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Pregnancy Weight Gain: New Guidelines

How Much Weight Should Women Gain During Pregnancy? Maybe Less Than You Think

Overdoing Pregnancy Weight Gain continued...

During pregnancy, "women need to gain weight, but they don't need to gain an unlimited amount of weight. It is really hard to lose it afterward," Rasmussen says.

Linda Barbour, MD, MSPH, a professor of medicine and obstetrics-gynecology at the University of Colorado at Denver, disagrees with the idea that all women need to gain weight during pregnancy.

Barbour says she is "disappointed" that the IOM's new guidelines don't reflect recent data that suggest not gaining any weight during pregnancy may be OK for obese women, particularly those who are severely obese.

"There's been a lot of data suggesting that obese women really don't have to gain any weight to have a baby that is normally grown," Barbour says.


Eating for Two?

Talking with patients about weight and pregnancy can be difficult, says Melissa Goist, MD, clinical assistant professor in the obstetrics-gynecology department of the Ohio State University Medical Center.

Goist says many people aren't aware that there are limits on healthy weight gain during pregnancy.

"I think people still feel like pregnancy is fair game," Goist says. "You only need 300 extra calories per day to actually maintain a pregnancy."

So if you think eating for two means doubling your calories, forget it.

"If you think about the normal diet of maybe 1,800-2,000 calories, depending on the size of the person, 300 extra calories is a sixth of that. So that's barely like eating anything," Goist says.

Preconception Counseling

The IOM's new guidelines call for women to be offered preconception counseling that includes their weight, diet, and physical activity.

Most women don't get preconception counseling, Rasmussen says.

Goist agrees. Only about 10% of her patients ask how they can get healthier before pregnancy, and "probably less than 1% of those patients are women who are obese with concerns that maybe they need to lose weight prior to getting pregnant," Goist says.

"It would be huge" for all women considering pregnancy to get preconception counseling, Goist says. "I think that if all patients thought that's what they were supposed to do, potentially we would have more patients doing it."

Delaying Pregnancy to Lose Weight

The new IOM guidelines call for preconception counseling to include access to contraception for overweight or obese women who decide to use birth control as they work toward a healthy weight.

Rasmussen acknowledges debate among obstetricians about whether overweight or obese women should consider contraception until reaching a healthy weight.

"But certainly, we would like to see as many women as possible conceive at a healthy weight that will reduce their general obstetric risk," Rasmussen says.

Goist says most of her patients don't like the idea of delaying pregnancy so they can lose extra pounds.

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