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Pregnancy and Weight Gain: How Much Is Too Little?

December 20, 2012

Washington, DC -- Overweight and obese women may be able to gain less than what is recommended during pregnancy and still have a healthy baby, according to new recommendations issued today by The American College of Obstetricians and Gynecologists (The College). Gaining less weight than recommended may be appropriate as long as the fetus is growing appropriately. All women, regardless of weight, should avoid excessive weight gain in pregnancy.

In 2009 the Institute of Medicine (IOM) revised its guidelines for pregnancy weight gain, which The College supports. Overweight women carrying a single fetus are advised to gain a total of 15–25 lbs. during pregnancy (compared with 25–35 lbs. for normal-weight women). Obese women are advised to gain less: 11–20 lbs. These IOM recommendations have met with controversial reactions from some physicians who believe that the weight gain targets are too high, especially for overweight (body mass index of 25–29.9) and obese (body mass index of 30 or greater) women. There is concern that the IOM weight gain targets do not properly address concerns regarding postpartum weight retention, which carries both short- and long-term health risks. 

Today, more than half of all pregnant women in the US are overweight or obese, according to separate guidelines also issued today by The College. Overweight and obese women are at increased risk for pregnancy complications, including gestational diabetes, hypertension, preeclampsia, and cesarean delivery. Cesarean surgery poses greater dangers for overweight/obese women than for normal-weight women because of increased risks associated with anesthesia, excessive blood loss, blood clots, and infection at the incision site. These women also have a greater risk of miscarriage, premature birth, stillbirth, and having a baby with a birth defect.  

The College recommends that ob-gyns counsel their overweight and obese patients considering pregnancy to lose weight before planning to conceive. Nutrition and exercise counseling, as well as weight monitoring, should continue throughout pregnancy and postpartum. 

Committee Opinion #548, “Weight Gain During Pregnancy,” and Committee Opinion #549, “Obesity in Pregnancy,” are published in the January 2013 issue of Obstetrics & Gynecology.

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Other recommendations issued in this month’s Obstetrics & Gynecology:

Committee Opinion #549 “Obesity in Pregnancy” (Revised)
ABSTRACT: In the US, more than one-third of women are obese, more than one-half of pregnant women are overweight or obese, and 8% of reproductive-age women are extremely obese, putting them at a greater risk of pregnancy complications. Therefore, preconception assessment and counseling are strongly encouraged for obese women and should include the provision of specific information concerning the maternal and fetal risks of obesity in pregnancy, as well as encouragement to undertake a weight-reduction program. At the initial prenatal visit, height and weight should be recorded for all women to allow calculation of body mass index (calculated as weight in kilograms divided by height in meters squared), and recommendations for appropriate weight gain should be reviewed at the initial visit and periodically throughout pregnancy. Nutrition consultation should be offered to all overweight or obese women, and they should be encouraged to follow an exercise program. Pregnant women who have undergone bariatric surgery should be evaluated for nutritional deficiencies and the need for vitamin supplementation when indicated. Obese patients undergoing cesarean delivery may require thromboprophylaxis with pneumatic compression devices and unfractionated heparin or low molecular weight heparin. For all obese patients, anesthesiology consultation early in labor should be considered, and consultation with weight-reduction specialists before attempting another pregnancy should be encouraged.

Committee Opinion #550 “Maternal-Fetal Surgery for Myelomeningocele” (NEW!)
ABSTRACT: Myelomeningocele, the most severe form of spina bifida, occurs in approximately 1 in 1,500 births in the US. Fetuses in whom myelomeningocele is diagnosed typically are delivered at term and are treated in the early neonatal period. A recent randomized controlled trial found that fetal surgery for myelomeningocele improved a number of important outcomes, but also was associated with maternal and fetal risks. Maternal-fetal surgery is a major procedure for the woman and her fetus, and it has significant implications and complications that occur acutely, postoperatively, for the duration of the pregnancy, and in subsequent pregnancies. Therefore, it should only be offered at facilities with the expertise, multidisciplinary teams, services, and facilities to provide the intensive care required for these patients.

Committee Opinion #551 “Coping with the Stress of Medical Professional Liability Litigation” (Revised)
ABSTRACT: Obstetrician-gynecologists should recognize that being a defendant in a medical professional liability lawsuit can be one of life’s most stressful experiences. Negative emotions in response to a lawsuit are normal, and physicians may need help from family members, peers, or professionals to cope with this stress. Open communication will assist in reducing emotional isolation and self-blame. However, pertinent legal and clinical aspects of a case must be kept confidential, except for disclosure within the confines of a protected counselor-patient relationship as determined by state law.

Committee Opinion #552 “Benefits to Women of Medicaid Expansion Through the Affordable Care Act” (NEW!)
ABSTRACT: Many US women are uninsured and face avoidable adverse obstetric and gynecologic health outcomes. The Affordable Care Act requires an expansion of Medicaid that would increase the percentage of US women with health insurance, with the anticipated benefit of improved health. The 2012 Supreme Court decision allows states to opt out of Medicaid expansion. The American College of Obstetricians and Gynecologists supports appropriate reimbursement to health care providers and the expansion of Medicaid as key strategies to improve women’s health.

The American College of Obstetricians and Gynecologists (The College), a 501(c)(3) organization, is the nation’s leading group of physicians providing health care for women. As a private, voluntary, nonprofit membership organization of approximately 56,000 members, The College strongly advocates for quality health care for women, maintains the highest standards of clinical practice and continuing education of its members, promotes patient education, and increases awareness among its members and the public of the changing issues facing women’s health care. The American Congress of Obstetricians and Gynecologists (ACOG), a 501(c)(6) organization, is its companion organization. www.acog.org

 

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