal and infant outcomes: a systematic review and meta-analysis. JAMA 317 , 2207–2225 (2017).

Armstrong, L. E. & Johnson, E. C. Water intake, water balance, and the elusive daily water requirement. Nutrients 10 , 1928 (2018).

Agnoli, C. et al. Macronutrient composition of the diet and long-term changes in weight and waist circumference in the EPIC-Italy cohort. Nutr. Metab. Cardiovasc. Dis. 31 , 67–75 (2021).

Boushey, C. J. in Calcium in Human Health (eds Weaver, C. M. & Heaney, R. P.) 39–63 (Springer, 2006).

Diemert, A. et al. Maternal nutrition, inadequate gestational weight gain and birth weight: results from a prospective birth cohort. BMC Pregnancy Childbirth 16 , 1–9 (2016).

Blumfield, M. L., Hure, A. J., Macdonald-Wicks, L., Smith, R. & Collins, C. E. Systematic review and meta-analysis of energy and macronutrient intakes during pregnancy in developed countries. Nutr. Rev. 70 , 322–336 (2012).

Barker, D. J. The developmental origins of adult disease. J. Am. Coll. Nutr. 23 , 588S–595S (2004).

Rondinone, O. et al. Extensive placental methylation profiling in normal pregnancies. Int. J. Mol. Sci . 22 , 2136 (2021).

Pathirathna, M. L. et al. Impact of second trimester maternal dietary intake on gestational weight gain and neonatal birth weight. Nutrients 9 , 627 (2017).

Download references

Acknowledgements

We thank Ms. Barbara Botta for questionnaire management and database preparation and all mothers participating in the study.

The present study was entirely funded by the Italian Health Ministry (RF-2013-02359454).

Author information

Authors and affiliations.

Research Laboratories Coordination Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy

Jole Costanza, Margherita Camanni, Laura Fontana, Silvia Motta & Monica Miozzo

Unit of Obstetric, Department of Woman, Child and Neonate “L. Mangiagalli”, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy

Maria Maddalena Ferrari, Tatjana Radaelli, Giulia Privitera, Daniela Alberico, Fabio Parazzini & Enrico Ferrazzi

Pediatric Intermediate Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy

Valentina De Cosmi & Carlo Agostoni

Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy

Valentina De Cosmi, Chiara Tabasso, Paola Roggero, Fabio Parazzini, Fabio Mosca, Enrico Ferrazzi & Carlo Agostoni

Laboratory of Medical Genetics, Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico, Milan, Italy

Silvia Tabano

Department of Pathophysiology & Transplantation, Università degli Studi di Milano, Milan, Italy

Silvia Tabano, Laura Fontana & Patrizia Colapietro

Medical Genetics, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy

Silvia Sirchia & Monica Miozzo

Unit of Fetal Medicine and Prenatal Diagnosis, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy

Tamara Stampalija

Department of Medical, Surgical and Health Science, Università diTrieste, Trieste, Italy

Neonatal Intensive Care Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy

Chiara Tabasso, Paola Roggero & Fabio Mosca

Scientific Direction, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy

Silvano Bosari

You can also search for this author in PubMed   Google Scholar

Contributions

J.C. performed the analysis and drafted the manuscript; M.C. collected the data and drafted the manuscript; M.M.F., V.C.D., G.P., C.T., P.R., S.T., T.R., and L.F. contributed to the interpretation of the data and drafted the manuscript; D.A., P.C., S.M., and T.S. collected the data; S.S. contributed to the interpretation of the data; F.P., F.M., E.F., S.B., M.M., and C.A. have all contributed to the planning and design of the study, to the interpretations of the data, and have critically revised the manuscript.

Corresponding author

Correspondence to Monica Miozzo .

Ethics declarations

Competing interests.

The authors declare no competing interests.

Ethics approval and consent to participate

The study protocol was approved by Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico Milano Area B Ethical Committee (reference ID number 2487-588ter (28.04.2015) and written informed consent was obtained from each woman.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Supplementary material, rights and permissions.

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/ .

Reprints and permissions

About this article

Cite this article.

Costanza, J., Camanni, M., Ferrari, M.M. et al. Assessment of pregnancy dietary intake and association with maternal and neonatal outcomes. Pediatr Res 91 , 1890–1896 (2022). https://doi.org/10.1038/s41390-021-01665-6

Download citation

Received : 23 December 2020

Revised : 19 June 2021

Accepted : 30 June 2021

Published : 03 August 2021

Issue Date : June 2022

DOI : https://doi.org/10.1038/s41390-021-01665-6

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

Quick links

• Explore articles by subject
• Guide to authors
• Editorial policies

• Research article
• Open access
• Published: 21 February 2013

Perspectives about and approaches to weight gain in pregnancy: a qualitative study of physicians and nurse midwives

• Tammy Chang 1 , 2 ,
• Mikel Llanes 1 , 4 ,
• Katherine J Gold 1 , 3 &
• Michael D Fetters 1 , 5  

BMC Pregnancy and Childbirth volume  13 , Article number:  47 ( 2013 ) Cite this article

8663 Accesses

44 Citations

4 Altmetric

Metrics details

Over one third of reproductive age women in the US are obese. Pregnancy is a strong risk factor for obesity, with excess weight gain as the greatest predictor of long term obesity. The majority of pregnant women gain more weight than recommended by the Institute of Medicine guidelines. The objective of this study was to understand prenatal care providers’ perspectives on weight gain during pregnancy.

Semi-structured qualitative interviews of 10 prenatal care providers (three family physicians, three obstetricians, and four nurse midwives) at a University Hospital in the Midwest, that included the ranking of important prenatal issues, and open-ended questions addressing: 1) general perceptions; 2) approach with patients; and 3) clinical care challenges.

Providers felt that appropriate weight gain during pregnancy was not a high priority. Many providers waited until patients had gained excess weight before addressing the issue, were not familiar with established guidelines, and lacked resources for patients. Providers also believed that their counseling had low impact on patients, avoided counseling due to sensitivity of the topic, and believed that patients were more influenced by other factors, such as their family, habits, and culture.

Conclusions

Both providers and patients may benefit from increased awareness of the morbidity of excess weight gain during pregnancy. Practice-level policies that support the monitoring and management of weight gain during pregnancy could also improve care. Research that further investigates the barriers to appropriate weight gain is warranted.

Peer Review reports

Obesity among reproductive age women is a prevalent, debilitating, and expensive public health problem. Obesity is associated with serious physical, psychological and social problems including cardiovascular disease, lower quality of life, and stigma [ 1 – 4 ]. Despite over a decade of focus, overall rates of obesity among reproductive age women in the US remain high, with between a quarter and a third of women age 20–44 categorized as obese [ 5 , 6 ].

Pregnancy is a time of expected weight gain. However, the majority of US women gain more than the recommended weight per Institute of Medicine guidelines [ 7 , 8 ]. In fact, pregnancy itself is a strong risk factor for future obesity, with excess weight gain during pregnancy as the greatest predictor of long term obesity [ 9 – 11 ].

Excess weight gain during pregnancy is associated with serious short and long-term consequences for both mothers and their infants. Risks of excess maternal weight gain to infants include low five- minute APGAR score, seizure, hypoglycemia, hyperbilirubinemia, polycythemia, meconium aspiration syndrome, macrosomia, and childhood overweight [ 12 – 14 ]. Perinatal complications such as miscarriage, Caesarean section, development of diabetes mellitus, pregnancy-induced hypertension, as well postpartum weight retention and overweight are among the adverse consequences of excess weight gain during pregnancy for mothers [ 10 , 15 , 16 ].

In general, weight management during pregnancy has not been emphasized in the prenatal care of patients. One cross-sectional study of Canadian patients of midwives, family physicians, and obstetricians showed very low rates (5.7%-16.3%) of counseling about gestational weight gain by all types of providers [ 17 ]. When information is given antenatally regarding weight gain, the advice is typically brief and generally not related to weight management as reported by a recent study in the UK [ 18 ]. Interestingly, despite having the highest rates of excessive weight gain nationally, white women were the least likely to receive counseling about nutrition during pregnancy in a cohort study of predominantly low-income prenatal patients in the US [ 19 ].

Studies have examined the patient’s perspective of weight gain during pregnancy. These studies show that gestational weight gain is associated with overall body image [ 20 ], and that the desire to return to prepregnancy weight was a strong motivating factor to control weight gain. In addition, the health and well-being of their unborn baby is often central in women’s decisions about appropriate weight gain [ 21 ], and women’s attitudes about weight gain in pregnancy are embedded in their overall orientation toward pregnancy and their general psychological functioning [ 22 ]. Low-income black women in the US had more perceptions encouraging high gestational weight gain than discouraging it [ 23 ]. Furthermore, low-income black women did not limit their gestational weight gain, despite knowledge of the risk for weight retention due to their belief that gaining more weight is indicative of a healthy infant [ 24 ].

To better understand the complex problem of excess weight gain during pregnancy, it is vital to understand the perspectives of prenatal care providers as well. The objective of this study was to understand the perceptions, approach, and challenges regarding management of weight gain during pregnancy among a sample of family physicians, obstetricians, and certified nurse midwives who provide prenatal care.

We used a qualitative design employing semi-structured qualitative interviews. This study was approved by the University of Michigan’s institutional review board.

Academic medical center in the Midwest with Family Medicine, Nurse Midwifery, and Obstetrics clinical and educational programs [ 25 , 26 ].

