Obese women - should they gain weight in pregnancy?

From Reuters Health Information

New Study Questions Pregnancy Weight Gain for Obese Women

Jun 09 - Newly published research is challenging guidelines from the American College of Obstetricians and Gynecologists stating that all women, even those who are obese, should gain between 26 to 35 pounds during their pregnancy.

The Institute of Medicine has recommended a lower amount of weight gain for overweight and obese patients, about 15 pounds, but the new data suggest that even this is too much and goes on to show that these patients can safely be placed on a calorie-appropriate nutritional program.

"Women who are obese when beginning a pregnancy are, by definition, unhealthy," lead author Dr. Yvonne S. Thornton, from New York Medical College, Valhalla, said in a statement. "To say that they should gain even more weight is counter-intuitive, and our study bears that out."

The study, reported in the Journal of the National Medical Association for June, featured 232 obese pregnant women who were randomized to follow conventional "eat to appetite" prenatal nutritional guidelines or to participate in a well-balanced, monitored nutritional program involving the use of daily food diaries.

On average, women in the study group gained 11 pounds, while controls gained 31 pounds. Twenty-three subjects with extreme obesity lost weight during their pregnancy.

Contrary to what some prior researchers may have feared, use of the nutritionally monitored program did not result in any fetal deaths or any growth-restricted infants.

On the plus side, women who adhered to the nutritional regimen had fewer babies weighing over 10 pounds, fewer cesarean sections, a lower rate of gestational diabetes, and retained less weight after delivery.

"Rather than focusing on numerical endpoints with respect to weight gain, we need to focus on making (obese) women healthier by getting them to eat a well-balanced diet," Dr. Thornton emphasized.

The statement from New York Medical College notes, "The study grew out of Dr. Thornton's personal experience with obesity and pregnancy. Despite being overweight, she gained a substantial amount of weight during her first pregnancy, exacerbating her life-long battle with obesity. During her second pregnancy, she followed a well balanced diet and gained little weight, with no adverse consequences for mother or baby. Dr. Thornton observed the same pattern in her own clinical practice, leading her to question prevailing guidelines for weight gain during pregnancy."

J Nat Med
http://www.medscape.com/viewarticle/704113?sssdmh=dm1.484181&src=nldne Assoc 2009