Overweight Women Need More Guidance on Appropriate Weight Gain in Pregnancy

The advice that many overweight and obese women are receiving on gestational weight gain (GWG) from their providers is insufficient and often inappropriate, concludes a small study conducted at Penn State College of Medicine.¹

Because excessive GWG is highly correlated with postpartum weight retention and long-term obesity, it is important that clinicians give overweight and obese women appropriate advice about weight gain during pregnancy. Researchers interviewed 12 overweight and 12 obese women after the birth of their first child to determine what advice they were given about GWG. All 12 of the overweight women and 9 of the obese women exceeded the recommended weight gain during pregnancy (15 to 25 lb for overweight women and 11 to 20 lb for obese women).²

In terms of provider advice on GWG, women were advised to gain too much weight or given no recommendation at all for GWG, providers seemed unconcerned about excessive GWG, and women want and value advice from their providers about GWG. Regarding provider advice on exercise during pregnancy, women received limited or no advice on appropriate physical activity during pregnancy, clinicians advised women to be cautious and limit exercise during pregnancy, and provider knowledge about appropriate exercise intensity and frequency during pregnancy seemed limited.

The researchers found that 12 women were advised to gain too much weight, with the providers basing their recommendations on the guidelines for normal-weight women. Weight gain was never specifically discussed with 9 of 24 women. One woman received nonspecific advice, and only 2 women were advised to gain the appropriate amount of weight. All women reported that their weight was monitored at every clinician visit.

Only 10 women in the study were given exercise advice. The topic of exercise during pregnancy was generally brought up by the patient, was limited to the initial prenatal visit, or handled through written handouts. None of the women were told to increase their physical activity, 4 were told to maintain their activity, and 10 were told to limit their activity, reported the researchers. The duration or intensity of exercise was not discussed, however, and walking and stretching were the exercises most suggested.

“Providers need tools to address weight gain and exercise levels,” the researchers stated. “Office-based tools like BMI calculators may help to identify patients as overweight and obese to provide appropriate preconception counseling and accurate weight gain targets. It may also be beneficial to offer educational materials prior to a first prenatal visit.”

Pertinent Points:
- Overweight and obese women need better guidance on how much weight to gain during pregnancy.
- Overweight women should gain between 15 and 25 pounds during pregnancy, and obese women should gain between 11 and 20 pounds during pregnancy.

References:

1. Stengel MR, Krashchnewski JL, Hwang SW, et al. “What my doctor didn’t tell me”: examining health care provider advice to overweight and obese pregnant women on gestational weight gain and physical activity. Womens Health Issues. 2012;22:e535-e540.
2. Pregnancy weight gain: what’s healthy? Available at: http://www.mayoclinic.com/health/pregnancy-weight-gain/PR00111. Accessed December 28, 2012.