Participants and recruitment

We used maximum variation sampling to obtain a variety of medical specialties and providers with a breadth of background and experience within our sample. Providers were selected based on specialty (FP, OB, CNM) and to represent a broad level of experience (faculty vs resident), and were either contacted by email or face-to-face to participate in our study. From this process, we recruited three family physicians (FP), three obstetricians (OB) and four certified nurse midwives (CNM) who practice at community-based sites as part of a university hospital in the Midwest. All eligible providers that were asked to participate consented to be interviewed for the study (n = 10). No incentive was offered for participation. Verbal informed consent was obtained from all study participants, and documented by audio-recording.

Data collection

Two investigators (TC, ML) conducted face-to-face, in-depth, semi-structured interviews using an interview guide developed by the authors after the participants provided their verbal informed consent to participate. The interviews began by participants ranking a list of eleven important prenatal issues occurring during a typical prenatal visit to learn their perceptions about the importance of weight gain relative to other common issues. We then asked semi-structured, open-ended questions addressing their general perceptions about weight gain, their clinical approach to weight gain, and challenges they encounter in the management of weight gain during pregnancy. Interviews were performed by two researchers in private rooms and were audio-recorded.

Standard Interview Guide

Domain 1. Perception of weight gain management

How would you prioritize these prenatal care issues?

Substance abuse

Folic acid supplementation

Appropriate weight gain

Domestic abuse

Nutrition/Diet

Mood disturbances

STD prevention

Round ligament pain

Tell me your thoughts about the management of weight gain during pregnancy?

Probe- Is it a problem? How important is it? Why?

Domain 2. Counseling of patients

What is your general approach to weight gain in pregnancy?

Why do you follow this approach?

Probe – Do you follow any guidelines or general rules?

How do you approach these discussions?

Probe –Timing, specific advice

What resources do you use to help patients?

What factors influence your approach?

Domain 3. Challenges with counseling about weight gain in pregnancy

What is the impact of your weight gain management?

How receptive do you feel your patients are to counseling?

What do you find is most effective?

What do you find is not effective?

What are specific barriers or other challenges?

Data analysis

Interviews were transcribed verbatim, and reviewed for accuracy. We used inductive qualitative techniques informed by thematic analysis [ 27 ]. We began by exploring how providers perceived the management of weight gain during pregnancy and their specific approaches to management. Transcripts were reviewed line by line to identify prominent concepts and ideas to draft preliminary coding categories. These initial findings were reviewed, coding categories were created, and themes were added and clarified as a team. Two researchers (TC, ML) engaged in an inductive process of reading and manually coding two transcripts together. Codes were further clarified and a codebook with definitions was developed. From this codebook, the remaining transcripts were coded independently. Inter-coder agreement was 92%. Team members (TC, ML) reviewed results in frequent meetings and discussions, using memos to identify emerging themes and describe relationships among coding categories [ 28 ]. The final coding scheme and analysis of the findings were reviewed, and disagreements were discussed until consensus was reached. We organized the results using the coding scheme structure and illustrated the themes and sub-themes with representative quotations.

To help achieve ‘trustworthiness’ of our results, we performed “member checking” where the overall results of the study were emailed to each participant. Eight of the interviewed providers including at least one provider from each specialty (FP, OB, CNM) responded to the request for member checking. Each of them indicated that the results included and accurately represented their viewpoints.

Participant characteristics

Providers included had varying levels of clinical experience and included senior residents and senior faculty members. Most providers reported the composition of their patient population was primarily white. However, several of the providers also worked with populations of patients whose composition was primarily black or diverse (Table  1 ). All providers were employed by a large academic health system where they provided labor and delivery care, though their outpatient prenatal care was based in local community settings.

The following sections describe major themes around perceptions of the management of weight gain during pregnancy, approaches to management, and challenges faced. Quotations are labeled by participant number. We found no notable differences between specialty groups (FP, CNM, OB) in regards to their perceptions and general approaches to counseling and care.

Priority of weight gain relative to other common prenatal issues

When asked to verbally rank a list of 11 common prenatal issues (see subsection Standard Interview Guide), some providers ranked the issues numerically, while others discussed only their “top” issues stating that the remainder were less important. Three providers reported that “appropriate weight gain” was not a “top” priority, while assessing smoking, substance abuse, domestic abuse, and mood disturbances as more important.

The highest numerical ranking of “appropriate weight gain” among any of the participants was only 4 out of 11, while five providers ranked it 7 or lower (7 by one provider, 8 by three providers, and 9 by one provider.)

Qualitative comments made by providers from all three specialties further illustrated their belief that weight gain during pregnancy was not a high priority compared to competing issues.

“ …her weight would be last on the priority list.” (Participant 8)

“I tend not to talk about weight gain.” (1)

Approaches to care

The approach to weight gain during pregnancy ranged from no approach to a focus on diet and exercise rather than on appropriate weight gain.

“I mention their labs, blood pressure, weight gain as routine. May comment on it, but I may not think it’s an issue. When is it an issue? When do I worry about weight gain? I have to say that I probably don’t focus on the weight gain as a concern as much as nutrition. If they are eating healthy but they are gaining a little more weight than the recommendation, I may mention it to them, but I don’t worry about it.” (6)

When asked about guidelines informing their approach to appropriate weight gain, none stated knowledge of the IOM guidelines, while others described varying ranges of weight gain recommendations they followed that were learned during their training.

“It’s the nutritional guidelines through the governmental regulations for pregnancy- that is the benchmarks.” (4)

“I have a range… if the patient is normal weight, I say a minimum of 15 pounds, maybe 15–25 pounds.”(10)

Although many providers reported that weight gain was not emphasized during routine prenatal care, once excess weight gain was detected, providers would then focus on the issue.

“I guess I might bring it up more if they are gaining a lot of weight.” (9)

Most providers reported a lack of accessible and effective resources for patients, especially nutritional education/counseling. Moreover these providers doubted the efficacy of nutritional counseling or doubted that patients would have access to these resources due to cost and insurance limitations.

“I don’t think dieticians are very successful so I don’t send my patients.” (10)

“(I refer for) nutritional counseling if their insurance will pay for it, but it gets tricky…” (3)

Attitudes and beliefs

Not only did providers believe that nutritional counseling was ineffective, many providers did not believe their own interventions could change their patients’ behavior.

“No- I don’t think my lame diet counseling makes a difference just the same way that people don’t lose weight even after doctor’s counseling. Is it cultural or habit- yeah.” (7)

“It seems that some doctors really harp on it, but I don’t. I don’t believe we have much control over this.” (7)

Providers perceived sensitivity to discussing weight with their patients and also expressed their own caution in addressing this topic. Many providers wanted to avoid ideas of body image, specifically patients perceiving that their doctor was labeling them.

“It’s probably because it makes me uncomfortable. Probably some of my care is biased because it’s someplace I don’t want to go. I don’t want to tell a patient that they are fat.” (2)

Many providers perceived that patients were more influenced by other factors in regards to weight gain during pregnancy, which was one reason why providers felt they had little impact on a patient’s weight gain.

“The patients that are obese are obese for various reasons and those habits are hard to break. They may have socio-economic factors that make them not be able to afford healthy foods and I think those are not overcomeable very easily.” (9)

“It’s a challenge because it is a cultural issue depending on their family history.” (5)

Our study begins to characterize the complexity of weight gain during pregnancy from the perspective of a variety of prenatal care providers at an academic institution. In addition, we have identified several barriers among prenatal care providers to effective weight management, as well as potential interventions and policy changes to address these challenges (Table  2 ). Not only does it appear that providers perceive that many women believe that they should be “eating for two” as suggested by past studies [ 23 , 24 ], providers may not consider the management of weight gain during pregnancy as important or effective.

Several of our findings are consistent with a recent study using focus groups to examine prenatal care providers’ knowledge, attitudes and practices regarding prevention of excessive weight gain during pregnancy [ 29 ]. One important difference is that this study sampled providers with expressed interest in weight and nutrition counseling, while our study sampled from a group of providers with no previous knowledge of our research focus. Our findings are similar in that both studies reported a lack of knowledge by providers, a “reactive” approach to excess weight gain, skepticism about counseling’s impact, and perceived sensitivity of the topic. However, one major difference is that our study finds that providers did not prioritize appropriate weight gain highly, while the aforementioned study reports “deep concern” by providers regarding appropriate weight gain [ 29 ]. This distinction is likely due to the sampling differences mentioned previously.

Our findings lend support for greater education regarding the morbidity of excess weight gain during pregnancy. In a recent study of obstetric and midwifery staff at a university teaching hospital in Australia, 79% of staff considered their training in advising women about weight gain in pregnancy to be inadequate [ 30 ]. For providers, this training should focus on not only the dangers of excess weight gain, but also on ways to approach this topic in a culturally sensitive manner. In addition, greater emphasis on weight gain guidelines during training may benefit providers, while media campaigns focusing on this issue may be effective for patients.

