More than 60% of American women of childbearing age are overweight or obese and a large number of women gain too much weight during pregnancy. The first revision to pregnancy-weight guidelines since 1990 was issued last May by a panel convened by the Institute of Medicine. However, the committee voted to retain the 1990 guidelines (with the exception of putting an upper limit on weight gain for obese women) despite the rapid upswing in obesity rates.
In a commentary published in the January issue of the journal Obstetrics & Gynecology, Dr. Raul Artal, chairman of the department of obstetrics, gynecology and women's health at St. Louis University, calls into question the guidelines and some of the scientific evidence used to support them. Artal, who co-authors the editorial with Dr. Charles L. Lockwood of Yale University and Dr. Haywood L. Brown of Duke University, said the IOM panel's concern that limiting weight gain might result in under-nourishment of women and their babies was no longer valid because the national rates of overweight and obesity have soared. Further, they write, the IOM failed to apply specific recommendations for each category of obesity: class I (BMI of 30 to 34.9), class II (BMI of 35 to 39.9) and class III (BMI of 40 or greater).
In the IOM guidelines, obese women are generally advised to gain 11 to 20 lbs. But Artal recommends obese pregnant women eat a nutrient-rich diet of between 2,000 and 2,500 calories a day, which would cap weight gain at about 10 lbs. He maintains that obese women can safely exercise and gain little or no weight during pregnancy while under a doctor's guidance.
The new guidelines also fail to acknowledge recent research demonstrating the long-term health repercussions on both women and their babies from excessive weight during pregnancy, the authors said.
"Gestational weight gain should reflect a balance between an optimal outcome for the fetus and mother alike," they wrote. "Reaffirmation of the IOM 1999 recommendations has the potential to amplify pregnancy-related risk for mother and fetus and long-term morbidities for women."
-- Shari Roan
Photo credit: Mark Boster / Los Angeles Times