Pregnant
patients and lactating mothers have always been advised to “Eat for two”, but weight
gain more than or less than guideline recommendations puts the mother and baby
at high risk for adverse outcomes reports the result of a Systematic Review and
Meta-analysis published online June 6, 2017 in JAMA.
The research
was conducted by Monash University in Victoria, Australia.
The
Institute for Medicine(IOM) released its updated guidelines for gestational
weight gain in 2009. The guidelines are individualized according to pre-pregnancy
BMI and are independent of age, parity, smoking history, race, and ethnic
background. A separate recommendation was made for twin pregnancy.
The recommended
gestational weight gain according to BMI are: gain of 12.5-18 kg for underweight women with BMI
<18.5; 11.5-16 kg for normal-weight women with BMI 18.5-24.9; 7-11 kg for
overweight women with BMI 25-29.9; and 5-9 kg for obese women BMI ≥30.
In this systematic
review and Meta-analysis, Goldstein et al. compared women who gained weight
according to IOM guidelines to women who gained more or less than the recommended
guideline.
It included 23
studies between January 1, 1999, and February 7, 2017, involving more than a
million women (1,309,136) across 10 countries.
Data extraction
and analysis showed that about 25% women gained less weight and nearly 50%
gained more weight than the recommended allowance.
Women who
gained more weight faced 30% (OR=1.30) increased odds of a cesarean delivery as
compared to women within the recommended allowance (617 vs 327). The
neonates of these women also had nearly twice (OR=1.95) the odds of being born with
macrosomia (111 vs 63).
Women who
fell below the recommended weight gain were at 53% increased odds of giving
birth to small for gestational age infant (OR= 1.53), 70% more odds of having a
preterm birth (OR=1.70) and 41% less risk of large for gestational age child (
OR=.59).
In an accompanying
editorial Dr Aaron B. Caughey, MD, chair of obstetrics and gynecology at Oregon
Health and Science University in Portland writes that this study raises two
questions: (1) can clinician offer interventions to patients to change the
amount of weight gain during pregnancy, and (2) could altering the weight gain
to IOM recommendation improve maternal and neonatal outcome.
Multiple
randomized trials have shown that interventions in pregnancy to limit weight
gain are effective but the magnitude of effect is very modest and only limited
information is available about peripartum gains with not much information available
about long term gains for the neonate.
To conclude,
mothers and babies do well, with few maternal and neonatal complications if the
maternal weight gain is within the recommended limits.
“Basically,
it's not about eating for two. For the first trimester, there should be no increased
calories, the second trimester is about 330 calories extra a day and third
trimester is about 450 calories a day (extra),” said Professor Helena Teede,
The Monash researcher and one of the lead author.
"Women also
don't need to be 'confined', they need to remain active."
The ACOG
committee opinion about weight gain in pregnancy can be accessed here.
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