Next, although providers reported that management of weight gain during pregnancy is not a high priority, most providers recognized the importance of diet and exercise and seemed to “try their best” with this approach. What appears to be lacking is effective and affordable interventions to assist both providers and women in managing weight gain during pregnancy as well as research to evaluate the efficacy of those interventions. According to a large prospective cohort study in the US, the advice, when given by providers, has not been shown to influence actual gains during pregnancy [ 31 ]. Future studies to further understand barriers to the management of appropriate weight gain can inform more effective interventions. Successful interventions will likely require a team approach including nurses and medical assistants, as often, prenatal education of patients includes these team members. In the meantime, providers must set appropriate expectations and goals for weight gain and follow trends throughout pregnancy. Charts provided to patients at each visit, similar to infant growth charts, might help patients to visualize their weight gain and alert both providers and patients early on about trends towards excess weight gain.

Finally, our findings suggest that providers perceive that patients are influenced more by other factors, such as the patient’s culture, family, and friends. One way to capitalize on this influence is to encourage greater involvement of these support people as shown by studies that recommend that fathers’ needs be assessed and incorporated in a family-oriented approach to prenatal care [ 32 , 33 ]. This would give providers the opportunity to develop meaningful relationships with the patient and those that influence her, and perhaps give more credibility to providers’ advice on weight gain during pregnancy.

Limitations to our study include that a qualitative study is not designed to produce generalizable results beyond the study participants, though as found here, the design does elicit a breadth of opinions about excessive weight gain. Also, our small sample size that included a variety of providers (FP, OB, CNM) with a range of clinical experience from differing sites were analyzed together as part of maximum variation sampling. The location in an academic center where more complex patients tend to accumulate could have contributed to the sense of competing demands with other “more important” or at least “more immediate needs” reported by participants. Finally, we observed that providers often confused excess weight gain during pregnancy with the general concept of obesity during pregnancy and they would often require redirection during interviews.

Pregnancy represents a critical period when women are at very high risk for transitioning from normal weight to overweight or even obesity. The few months that a woman is pregnant can determine whether she and her child will suffer from the long-term sequelae of obesity and its associated morbidity. Furthermore, pregnancy has been shown to be a time when pregnant women may be especially receptive to behavior change recommendations [ 34 ]. This study provides important insight into the challenges prenatal care providers face in managing weight gain during pregnancy. Both providers and patients may benefit from increased awareness of the morbidity of excess weight gain in gestation. Practice-level policies that support the monitoring and management of weight gain during pregnancy could also improve care. These findings should serve as a catalyst for research that further investigates barriers to appropriate weight gain to inform effective interventions.

Authors’ information

Tammy Chang, MD, MPH is a Robert Wood Johnson Foundation Clinical Scholar and Clinical Lecturer in the University of Michigan Medical School. She is a family physician who studies obesity in reproductive age women and new media interventions for health promotion.

Mikel Llanes, MD is a Clinical Lecturer in the University of Michigan Medical School. He is a family physician interested in high-risk obstetrical care and preventative healthcare in Latino communities.

Katherine Gold, MD, MSW, MS is an Assistant Professor in the University of Michigan Departments of Family Medicine and the Department of Obstetrics & Gynecology. Her research focuses on pregnancy complications, perinatal loss, and maternal mental health in the peripartum period.

Michael Fetters, MD, MPH, MA serves as Professor of Family Medicine in the University of Michigan. His research interests focus on prevention and the influence of culture on medical decision making, and the application of qualitative and mixed methods research.

Wilson PW, D’Agostino RB, Sullivan L, Parise H, Kannel WB: Overweight and obesity as determinants of cardiovascular risk: the framingham experience. Arch Intern Med. 2002, 162 (16): 1867-1872. 10.1001/archinte.162.16.1867.

Article   PubMed   Google Scholar  

Jia H, Lubetkin EI: The impact of obesity on health-related quality-of-life in the general adult US population. J Public Health (Oxf). 2005, 27 (2): 156-164. 10.1093/pubmed/fdi025.

Article   Google Scholar  

Kolotkin RL, Meter K, Williams GR: Quality of life and obesity. Obes Rev. 2001, 2 (4): 219-229. 10.1046/j.1467-789X.2001.00040.x.

Article   CAS   PubMed   Google Scholar  

Schafer MH, Ferraro KF: The stigma of obesity: does perceived weight discrimination affect identity and physical health?. Soc Psychol Quart. 2011, 74 (1): 76-97. 10.1177/0190272511398197.

Flegal KM, Carroll MD, Kit BK, Ogden CL: Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999–2010. JAMA. 2012, 307 (5): 491-497. 10.1001/jama.2012.39.

Vahratian A: Prevalence of overweight and obesity among women of childbearing age: results from the 2002 national survey of family growth. Matern Child Health J. 2009, 13 (2): 268-273. 10.1007/s10995-008-0340-6.

Fontaine PL, Hellerstedt WL, Dayman CE, Wall MM, Sherwood NE: Evaluating body mass index-specific trimester weight gain recommendations: differences between black and white women. J Midwifery Womens Health. 2012, 57 (4): 327-335. 10.1111/j.1542-2011.2011.00139.x.

Article   PubMed   PubMed Central   Google Scholar  

Vahratian A, Siega-Riz AM, Savitz DA, Zhang J: Maternal pre-pregnancy overweight and obesity and the risk of cesarean delivery in nulliparous women. Ann Epidemiol. 2005, 15 (7): 467-474. 10.1016/j.annepidem.2005.02.005.

Hernandez DC: Gestational weight gain as a predictor of longitudinal body mass index transitions among socioeconomically disadvantaged women. J Women’s Health (Larchmont, NY 2002). 2012, 21 (10): 1082-1090.

Herring SJ, Rose MZ, Skouteris H, Oken E: Optimizing weight gain in pregnancy to prevent obesity in women and children. Diabetes Obes Metab. 2012, 14 (3): 195-203. 10.1111/j.1463-1326.2011.01489.x.

Rooney BL, Schauberger CW: Excess pregnancy weight gain and long-term obesity: one decade later. Obstet Gynecol. 2002, 100 (2): 245-252. 10.1016/S0029-7844(02)02125-7.

PubMed   Google Scholar  

Oken E, Taveras EM, Kleinman KP, Rich-Edwards JW, Gillman MW: Gestational weight gain and child adiposity at age 3 years. Am J Obstet Gynecol. 2007, 196 (4): 322-

Hedderson MM, Weiss NS, Sacks DA, Pettitt DJ, Selby JV, Quesenberry CP, Ferrara A: Pregnancy weight gain and risk of neonatal complications: macrosomia, hypoglycemia, and hyperbilirubinemia. Obstet Gynecol. 2006, 108 (5): 1153-1161. 10.1097/01.AOG.0000242568.75785.68.

Stotland NE, Cheng YW, Hopkins LM, Caughey AB: Gestational weight gain and adverse neonatal outcome among term infants. Obstet Gynecol. 2006, 108 (3 Pt 1): 635-643.

Cedergren M: Effects of gestational weight gain and body mass index on obstetric outcome in Sweden. Int J Gynaecol Obstet. 2006, 93 (3): 269-274. 10.1016/j.ijgo.2006.03.002.

Muktabhant B, Lumbiganon P, Ngamjarus C, Dowswell T: Interventions for preventing excessive weight gain during pregnancy. Cochrane Database Syst Rev. 2012, 4: CD007145-

PubMed   PubMed Central   Google Scholar  

McDonald SD, Pullenayegum E, Bracken K, Chen AM, McDonald H, Malott A, Hutchison R, Haley S, Lutsiv O, Taylor VH: Comparison of midwifery, family medicine, and obstetric patients’ understanding of weight gain during pregnancy: a minority of women report correct counselling. J Obstet Gynaecol Can. 2012, 34 (2): 129-135.

Brown A, Avery A: Healthy weight management during pregnancy: what advice and information is being provided. J Hum Nutr Diet. 2012, 25 (4): 378-387. 10.1111/j.1365-277X.2012.01231.x.

Stotland N, Tsoh JY, Gerbert B: Prenatal weight gain: Who is counseled?. J Womens Health (Larchmt). 2012, 21 (6): 695-701. 10.1089/jwh.2011.2922.

Mehta UJ, Siega-Riz AM, Herring AH: Effect of body image on pregnancy weight gain. Matern Child Health J. 2011, 15 (3): 324-332. 10.1007/s10995-010-0578-7.

Wiles R: The views of women of above average weight about appropriate weight gain in pregnancy. Midwifery. 1998, 14 (4): 254-260. 10.1016/S0266-6138(98)90098-5.

Dipietro JA, Millet S, Costigan KA, Gurewitsch E, Caulfield LE: Psychosocial influences on weight gain attitudes and behaviors during pregnancy. J Am Diet Assoc. 2003, 103 (10): 1314-1319. 10.1016/S0002-8223(03)01070-8.

Herring SJ, Henry TQ, Klotz AA, Foster GD, Whitaker RC: Perceptions of low-income African-American mothers about excessive gestational weight gain. Matern Child Health J. 2011, 16 (9): 1837-1843.

Groth SW, Morrison-Beedy D, Meng Y: How pregnant African American women view pregnancy weight gain. J Obstet Gynecol Neonatal Nurs. 2012, 41 (6): 798-808. 10.1111/j.1552-6909.2012.01391.x.

Berman DR, Johnson TR, Apgar BS, Schwenk TL: Model of family medicine and obstetrics-gynecology collaboration in obstetric care at the university of Michigan. Obstet Gynecol. 2000, 96 (2): 308-313. 10.1016/S0029-7844(00)00892-9.

