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Doctors urge less pregnancy weight gain for obese women

By Lauran Neergaard
Associated Press / May 29, 2009
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WASHINGTON - Eating for two? New guidelines are setting how much weight women should gain during pregnancy - surprisingly little if they're already overweight.

The most important message: Get to a healthy weight before you conceive, says the Institute of Medicine in the first national recommendations on pregnancy weight since 1990. It's healthiest for the mother - less chance of pregnancy-related high blood pressure or diabetes, or the need for a C-section - and it's best for the baby, too. Babies born to overweight mothers have a greater risk of premature birth or of later becoming overweight themselves, among other concerns.

Meeting the guidelines could be a tall order, considering that about 55 percent of women of childbearing age are overweight, that preconception care isn't that common, and about half of pregnancies are unplanned.

Once a woman's pregnant, the guidelines issued yesterday aren't too different from what obstetricians already recommend, although about half of women don't follow that advice today.

What if a mom-to-be has gained too much? On average, overweight and obese women already are gaining five more pounds than the upper limit.

But pregnancy is not a time to lose weight, stressed guidelines co-author Dr. Anna Maria Siega-Riz of the University of North Carolina, Chapel Hill.

"It's not, 'Hey, you gained enough, now you need to stop,' " Siega-Riz said. "Let's take stock of where you're at and start gaining correctly."

Indeed, underweight and normal-weight mothers should put on a pound a week for proper fetal growth in the second and third trimesters, the guidelines say. The overweight and obese need about half a pound a week.

Hopping on the scale during prenatal checkups makes for a sensitive moment.

Implementing the guidelines may take a move "to change the whole culture about pregnancy" and eating, Siega-Riz said. She noted that in studies of the overweight, "most of these women will tell you that they've never been told how much weight to gain."

The guidelines call for increased nutrition and exercise counseling during pregnancy, saying doctors or midwives may need to consult a dietitian to tailor a woman's care no matter her starting weight. Also, providers should discuss whether a woman plans to breastfeed, which not only is optimal for the baby but helps the new mother shed pounds, too.

"It's really a teachable moment," said guidelines coauthor Dr. Patrick Catalano, obstetrics chairman at Ohio's Case Western Reserve University.

Obstetricians, who have struggled with how to advise heavier women as US obesity rates have soared over the past two decades, welcomed the guidelines - especially the recognition that babies born too large tend to grow into overweight children at risk for their own health problems. Not too many years ago it was rare to see a 9-pound, or larger, newborn.

New recommendations

A normal-weight woman, as measured by BMI or body mass index, should gain between 25 and 35 pounds during pregnancy. A normal BMI, a measure of weight for height, is between 18.5 and 24.9.

An overweight woman - BMI 25 to 29.9 - should gain 15 to 25 pounds during pregnancy.

For the first time, the guidelines set a standard for pregnancy gain for obese women - BMI of 30 or higher: 11 to 20 pounds.

An underweight woman - BMI less than 18.5 - should gain 28 to 40 pounds.

SOURCE: Associated Press

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