Elsevier

The Lancet

Volume 351, Issue 9108, 4 April 1998, Pages 1054-1055
The Lancet

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Eating for two: are guidelines for weight gain during pregnancy too liberal?

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Low weight gain and adverse birth outcomes

The ideal support for a general recommendation of liberalised calorie intake during gestation would be evidence from community-wide randomised trials proving that any harm caused by increased weight gains for the majority of women was strongly over-ridden by benefits for the minority at risk from inadequate weight gain. No such evidence exists.3

Instead, as Johnson and Yancey4 have vigorously argued, the new policies rest on observational studies that are a swamp of causes, effects, confounders,

Low weight gain and adult disease

Barker's group6 has shown that among people born between 1920 and 1950, the frequencies of coronary heart disease and of risk factors such as hypertension, diabetes, and high serum cholesterol are higher in those of low birthweight than in those of higher birthweight. In theory, then, lower maternal weight gain during pregnancy could be harmful by increasing the number of children with lower birthweights. However, this idea is implausible. The experience of the Dutch famine of 1944–45 suggests

Adverse effects of excess weight gain

Research on excess maternal weight gain and adverse short-term or longer-term outcomes is surprisingly scanty. A Cochrane review found only two controlled trials—both published more than 10 years ago—that addressed the effects of prescribing a low-energy diet to pregnant women who were either overweight or who showed high weight gain earlier in gestation. Most clinical endpoints were not measured.10 However, two observational studies11, 12 have shown a strong and independent relation between

Conclusions

Although there seems to be a threshold (around 15 Ib [6·8 kg]) below which maternal weight gain should not generally fall, the current US guidelines err in the opposite direction by recommending weight gains of 25–35 Ib (11·4–15·9 kg) for women of normal pre-pregnant weight-for-height. The apparent goal of these liberalised weight-gain criteria is to prevent adverse outcomes caused by fetal undernourishment. Yet, as shown above, the relations between maternal weight gain and birth outcomes are

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    Detecting and managing GDM is essential. Advice to eat for two77 are inappropriate, and there are now updated recommendations that obese women should gain a maximum of 5–9 kg over the whole pregnancy. The development of lifestyle interventions are at an early stage.

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    Current recommendations advise it is safe for an obese woman to gain less than this but that minimum weight gain should be 6.8 kg. It has been suggested that these targets may be too liberal.27 One study in women without diabetes who had a prepregnancy BMI above 35 showed that little or no maternal weight gain had no effect on infant birth weight.28

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    The lower end of the 2009 IOM weight gain recommendations should be used as target weight gains (Table 1).6 Feig and Naylor28 recommend that normal-weight women should limit prenatal weight gain to 11.4 kg (25 lb), based on increasing adult obesity in postindustrial countries. The target weight gain should be documented in the prenatal record.

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