CAS   PubMed   Google Scholar  

Brown DBCD, Karides M, Lukas LA: The phenomenon of collaboration: a phenomenologic study of collaboration between family medicine and obstetrics and gynecology departments at an academic medical center. The Qualitative Report. 2011, 16 (3): 657-681.

Google Scholar  

Liamputtong P, Ezzy D: Qualitative research methods: a health focus. 1999, South Melbourne, Vic: Oxford University Press

Corbin JM, Strauss AL: Basics of qualitative research: techniques and procedures for developing grounded theory. 2008, Los Angeles, Calif: Sage Publications, Inc, 3

Book   Google Scholar  

Stotland NE, Gilbert P, Bogetz A, Harper CC, Abrams B, Gerbert B: Preventing excessive weight gain in pregnancy: how do prenatal care providers approach counseling?. J Womens Health (Larchmt). 2010, 19 (4): 807-814. 10.1089/jwh.2009.1462.

Stewart ZA, Wallace E, Allan C: Weight gain in pregnancy: a survey of current practices in a teaching hospital. Aust N Z J Obstet Gynaecol. 2012, 52 (2): 208-210. 10.1111/j.1479-828X.2012.01418.x.

Ferrari RM, Siega-Riz AM: Provider advice about pregnancy weight gain and adequacy of weight gain. Matern Child Health J. 2012, Epub ahead of print Feb 24 2012

Premberg A, Carlsson G, Hellstrom AL, Berg M: First-time fathers’ experiences of childbirth–a phenomenological study. Midwifery. 2011, 27 (6): 848-853. 10.1016/j.midw.2010.09.002.

Jungmarker EB, Lindgren H, Hildingsson I: Playing second fiddle is okay–Swedish fathers’ experiences of prenatal care. J Midwifery Womens Health. 2010, 55 (5): 421-429. 10.1016/j.jmwh.2010.03.007.

McBride CM, Emmons KM, Lipkus IM: Understanding the potential of teachable moments: the case of smoking cessation. Health Educ Res. 2003, 18 (2): 156-170. 10.1093/her/18.2.156.

Pre-publication history

The pre-publication history for this paper can be accessed here: http://www.biomedcentral.com/1471-2393/13/47/prepub

Download references

Acknowledgements

The authors graciously thank the certified nurse midwives, family physicians, and obstetricians who participated in this research. The authors express special thanks to Jane Forman for her guidance in qualitative analytic methods. This work was supported by the Robert Wood Johnson Foundation Clinical Scholars Program and the Department of Family Medicine at the University of Michigan. Dr. Chang had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Dr. Fetters' participation in this research was possible in part through the generous support of the Jitsukoukai Foundation.

Author information

Authors and affiliations.

Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA

Tammy Chang, Mikel Llanes, Katherine J Gold & Michael D Fetters

University of Michigan, Robert Wood Johnson Clinical Scholars Program, North Campus Research Complex, 2800 Plymouth Road, Building 10 – Room G016, Ann Arbor, MI, 48109-2800, USA

Tammy Chang

Department of Family Medicine, Department of Obstetrics & Gynecology, University of Michigan, 1018 Fuller Street, Ann Arbor, MI, 48104-1213, USA

Katherine J Gold

Ypsilanti Health Clinic, University of Michigan, 200 Arnet Street, Suite 200, Ypsilanti, MI, 48198, USA

Mikel Llanes

Department of Family Medicine, University of Michigan, 1018 Fuller Street, Ann Arbor, MI, 48104-1213, USA

Michael D Fetters

You can also search for this author in PubMed   Google Scholar

Corresponding author

Correspondence to Tammy Chang .

Additional information

Competing interests.

The authors declare that they have no competing interests.

Authors’ contributions

All authors contributed to the conception, design, drafting and revising the manuscript, and have given final approval of the version to be published. TC and ML interviewed the participants, transcribed, coded, and analyzed the qualitative data. All authors read and approved the final manuscript.

Authors’ original submitted files for images

Below are the links to the authors’ original submitted files for images.

Authors’ original file for figure 1

Rights and permissions.

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0 ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Reprints and permissions

About this article

Cite this article.

Chang, T., Llanes, M., Gold, K.J. et al. Perspectives about and approaches to weight gain in pregnancy: a qualitative study of physicians and nurse midwives. BMC Pregnancy Childbirth 13 , 47 (2013). https://doi.org/10.1186/1471-2393-13-47

Download citation

Received : 21 November 2012

Accepted : 18 February 2013

Published : 21 February 2013

DOI : https://doi.org/10.1186/1471-2393-13-47

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Prenatal care
• Gestational weight gain
• Qualitative study
• Certified nurse midwives
• Family physician

BMC Pregnancy and Childbirth

ISSN: 1471-2393

• Submission enquiries: [email protected]
• General enquiries: [email protected]

Appointments at Mayo Clinic

• Pregnancy week by week

Pregnancy weight gain: What's healthy?

From promoting your baby's development to paving the way for post-pregnancy weight loss, here's why pregnancy weight gain matters.

Healthy lifestyle habits can help you manage pregnancy weight gain and support your baby's health. Also, making smart meal choices during pregnancy can make it easier to shed the extra pounds after you deliver your baby.

Pregnancy weight-gain guidelines

There's no one-size-fits-all approach to pregnancy weight gain. Appropriate weight gain during pregnancy depends on various factors, including your pre-pregnancy weight and body mass index (BMI). Your health and your baby's health also play a role. Work with your health care provider to determine what's right for you.

Consider these general guidelines for pregnancy weight gain:

When you're carrying twins or other multiples

If you're carrying twins or other multiples, you'll likely need to gain more weight. Again, work with your health care provider to determine what's right for you.

Consider these general guidelines for pregnancy weight gain if you're carrying twins:

When you're overweight

Being overweight before pregnancy increases the risk of various pregnancy complications, such as gestational diabetes, high blood pressure disorders of pregnancy — including preeclampsia — the need for a C-section and premature birth.

Although a certain amount of pregnancy weight gain is recommended for people who are overweight or obese before pregnancy, some research suggests that people who are obese can safely gain less weight than the guidelines recommend. More research is needed.

Work with your health care provider to determine how much weight you should gain during pregnancy. Your health care provider can offer guidance on nutrition and physical activity and strategies to manage your weight throughout pregnancy.

When you're underweight

If you're underweight before pregnancy, it's essential to gain a reasonable amount of weight while you're pregnant. Without the extra weight, your baby might be born early (premature birth) or smaller than expected.

When you gain too much

Gaining too much weight during pregnancy can increase your baby's risk of health problems, such as being born significantly larger than average, and complications at birth, such as the baby's shoulder becoming stuck after the head is delivered (shoulder dystocia). Excessive weight gain during pregnancy can also increase your risk of postpartum weight retention.

Where does pregnancy weight gain go?

Let's say your baby weighs in at 7 or 8 pounds (about 3 to 3.6 kilograms). That accounts for some of your pregnancy weight gain. What about the rest? Here's a sample breakdown:

• Larger breasts: 1 to 3 pounds (about 0.5 to 1.4 kilogram)
• Larger uterus: 2 pounds (about 0.9 kilogram)
• Placenta: 1 1/2 pounds (about 0.7 kilogram)
• Amniotic fluid: 2 pounds (about 0.9 kilogram)
• Increased blood volume: 3 to 4 pounds (about 1.4 to 1.8 kilograms)
• Increased fluid volume: 2 to 3 pounds (about 0.9 to 1.4 kilograms)
• Fat stores: 6 to 8 pounds (about 2.7 to 3.6 kilograms)

Putting on the pounds

In the first trimester, most people don't need to gain much weight. This is good news if you're struggling with morning sickness.

If you start out at a healthy weight, you need to gain only about 1 to 4 pounds (0.5 to 1.8 kilograms) in the first few months of pregnancy. You can do this by eating a healthy diet — no extra calories are necessary.

Steady weight gain is more important in the second and third trimesters — especially if you start out at a healthy weight or you're underweight. According to the guidelines, you'll gain about 1 pound (0.5 kilogram) a week until delivery. An extra 300 calories a day — half a sandwich and a glass of skim milk — might be enough to help you meet this goal. For people who are overweight or obese, the guidelines translate to a weight gain of about 1/2 pound (0.2 kilogram) a week in the second and third trimesters. Try adding a glass of low-fat milk or an ounce of cheese and a serving of fresh fruit to your diet.

Working with your health care provider

Your health care provider will keep a close eye on your weight. You can do your part by eating a healthy diet. Also, for most pregnant women, getting at least 30 minutes of moderate-intensity exercise, such as brisk walking or swimming, is recommended on most days. However, talk to your health care provider before starting an exercise program. And be sure to keep your prenatal appointments. To keep your pregnancy weight gain on target, your health care provider might offer suggestions for boosting calories or scaling back as needed.

There is a problem with information submitted for this request. Review/update the information highlighted below and resubmit the form.

From Mayo Clinic to your inbox

Sign up for free and stay up to date on research advancements, health tips, current health topics, and expertise on managing health. Click here for an email preview.

Error Email field is required

Error Include a valid email address

To provide you with the most relevant and helpful information, and understand which information is beneficial, we may combine your email and website usage information with other information we have about you. If you are a Mayo Clinic patient, this could include protected health information. If we combine this information with your protected health information, we will treat all of that information as protected health information and will only use or disclose that information as set forth in our notice of privacy practices. You may opt-out of email communications at any time by clicking on the unsubscribe link in the e-mail.

