Although overweight or obese women should gain no more than 25 pounds in a singleton pregnancy, there is no harm in their gaining less, as long as the fetus is growing as it should, according to the American College of Obstetricians and Gynecologists.
There is no medical need to increase weight gain just to meet the goals the Institute of Medicine recommended in 2009, ACOG said.
There is no medical need to increase weight gain just to meet the goals the Institute of Medicine recommended in 2009, according to ACOG.
"For an obese pregnant woman who is gaining less weight than recommended, but who has an appropriately growing fetus, no evidence exists that encouraging increased weight to conform with the updated IOM guidelines will improve maternal or fetal outcomes," ACOG’s Committee on Obstetric Practice wrote in the January issue of Obstetrics and Gynecology (2013;121:210-2). The committee made a similar statement about overweight pregnant women.
In examining the IOM recommendations, ACOG reviewed the extant literature on maternal and fetal outcomes in overweight and obese women. The 2009 weight gain recommendations have not been universally embraced, the group said, because many clinicians feel they aren’t strict enough for overweight or obese women.
"The [recommendations] have met with controversial reactions from some physicians who believe that the weight gain targets are too high," the committee wrote. "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."
Setting weight goals for any pregnancy means balancing risks and benefits for two patients simultaneously, the committee noted. Obese mothers are more likely to develop gestational diabetes and preeclampsia. They have more cesarean births, and with those, a greater risk of wound infection and venous thromboembolism.
The infants of these mothers are more likely to have birth defects, including a doubling of the risk for neural tube defects. Stillbirth is more common, as is fetal macrosomia, a prime driver of an increased risk for cesarean section and its attendant maternal risks.
After reviewing both the IOM recommendations and the current literature, ACOG made several of its own recommendations for managing overweight or obese pregnant patients (Obstet. Gynecol. 2013;121:213-7).
In the preconceptional period:
• Include information about the risks obesity poses to both mother and infant, and encourage the patient to lose weight before becoming pregnant.
• Offer a nutritional assessment and exercise prescription.
During pregnancy:
• Assess height, weight, and body mass index at the first prenatal visit, and explain the IOM weight gain recommendations. Review them at each visit.
• Continue with nutritional counseling and exercise.
• For patients who have undergone bariatric surgery, prescribe additional iron, vitamin B12, folate, vitamin D, and calcium.
During labor and delivery:
• Get an early anesthesia consult, as both epidurals and general anesthesia are uniquely challenging in obese patients.
• For patients undergoing a cesarean, consider a higher-than-usual dose of prophylactic antibiotics to ward off wound infections.
• Assess each patient for thromboembolism potential; use pneumatic compression, unfractionated heparin, or low-molecular-weight heparin as indicated.
• Consider suture closure of the subcutaneous fat layer after a cesarean, as this could help reduce the risk of postoperative wound disruption.
Post partum:
• Encourage the patient to lose weight before attempting another pregnancy – enlist the help of a specialist.
All ACOG committee members are required to follow the college’s guidelines for relationships with the health care industry, according to the ACOG website.