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Restricting Prenatal Weight Gain in Women of Size: Adverse Side Effects

Here's another study questioning whether rigid weight-gain restrictions in "obese" women are wise.  

We've talked about this extensively before.  But given how often care providers tout this as a way to improve outcomes in women of size, it bears frequent repetition.

In this study, the lower Cedergren weight gain criteria for obese women (less than 13 lbs.) resulted in slightly lower cesarean rates and definitely less macrosomia than the IOM guidelines.

However, it also resulted in an increase in preterm births, low birth weight babies, and NICU admissions.

Many providers mean well when they advise women of size to gain less weight in pregnancy. The question is, are we harming more than we are helping?

When restrictions are too draconian, I think the balance definitely falls to harm.

Discuss good nutrition and reasonable intake? Absolutely.  Have rigid weight gain goals that require significant restriction?  Not a good idea.

How about we emphasize excellent nutrition and trust the woman's body to gain what it needs?

Am J Perinatol. 2010 May;27(5):415-20. Obstetric outcomes in normal weight and obese women in relation to gestational weight gain: comparison between Institute of Medicine guidelines and Cedergren criteria. Potti S, Sliwinski CS, Jain NJ, Dandolu V.  PMID: 20013574 

We compared obstetric outcomes based on gestational weight gain in normal-weight and obese women using traditional Institute of Medicine (IOM) guidelines and newly recommended Cedergren criteria. Using the New Jersey Pregnancy Risk Assessment Monitoring System (PRAMS) database and electronic birth records, perinatal outcomes were analyzed to estimate the independent effects of prepregnancy body mass index (BMI) and gestational weight gain by IOM versus Cedergren criteria. Of 9125 subjects in PRAMS database from 2002 to 2006, 53.7% had normal BMI, 12.3% were overweight, 18.2% were obese, and the rest were underweight. 

Among normal-weight mothers, when compared with the IOM guidelines, macrosomia (6.45% versus 4.27%) and cesarean delivery rates (30.42% versus 29.83%) were lower using Cedergren criteria but the rates of preterm delivery (5.06% versus 9.44%), low birth weight (0.38% versus 2.42%), and neonatal intensive care unit (NICU) admissions (7.02% versus 10.86%) were higher with the Cedergren criteria.  

Similarly, among obese patients, when compared with IOM guidelines, macrosomia (10.79% versus 5.47%) and cesarean delivery rates (43.95% versus 40.71%) were lower using Cedergren criteria but the rates of preterm delivery (6.83% versus 8.32%), low birth weight (0.87% versus 1.88%), and NICU admissions (8.92% versus 13.78%) were higher with the Cedergren criteria.  

Based on our results, ideal gestational weight gain is presumably somewhere between the IOM and Cedergren's guidelines.

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