Thank you for subscribing!

You'll soon start receiving the latest Mayo Clinic health information you requested in your inbox.

Sorry something went wrong with your subscription

Please, try again in a couple of minutes

• Poston L. Gestational weight gain. https://www.uptodate.com/contents/search. Accessed Jan. 11, 2022.
• Landon MB, et al., eds. Gabbe's Obstetrics: Normal and Problem Pregnancies. 8th ed. Elsevier; 2021. https://www.clinicalkey.com. Accessed Jan. 11, 2022.
• American College of Obstetricians and Gynecologists. Practice Bulletin No. 230: Obesity in pregnancy. Obstetrics & Gynecology. 2021; doi:10.1097/AOG0000000000004395.
• Pregnancy: Staying healthy and safe. Office on Women's Health. https://www.womenshealth.gov/pregnancy/youre-pregnant-now-what/staying-healthy-and-safe. Accessed Jan. 11, 2022.
• Weight gain during pregnancy. Centers for Disease Control and Prevention. https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pregnancy-weight-gain.htm. Accessed Jan. 11, 2022.
• American College of Obstetricians and Gynecologists. Committee Opinion No. 548: Weight gain during pregnancy. Obstetrics & Gynecology. 2013; doi:10.1097/01.AOG.0000425668.87506.4c.
• Ramsey PA, et al. Obesity in pregnancy: Complications and maternal management. https://www.uptodate.com/contents/search. Accessed Jan. 11, 2022.
• Physical Activity Guidelines for Americans. 2nd ed. U.S. Department of Health and Human Services. https://health.gov/our-work/physical-activity/current-guidelines. Accessed Jan. 14, 2022.

Products and Services

• Available Solutions for Prenatal Nutrition from Mayo Clinic Store
• A Book: Mayo Clinic Guide to a Healthy Pregnancy
• Air travel during pregnancy
• Allergy medications during pregnancy
• Ankle swelling during pregnancy
• Antibiotics and pregnancy
• Aspirin during pregnancy
• Pregnancy back pain
• Falling during pregnancy: Reason to worry?
• Fetal ultrasound
• Flu shot in pregnancy
• Headaches during pregnancy: What's the best treatment?
• Iron deficiency anemia during pregnancy: Prevention tips
• Leg cramps during pregnancy
• Pregnancy acne
• Pregnancy and fish
• Pregnancy constipation
• Pregnancy diet: Essential nutrients
• Pregnancy due date calculator
• Pregnancy exercises
• Pregnancy nutrition don'ts
• Pregnancy stretches
• Pregnant. Now What Happens?
• Prenatal testing
• Prenatal vitamins and pregnancy
• Sex during pregnancy
• Twin pregnancy
• Vaccines during pregnancy
• Vaping during pregnancy
• Working during pregnancy
• X-ray during pregnancy

Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission.

• Opportunities

Mayo Clinic Press

Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press .

• Mayo Clinic on Incontinence - Mayo Clinic Press Mayo Clinic on Incontinence
• The Essential Diabetes Book - Mayo Clinic Press The Essential Diabetes Book
• Mayo Clinic on Hearing and Balance - Mayo Clinic Press Mayo Clinic on Hearing and Balance
• FREE Mayo Clinic Diet Assessment - Mayo Clinic Press FREE Mayo Clinic Diet Assessment
• Mayo Clinic Health Letter - FREE book - Mayo Clinic Press Mayo Clinic Health Letter - FREE book
• Healthy Lifestyle
• Pregnancy weight gain Whats healthy

Double your impact on fighting cancer

Make a gift before July 31 and it can go twice as far to fight cancer.

Weight Gain During Pregnancy: Reexamining the Guidelines (2009)

Chapter: front matter, weight gain during pregnancy.

REEXAMINING THE GUIDELINES

Kathleen M. Rasmussen and Ann L. Yaktine, Editors

Committee to Reexamine IOM Pregnancy Weight Guidelines

Food and Nutrition Board

Board on Children, Youth, and Families

INSTITUTE OF MEDICINE AND NATIONAL RESEARCH COUNCIL OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS

Washington, D.C. www.nap.edu

500 Fifth Street, N.W. Washington, DC 20001

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.

This study was supported by Contract No. HHSH250200446009I TO HHSH240G5806 between the National Academy of Sciences and U.S. Department of Health and Human Services Health Resources and Services Administration; Contract No. 200-2007-M-21619 between the National Academy of Sciences and Centers for Disease Control and Prevention Division of Nutrition, Physical Activity and Obesity; Contract No. N01-OD-4-2139 TO 192 between the National Academy of Sciences and National Institutes of Health Eunice Kennedy Shriver National Institute of Child Health and Human Development; Contract No. N01-OD-4-2139 TO 192 between the National Academy of Sciences and National Institutes of Health National Institute of Diabetes and Digestive and Kidney Diseases; Contract No. HHSP23300700522P between the National Academy of Sciences and U.S. Department of Health and Human Services Office on Women’s Health; Contract No. HHSP23320070071P between the National Academy of Sciences and U.S. Department of Health and Human Services Office of Disease Prevention and Health Promotion; and Contract No. 21-FY07-576 between the National Academy of Sciences and March of Dimes. Additional support came from U.S. Department of Health and Human Services Office of Minority Health and the National Minority AIDS Council. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project.

Library of Congress Cataloging-in-Publication Data

Weight gain during pregnancy : reexamining the guidelines / Kathleen M. Rasmussen and Ann L. Yaktine, editors ; Committee to Reexamine IOM Pregnancy Weight Guidelines, Food and Nutrition Board and Board on Children, Youth, and Families.

Includes bibliographical references and index.

ISBN 978-0-309-13113-1 (hardback)

1. Pregnant women—Weight gain. I. Rasmussen, Kathleen M. II. Yaktine, Ann L. III. Institute of Medicine (U.S.). Committee to Reexamine IOM Pregnancy Weight Guidelines.

[DNLM: 1. Prenatal Care—United States. 2. Weight Gain—United States. 3. Practice Guidelines as Topic—United States. 4. Pregnancy—United States. 5. Pregnancy Complications—prevention & control—United States. WQ 175 W419 2009]

RG559.P39 2011

618.2′4—dc22 2009033438

Additional copies of this report are available from the

National Academies Press,

500 Fifth Street, N.W., Lockbox 285, Washington, DC 20055; (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area); Internet, http://www.nap.edu .

For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu .

Copyright 2009 by the National Academy of Sciences. All rights reserved.

Printed in the United States of America

The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin.

Suggested citation: IOM (Institute of Medicine) and NRC (National Research Council). 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press.

“Knowing is not enough; we must apply.

Willing is not enough; we must do.”

—Goethe

INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES

Advising the Nation. Improving Health.

THE NATIONAL ACADEMIES

Advisers to the Nation on Science, Engineering, and Medicine

The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences.

The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is president of the National Academy of Engineering.

The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine.

The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of the National Research Council.

www.national-academies.org

COMMITTEE TO REEXAMINE IOM PREGNANCY WEIGHT GUIDELINES

KATHLEEN M. RASMUSSEN ( Chair ), Professor of Nutrition,

Division of Nutritional Sciences, Cornell University, Ithaca, NY

BARBARA ABRAMS, Professor,

School of Public Health, University of California–Berkeley

LISA M. BODNAR, Assistant Professor,

Department of Epidemiology, University of Pittsburgh, PA

CLAUDE BOUCHARD, Executive Director and George A. Bray Chair in Nutrition,

Pennington Biomedical Research Center, Baton Rouge, LA

NANCY BUTTE, Professor of Pediatrics,

Baylor College of Medicine, Houston, TX

PATRICK M. CATALANO, Chair,

Department of Obstetrics and Gynecology, Case Western Reserve University, Cleveland, OH

MATTHEW W. GILLMAN, Professor,

Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, MA

FERNANDO A. GUERRA, Director of Health,

San Antonio Metropolitan Health District, TX

PAULA A. JOHNSON, Executive Director,

Connors Center for Women’s Health and Gender Biology, Chief, Division of Women’s Health, Brigham and Women’s Hospital, Boston, MA

MICHAEL C. LU, Associate Professor of Obstetrics,

Gynecology, and Public Health, Schools of Medicine and Public Health, University of California–Los Angeles

ELIZABETH R. McANARNEY, Professor and Chair Emerita,

Department of Pediatrics, School of Medicine and Dentistry, University of Rochester, NY

RAFAEL PÉREZ-ESCAMILLA, Professor of Nutritional Sciences & Public Health, Director,

NIH EXPORT Center for Eliminating Health Disparities Among Latinos, University of Connecticut, Storrs

DAVID A. SAVITZ, Charles W. Bluhdorn Professor of Community & Preventive Medicine, Director,

Epidemiology, Biostatistics, and Disease Prevention Institute, Mount Sinai School of Medicine, New York, NY

ANNA MARIA SIEGA-RIZ, Associate Professor,

Department of Epidemiology, School of Public Health, University of North Carolina–Chapel Hill

Study Staff

ANN L. YAKTINE, Senior Program Officer

HEATHER B. DEL VALLE, Research Associate

M. JENNIFER DATILES, Senior Program Assistant

ANTON BANDY, Financial Officer

GERALDINE KENNEDO, Administrative Assistant

LINDA D. MEYERS, Food and Nutrition Board Director

ROSEMARY CHALK, Director,

This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s (NRC’s) Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report:

Haywood Brown, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC

Cutberto Garza, Boston College, MA

Susan Gennaro, William F. Connell School of Nursing, Boston College, MA

William Goodnight, Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of North Carolina–Chapel Hill School of Medicine

Erica P. Gunderson, Division of Research, Kaiser Permanente, Oakland, CA

Maxine Hayes, Department of Health, State of Washington, Tumwater

Lorraine V. Klerman, The Heller School for Social Policy and Management, Brandeis University, Waltham, MA

Kristine G. Koski, School of Dietetics and Human Nutrition, McGill University, Ste. Anne de Bellevue, Quebec, Canada

Charles Lockwood, Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT

Dawn Misra, Division of Epidemiology and Biostatistics, Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, Detroit, MI

Jose M. Ordovas, Nutrition and Genomics Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA

Roy M. Pitkin, University of California–Los Angeles (Professor Emeritus)

David Rush, Friedman School of Nutrition Science and Policy (Professor Emeritus), Tufts University, Boston, MA

Jeanette South-Paul, Department of Family Medicine, University of Pittsburgh, PA

Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations nor did they see the final draft of the report before its release. The review of this report was overseen by Neal A. Vanselow, Tulane University, Professor Emeritus and Nancy E. Adler, Departments of Psychiatry and Pediatrics and Center for Health and Community, University of California–San Francisco.

