NuPAFP ConferenceNuPAFP ConferenceOctober 13-14, 2010October 13-14, 2010NuPAFP ConferenceNuPAFP ConferenceOctober 13-14, 2010October 13-14, 2010
Color Me HealthyColor Me Healthy
Gestational Weight GainGestational Weight Gain
Paula Garrett, MS, RDPaula Garrett, MS, RD
Background
American Women are:
• Older when they become pregnant• More diverse• Having more twin and triplet
pregnancies
New Guidelines
• Based upon World Health Organization (WHO) cut-off points for BMI categories
• Specific, relatively narrow range of recommended weight gain for obese women
Determinants• Maternal Factors
– Socio-demographic• Adolescent• Older mothers• Race/Ethnicity• Socio-economic Status
Determinants• Interpersonal/Family
– Family Violence– Marital Status– Partner and Family Support
Determinants• Anthropometric and Physiological
Factors– Pregravid BMI– Basal Metabolic Rate (BMR)
Determinants• Medical Factors
– Pre-existing Morbidities– Hyperemesis Gravidarum– Anorexia & Bulimia Nervosa– Bariatric Surgery
Determinants• Psychological Factors
– Depression– Stress– Social Support– Attitudes Towards Weight Gain and
Loss
Determinants• Neighborhood/Community Factors
– Access to Healthy Food
– Opportunities for Physical Activity
Determinants• Behavioral Factors
– Diet– Physical Activity
Components of Gestational Weight
GainComponent Increase at Term (kg)
Fetus 3.40 (2.5-5.0)
Placenta .65
Amniotic Fluid .80
Maternal Tissue 1.38
Blood Volume 1.45
Maternal Fat Stores 3.35
Extracellular/Extravascular Fluid
1.48
Total 12.5
New Weight Gain Guidelines
Pre-pregnancy BMI Category
Total Weight Gain (lbs.)
Underweight 28-40
Normal Weight 25-35
Overweight 15-25
Obese 11-20
Provisional Guidelines for Women-Twins
Pre-Pregnancy BMI Category
Weight Gain at Term (lbs.)
Normal weight 37-54
Overweight 31-50
Obese 25-42
New Approaches to the Development of the
Guidelines
• Considered outcomes for the mother, not just the infant, and the inevitable trade-offs between them
Consequences for the Mother
• During Pregnancy– Gestational Diabetes Mellitus &
Impaired Glucose Tolerance– Hypertensive Disorders
Consequences for the Mother
• During Delivery– Induction of Labor– Length of Labor– Mode of Delivery– Maternal Mortality
Consequences for the Mother
• Post-Partum– Lactation– Post-partum Weight Retention– Post-partum Depression
• Long-Term
Consequences for the Child
• Stillbirth• Birth defects• Fetal Growth• Pre-term Birth
Consequences for the Child
• Long-Term– Neonatal Body Composition– Infant Weight Gain– Breastfeeding Initiation &
Maintenance– Effects on Obesity
Recommendation for Action
• Federal agencies, private voluntary organizations and medical and public health organizations should adopt these new guidelines and publicize them to their members and women of childbearing age
Recommendation for Action
• Those who provide prenatal care to women should offer them counseling, such as guidance on dietary intake and physical activity that is tailored to their lifestyle
Risk Revision 10• Policy Revision• Updated the following risks:
– #101-Underweight(Women)– #111-Overweight (Women)– #131-Low Maternal Weight Gain– #133-High Maternal Weight Gain– #335-Multi-Fetal Gestation
Weight Gain Grid• Printed four prenatal weight gain grids
– Underweight– Normal– Overweight– Obese
• Will be placed on Orbit order form
Questions/Comments
