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Read terms. This document reflects emerging clinical and scientific advances as of the date issued and is subject to change. The information should not be construed as dictating an exclusive course of treatment or procedure to be followed. Individualized care and clinical judgment are necessary in the management of the overweight or obese woman who is gaining or wishes to gain less weight than recommended but has an appropriately growing fetus. The amount of weight gained during pregnancy can affect the immediate and future health of a woman and her infant.

The population demographics of women who become pregnant have changed dramatically over the past decade; more women are overweight or obese at conception. Evidence supports associations between excessive gestational weight gain and increased birth weight and postpartum weight retention but also between inadequate weight gain and decreased birth weight 1.

Gestational weight gain recommendations aim to optimize outcomes for the woman and the infant. In , the Institute of Medicine IOM published revised gestational weight gain guidelines that are based on prepregnancy body mass index BMI ranges for underweight, normal weight, overweight, and obese women recommended by the World Health Organization and are independent of age, parity, smoking history, race, and ethnic background Table 1 2. Other changes include the removal of the previous recommendations for special populations and the addition of weight gain guidelines for women with twin gestations.

For twin pregnancy, the IOM recommends a gestational weight gain of The IOM guidelines recognize that data are insufficient to determine the amount of weight women with multifetal triplet and higher order gestations should gain. The updated IOM recommendations have met with controversial reactions from some physicians who believe that the weight gain targets are too high, especially for overweight and obese women. Also, these perceived high weight gain targets do not address concerns regarding postpartum weight retention.

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