Appointed by the NRC and Institute of Medicine, they were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.

In the last century, many answers have been given by health professionals to the question “how much weight should I gain while I am pregnant?” In the early 1900s, the answer was often only 15-20 pounds. Between 1970 and 1990, the guideline for weight gain during pregnancy was higher, 20-25 pounds, and in 1990, with the publication of Nutrition During Pregnancy , it went higher still for some groups of women. This most recent guideline reflected new knowledge about the importance of maternal body fatness before conception, as measured by body mass index, for the outcome of pregnancy. It had become clear that heavier women could gain less weight and still deliver an infant of good size. Since that time, the obesity epidemic has not spared women of reproductive age. In our population today, more women of reproductive age are severely obese (obesity class III; 8 percent) than are underweight (3 percent), and their short- and long-term health has become a concern in addition to the size of the infant at birth. Clearly the time had come to reexamine the guidelines for weight gain during pregnancy.

To prepare for this possibility, the National Research Council and the Institute of Medicine held a workshop in 2006 to evaluate the availability of data that could be used to reexamine the current guidelines. Based on the outcome of this workshop, numerous federal agencies (U.S. Department of Health and Human Services Health Resources and Services Administration; Centers for Disease Control and Prevention Division of Nutrition and Physical Activity and Obesity; National Institutes of Health Eunice Kennedy Shriver National Institute of Child Health and Human

Development; National Institutes of Health National Institute of Diabetes and Digestive and Kidney Diseases; U.S. Department of Health and Human Services Office on Women’s Health; U.S. Department of Health and Human Services Office of Disease Prevention and Health Promotion; March of Dimes; with additional support from U.S. Department of Health and Human Services Office of Minority Health and the National Minority AIDS Council) agreed to sponsor the work of this committee.

The committee was asked to review the determinants and a wide range of short- and long-term consequences of variation in weight gain during pregnancy for both the mother and her infant. Based on the outcome of this review, the committee was asked to recommend revisions to the current guidelines if this was deemed to be necessary. In addition, the committee was asked to consider the approaches that might be necessary to promote appropriate weight gain and to identify gaps in knowledge and make recommendations about priorities for future research.

Although many studies relevant to the committee’s charge have been published since 1990 and the Agency for Healthcare Research and Quality (AHRQ) completed its report Outcomes of Maternal Weight Gain while the committee was gathering data, many gaps in knowledge remained. To address this problem, the committee held a public session with project sponsors, and two workshops. We are grateful to those who participated in these sessions for sharing their experience and wisdom. We are also grateful to a number of individuals who supplied data to the committee: Raul Artal, Amy Branum, Marie Cedergren, Aimin Chen, K.S. Joseph, Sharon Kirmeyer, Joyce Martin, Alan Ryan, and Andrea Sharma, with special thanks to Patricia Dietz. The committee also commissioned additional analyses of data from both Denmark and the United States. We thank our consultants, Amy Herring, Ellen Aagaard Nohr, and Cheryl Stein for these analyses and for their contributions to the committee’s work. The committee also felt that it was important to understand what would be involved in analyzing the trade-off between mother and infant in risk of adverse outcomes of variation in weight gain during pregnancy. To accomplish this, we commissioned such an analysis based on the data at hand. We thank our consultant, James Hammitt, for conducting these analyses and for his contribution to the committee’s work.

The committee’s 14 members gave freely of their expertise and volunteered their time and energy in all aspects of the preparation of this report, from developing its intellectual framework, writing the text, and deliberating about the recommendations and conclusions of the report. Their efforts merit our sincere gratitude.

The committee received excellent staff support from Ann Yaktine, Study Director, Heather Del Valle, Research Associate, and Jennifer Datiles, Senior Program Assistant. Their effort on our behalf is sincerely appreci-

ated. We also thank Leslie Pray for technical editing and Florence Poillon for copyediting. Both the Director of the Food and Nutrition Board, Linda Meyers, and the Director of the Board on Children, Youth, and Families, Rosemary Chalk, contributed their wisdom and support to this effort, and we thank them for it.

Kathleen M. Rasmussen, Chair

This page intentionally left blank.

As women of childbearing age have become heavier, the trade-off between maternal and child health created by variation in gestational weight gain has become more difficult to reconcile. Weight Gain During Pregnancy responds to the need for a reexamination of the 1990 Institute of Medicine guidelines for weight gain during pregnancy. It builds on the conceptual framework that underscored the 1990 weight gain guidelines and addresses the need to update them through a comprehensive review of the literature and independent analyses of existing databases. The book explores relationships between weight gain during pregnancy and a variety of factors (e.g., the mother's weight and height before pregnancy) and places this in the context of the health of the infant and the mother, presenting specific, updated target ranges for weight gain during pregnancy and guidelines for proper measurement. New features of this book include a specific range of recommended gain for obese women.

Weight Gain During Pregnancy is intended to assist practitioners who care for women of childbearing age, policy makers, educators, researchers, and the pregnant women themselves to understand the role of gestational weight gain and to provide them with the tools needed to promote optimal pregnancy outcomes.

READ FREE ONLINE

Welcome to OpenBook!

You're looking at OpenBook, NAP.edu's online reading room since 1999. Based on feedback from you, our users, we've made some improvements that make it easier than ever to read thousands of publications on our website.

Do you want to take a quick tour of the OpenBook's features?

Show this book's table of contents , where you can jump to any chapter by name.

...or use these buttons to go back to the previous chapter or skip to the next one.

Jump up to the previous page or down to the next one. Also, you can type in a page number and press Enter to go directly to that page in the book.

Switch between the Original Pages , where you can read the report as it appeared in print, and Text Pages for the web version, where you can highlight and search the text.

To search the entire text of this book, type in your search term here and press Enter .

Share a link to this book page on your preferred social network or via email.

View our suggested citation for this chapter.

Ready to take your reading offline? Click here to buy this book in print or download it as a free PDF, if available.

Get Email Updates

Do you enjoy reading reports from the Academies online for free ? Sign up for email notifications and we'll let you know about new publications in your areas of interest when they're released.

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings
• My Bibliography
• Collections
• Citation manager

Save citation to file

Email citation, add to collections.

• Create a new collection
• Add to an existing collection

Add to My Bibliography

Your saved search, create a file for external citation management software, your rss feed.

• Search in PubMed
• Search in NLM Catalog
• Add to Search

New guidelines for weight gain during pregnancy: what obstetrician/gynecologists should know

Affiliation.

• 1 aDivision of Nutritional Sciences, Cornell University, Ithaca, New York, USA. [email protected]
• PMID: 19809317
• PMCID: PMC2847829
• DOI: 10.1097/GCO.0b013e328332d24e

Purpose of review: To review the recently issued guidelines for weight gain during pregnancy.

Recent findings: These guidelines were developed to minimize the negative health consequences for both mother and fetus of inadequate or excessive weight gain. They call for categorizing women's prepregnancy BMI using the WHO/National Heart, Lung and Blood Institute cutoff points and provide ranges of recommended weight gain for underweight (28-40 lb), normal weight (25-35 lb), overweight (15-25 lb) and obese (11-20 lb) gravidas. Data were insufficient to construct specific guidelines for women with class II or class III obesity. Women should attempt to conceive at a normal weight for better obstetric outcomes. Improved comprehensive preconceptional care is necessary to help women reach this goal. Most American women currently gain weight below or above the new ranges, so changes are required in both women's behavior and how their care is managed. Data from a variety of interventions related to improved diet and increased physical activity show that individualized care can assist women in gaining weight within these guidelines.

Summary: The guidelines offer many opportunities for obstetrician/gynecologists, together with ancillary healthcare providers, to assume a larger role as 'women's healthcare physicians' and to conduct research that could improve the health of mothers and children.

PubMed Disclaimer

Comparison of current gestational weight…

Comparison of current gestational weight gain of American women (Pregnancy Risk Assessment Monitoring…

Similar articles

• Impact of updated Institute of Medicine guidelines on prepregnancy body mass index categorization, gestational weight gain recommendations, and needed counseling. Simas TA, Liao X, Garrison A, Sullivan GM, Howard AE, Hardy JR. Simas TA, et al. J Womens Health (Larchmt). 2011 Jun;20(6):837-44. doi: 10.1089/jwh.2010.2429. Epub 2011 Apr 21. J Womens Health (Larchmt). 2011. PMID: 21510805
• [Prenatal care and weight gain during pregnancy]. Popa AD, Oleniuc M, Graur M. Popa AD, et al. Rev Med Chir Soc Med Nat Iasi. 2011 Oct-Dec;115(4):1149-54. Rev Med Chir Soc Med Nat Iasi. 2011. PMID: 22276462 Romanian.
• [Relationship between the risk of emergency cesarean section for nullipara with the prepregnancy body mass index or gestational weight gain]. Zhao RF, Zhang WY, Zhou L. Zhao RF, et al. Zhonghua Fu Chan Ke Za Zhi. 2017 Nov 25;52(11):757-764. doi: 10.3760/cma.j.issn.0529-567X.2017.11.008. Zhonghua Fu Chan Ke Za Zhi. 2017. PMID: 29179271 Chinese.
• Recommendations for weight gain during pregnancy in the context of the obesity epidemic. Rasmussen KM, Abrams B, Bodnar LM, Butte NF, Catalano PM, Maria Siega-Riz A. Rasmussen KM, et al. Obstet Gynecol. 2010 Nov;116(5):1191-5. doi: 10.1097/AOG.0b013e3181f60da7. Obstet Gynecol. 2010. PMID: 20966705 Free PMC article. Review.
• Offspring body size and metabolic profile - effects of lifestyle intervention in obese pregnant women. Tanvig M. Tanvig M. Dan Med J. 2014 Jul;61(7):B4893. Dan Med J. 2014. PMID: 25123127 Review.
• The Influence of Gestational Diabetes Mellitus on Maternal and Neonatal Outcomes: A Retrospective Study in Rzeszów, Poland. Kalandyk-Osinko K, Baran J, Baran R, Gierek K, Juza A, Kraśnianin E, Januszek S, Blajer-Olszewska B, Kluz T, Darmochwał-Kolarz D. Kalandyk-Osinko K, et al. Med Sci Monit. 2024 May 26;30:e943644. doi: 10.12659/MSM.943644. Med Sci Monit. 2024. PMID: 38796697 Free PMC article.
• Impact of bariatric surgery on maternal gestational weight gain and pregnancy outcomes in women with obesity: A population-based cohort study from Qatar. Vazhiyelethil J, Minisha F, Al Obaidly S, AlQubaisi M, Salama H, Ali N, Khenyab N, Mohan S, Pallivalappil AR, Al-Dewik N, Al Rifai H, Farrell T. Vazhiyelethil J, et al. Qatar Med J. 2024 Jan 22;2024(1):2. doi: 10.5339/qmj.2024.2. eCollection 2024. Qatar Med J. 2024. PMID: 38264267 Free PMC article.
• The risk prediction of intergenerational transmission of overweight and obesity between mothers and infants during pregnancy. Wei X, Hu J, Wen D. Wei X, et al. BMC Pregnancy Childbirth. 2024 Jan 23;24(1):74. doi: 10.1186/s12884-024-06268-7. BMC Pregnancy Childbirth. 2024. PMID: 38254080 Free PMC article.
• Metformin Plus Insulin for Preexisting Diabetes or Gestational Diabetes in Early Pregnancy: The MOMPOD Randomized Clinical Trial. Boggess KA, Valint A, Refuerzo JS, Zork N, Battarbee AN, Eichelberger K, Ramos GA, Olson G, Durnwald C, Landon MB, Aagaard KM, Wallace K, Scifres C, Rosen T, Mulla W, Valent A, Longo S, Young L, Marquis MA, Thomas S, Britt A, Berry D. Boggess KA, et al. JAMA. 2023 Dec 12;330(22):2182-2190. doi: 10.1001/jama.2023.22949. JAMA. 2023. PMID: 38085312 Free PMC article. Clinical Trial.
• Comparing body image dissatisfaction between pregnant women and non-pregnant women: a systematic review and meta-analysis. Crossland AE, Munns L, Kirk E, Preston CEJ. Crossland AE, et al. BMC Pregnancy Childbirth. 2023 Oct 4;23(1):709. doi: 10.1186/s12884-023-05930-w. BMC Pregnancy Childbirth. 2023. PMID: 37794358 Free PMC article.
• Institute of Medicine (Subcommittees on Nutritional Status and Weight Gain During Pregnancy and Dietary Intake and Nutrient Supplements During Pregnancy, Committee on Nutritional Status During Pregnancy and Lactation, Food and Nutrition Board) Nutrition During Pregnancy: Part I, Weight Gain; Part II, Nutrient Supplements. Washington, DC: National Academy Press; 1990.
• Ogden CL, Carroll MD, Curtin LR, et al. Prevalence of overweight and obesity in the United States, 1999–2004. JAMA. 2006;295:1549–1555. - PubMed
• Institute of Medicine (Committee on Unintended Pregnancy, Division of Health Promotion and Disease Prevention) The Best Intentions: Unintended Pregnancy an the Well-Being of Children and Families. Washington, D.C: National Academy Press; 1995.
• Institute of Medicine (Committee on Nutritional Status During Pregnancy and Lactation, Subcommittee for a Clinical Application Guide) Nutrition During Pregnancy and Lactation: An Implementation Guide. Washington, D.C: National Academy Press; 1992.
• Power ML, Cogswell ME, Schulkin J. Obesity prevention and treatment practices of U.S. obstetrician-gynecologists. Obstet Gynecol. 2006;108:961–968. - PubMed

Publication types

• Search in MeSH

Related information

• Cited in Books

Grants and funding

• R01 HD022965/HD/NICHD NIH HHS/United States
• R01 HD022965-16/HD/NICHD NIH HHS/United States
• HD292965/HD/NICHD NIH HHS/United States

LinkOut - more resources

Full text sources.

• Europe PubMed Central
• Ovid Technologies, Inc.
• PubMed Central
• Wolters Kluwer
• Genetic Alliance
• MedlinePlus Health Information

Research Materials

• NCI CPTC Antibody Characterization Program

Miscellaneous

• NCI CPTAC Assay Portal

• Citation Manager

NCBI Literature Resources

MeSH PMC Bookshelf Disclaimer

The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Unauthorized use of these marks is strictly prohibited.

Warning: The NCBI web site requires JavaScript to function. more...

An official website of the United States government

The .gov means it's official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings
• Browse Titles

NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.

InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-.

InformedHealth.org [Internet].

Pregnancy: learn more – weight gain in pregnancy.

Last Update: September 21, 2022 ; Next update: 2025.

It is important for pregnant women to have a balanced diet, both for themselves and their child. This helps them put on a good amount of weight. But how much weight gain is considered to be “normal” in pregnancy? When is it a good idea to change your diet and get more exercise? And how can you lose weight again afterwards?

In pregnancy the body changes to nurture and feed the unborn child. So weight gain increases in the last few months of pregnancy. This weight gain doesn’t only come from the growing child. The body gradually stores more water, which is needed for the child’s circulation, the placenta and the amniotic fluid, among other things.

Most women can simply trust their own appetite when it comes to eating during pregnancy. They don't need a special diet, and can eat what tastes good to them and what feels right. But it may be a good idea for some pregnant women to change their diet and get more exercise, including women who are very overweight, gain weight very quickly, or have gestational diabetes.

• How much weight gain do experts recommend?

The U.S. Institute of Medicine (IOM) issues guidelines that are followed by doctors around the world. They recommend how much weight should be gained during pregnancy as follows:

• For women who are underweight before pregnancy (body mass index (BMI) of less than 18.5): between 12.5 and 18 kilograms
• For women who are of normal weight before pregnancy (BMI of between 18.5 and 24.9): between 11.5 and 16 kilograms
• For women who are overweight before pregnancy (BMI of between 25 and 29.9): between 7 and 11.5 kilograms
• For women who are obese before pregnancy (BMI greater than 30): between 5 and 9 kilograms

A pregnant woman’s weight alone is not a good indicator of how well the baby is doing – and not even of how her baby is growing. That depends on a lot of factors. It is hard to predict during the pregnancy how much the baby will weigh at the end of pregnancy. Ultrasound scans and other tests can only give us a rough idea of how the baby is developing and how much he or she might weigh at birth .

• Can putting on too much or too little weight be harmful?

Women who gain a lot of weight in pregnancy have a higher risk of certain health problems and complications during childbirth. For instance, they are more likely to have a big child with a birth weight of over 4,000 g or 4,500 g (macrosomia), and are more likely to need a Cesarean section. The risk of a preterm birth is also higher.

Complications are more common in women who were very overweight before the pregnancy. They are also more likely to have difficulties losing the extra weight after giving birth.

On the other hand, if a woman doesn't gain enough weight and doesn’t get enough different foods in pregnancy, it can harm her growing baby: babies are then often born too early (preterm birth) or often weigh too little at birth.

• Is very fast weight gain problematic?

If a woman puts on weight suddenly, or if she generally gains more than half a kilogram per week, her weight will be monitored by a doctor or midwife. Additional tests and examinations might be needed too.

Very fast and extreme weight gain (such as 1 kilogram within a week) is typically due to changes in water retention and can be a sign of health problems such as pre-eclampsia. The main symptom of this pregnancy-related condition is high blood pressure, sometimes accompanied by nausea, headaches and dizziness too. Pre-eclampsia can be life-threatening for both the mother and her child, and it needs to be treated by a doctor as soon as possible.

Putting on a lot of weight in pregnancy can increase the risk of women developing diabetes in pregnancy (“gestational diabetes”) – or it can be a sign that they have developed it. Gestational diabetes is where blood sugar levels change in women who didn't have diabetes before becoming pregnant. Gestational diabetes increases the risk of pre-eclampsia, and can result in the unborn baby putting on a lot of weight. If the baby is very big and heavy, complications during childbirth are more common.

• Does avoiding too much weight gain have any advantages?

Keeping your weight in check during pregnancy lowers the risk of gestational diabetes and of the child being very large and heavy during childbirth.

This is best achieved by watching your diet and getting regular exercise. Even doing one of these things can make a difference. And doing both makes it easier to lose weight again after childbirth. This has been shown by studies that looked into programs to support women in changing their diet and exercising. The studies didn’t show that this will lower the risk of complications during childbirth or prevent the need for a Cesarean section, though.

These things are most effective if you have gestational diabetes . Changes to your diet and more exercise can lower your blood sugar levels and control weight gain. That can also lower the risk of complications during childbirth.

• What is important for diet and exercise?

Because carbohydrates increase blood sugar levels, women who are very overweight or have gestational diabetes are usually advised to cut down on carbohydrates (“carbs”) while making sure that they still get enough fiber, and to generally eat a balanced diet otherwise. Other common advice includes eating three not-too-big main meals and two to three smaller meals per day.

The exact dietary changes to be made will depend on things like how much you weighs, what sort of diet you have been eating so far, and how much exercise you get. Advice from a nutritional therapist can help to avoid adverse effects. Pregnant women need to make sure that they get enough calories and important nutrients, which is why they shouldn’t go on a low-calorie diet, for instance.

Doing at least 30 minutes of a strenuous physical activity on about three to four days per week is often enough. Suitable types of exercise include swimming, cycling and brisk walking. Women with a greater risk of preterm birth are usually advised to avoid sports altogether. When in doubt, don't hesitate to ask your gynecologist or midwife.

• How can underweight pregnant women gain enough weight?

If a woman who is underweight becomes pregnant and finds it difficult to put on weight, she can seek advice from her doctor or midwife. Studies suggest that professional dietary advice can help women gain weight and lower the risk of giving birth too early (preterm birth).

Protein supplements have been found to help some underweight women increase their weight. This lowers the risk of their child being born underweight, as well as reducing the risk of having a miscarriage. However, very protein-rich dietary supplements with a protein content of more than 25% don't appear to help. Research also suggests that these very high-protein products might limit the growth of the baby. So it's important to make sure you get a balanced mix of nutrients. “More” is not “better” in this case.

• Does watching your weight prevent stretch marks?

Stretch marks are caused by overextending the connective tissue. Although there are many claims about what might help, none of them have been confirmed in good-quality research.

Whether or not you get stretch marks not only depends on how much weight you gain in total. Factors like how fast you gain weight can make a difference too. For instance, gaining a lot of weight very suddenly can cause more stretch marks than gaining weight gradually. But it's not clear whether stretch marks can be prevented by keeping your weight down.

• What helps to lose weight after having a baby?

Many mothers find that it takes a while before they reach their pre-pregnancy weight again. For some women, breastfeeding and taking care of a baby are enough to melt away the weight gained during pregnancy: It's as though they really need this stored up energy to help get through the first few weeks and months of motherhood.

But most women won't really get close to their pre-pregnancy weight until perhaps six months after giving birth. Women who don't lose weight, or even gain weight instead, might have a higher risk of health problems. These problems could get worse in other pregnancies.

The best way to lose weight is by combining a change in diet with extra physical exercise. Exercise alone probably won't do much. Programs designed to help people change their eating and lifestyle habits are often used to try to lose weight. In the research on these programs, women started weight control efforts a month or two after giving birth, and sometimes later. Immediately after birth, mothers need enough nutrients to breastfeed their child, so it’s not a good time for them to try to lose weight.

Too much, or too sudden, weight loss can have disadvantages too. For instance, if you go on a diet that is too strict or too one-sided after having a baby, it could reduce the quantity of your breast milk or the nutrients it contains.

• How do women feel about their weight in pregnancy and afterwards?

Women are constantly confronted with idealized standards of beauty. The media also often show images of idealized pregnant women. This makes it difficult for many women to be happy with their figure, and it can damage their self-image and enjoyment of their body. The media add to the pressure on pregnant women and mothers by focusing a lot of attention on how quickly celebrities return to their pre-pregnancy figures after giving birth. But women need to gain weight during pregnancy – and they can't expect to lose it all again within a few weeks after giving birth.

A lot of women see pregnancy as a time to enjoy their belly, curves and the baby growing inside their body – and allow themselves some “time off” from worrying about their size.

• American College of Obstetricians and Gynecologists' Committee on Practice Bulletins (ACOG). Weight Gain During Pregnancy . 2020.
• Beauchesne AR, Cara KC, Chen J et al. Effectiveness of multimodal nutrition interventions during pregnancy to achieve 2009 Institute of Medicine gestational weight gain guidelines: a systematic review and meta-analysis . Ann Med 2021; 53(1): 1179-1197. [ PMC free article : PMC8284157 ] [ PubMed : 34263669 ]
• Cantor A, Jungbauer RM, McDonagh MS et al. Counseling and Behavioral Interventions for Healthy Weight and Weight Gain in Pregnancy: A Systematic Review for the U.S. Preventive Services Task Force . (AHRQ Evidence Syntheses; No. 203). 2021.
• Deutsche Gesellschaft für Gynäkologie und Geburtshilfe (DGGG). Adipositas und Schwangerschaft (S3-Leitlinie). AWMF-Registernr.: 015-081. 2019.
• Dodd JM, Deussen AR, O'Brien CM et al. Targeting the postpartum period to promote weight loss: a systematic review and meta-analysis . Nutr Rev 2018; 76(8): 639-654. [ PMC free article : PMC6280945 ] [ PubMed : 29889259 ]
• Lim S, O'Reilly S, Behrens H et al. Effective strategies for weight loss in post-partum women: a systematic review and meta-analysis . Obes Rev 2015; 16(11): 972-987. [ PubMed : 26313354 ]
• Magro-Malosso ER, Saccone G, Di Mascio D et al. Exercise during pregnancy and risk of preterm birth in overweight and obese women: a systematic review and meta-analysis of randomized controlled trials . Acta Obstet Gynecol Scand 2017; 96(3): 263-273. [ PubMed : 28029178 ]
• Michel S, Raab R, Drabsch T et al. Do lifestyle interventions during pregnancy have the potential to reduce long-term postpartum weight retention? A systematic review and meta-analysis . Obes Rev 2019; 20(4): 527-542. [ PubMed : 30548769 ]
• Muhammad HF, Pramono A, Rahman MN. The safety and efficacy of supervised exercise on pregnant women with overweight/obesity: A systematic review and meta-analysis of randomized controlled trials . Clin Obes 2021; 11(2): e12428. [ PubMed : 33167074 ]
• Muktabhant B, Lawrie TA, Lumbiganon P et al. Diet or exercise, or both, for preventing excessive weight gain in pregnancy . Cochrane Database Syst Rev 2015; (6): CD007145. [ PMC free article : PMC9428894 ] [ PubMed : 26068707 ]
• Ota E, Hori H, Mori R et al. Antenatal dietary education and supplementation to increase energy and protein intake . Cochrane Database Syst Rev 2015; (6): CD000032. [ PubMed : 26031211 ]
• Vincze L, Rollo M, Hutchesson M et al. Interventions including a nutrition component aimed at managing gestational weight gain or postpartum weight retention: a systematic review and meta-analysis . JBI Database System Rev Implement Rep 2019; 17(3): 297-364. [ PubMed : 30870329 ]
• Walker R, Bennett C, Blumfield M et al. Attenuating Pregnancy Weight Gain-What Works and Why: A Systematic Review and Meta-Analysis . Nutrients 2018; 10(7). [ PMC free article : PMC6073617 ] [ PubMed : 30037126 ]
• Wang J, Wen D, Liu X et al. Impact of exercise on maternal gestational weight gain: An updated meta-analysis of randomized controlled trials . Medicine (Baltimore) 2019; 98(27): e16199. [ PMC free article : PMC6635273 ] [ PubMed : 31277127 ]
• Wiles R. The views of women of above average weight about appropriate weight gain in pregnancy . Midwifery 1998; 14(4): 254-260. [ PubMed : 10076321 ]

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

• Cite this Page InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Pregnancy: Learn More – Weight gain in pregnancy. [Updated 2022 Sep 21].

In this Page

Informed health links, related information.

• PMC PubMed Central citations
• PubMed Links to PubMed

Recent Activity

• Pregnancy: Learn More – Weight gain in pregnancy - InformedHealth.org Pregnancy: Learn More – Weight gain in pregnancy - InformedHealth.org

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

Connect with NLM

National Library of Medicine 8600 Rockville Pike Bethesda, MD 20894

Web Policies FOIA HHS Vulnerability Disclosure

Help Accessibility Careers