The Institute of Medicine's (2009) guidelines for weight gain during pregnancy provided upper limits that were lacking in earlier guidelines. Of particular importance were recommendations limiting gestational weight gain (GWG) in women with a body mass index (BMI) greater than 30. Although guideline information has been widely distributed to both professional and lay audiences, adherence to the recommendations continues to be problematic. In a recent retrospective study of all nulliparous women with term singleton vertex live births in 2011 and 2012 in the United States, some women in all BMI categories were found to have higher than recommended GWG (Truong, Lee, Caugey, & Chen, 2015). Predictably, women who gained >20 lb over the recommended guidelines for their BMI category and their babies experienced more complications during and after birth (Truong et al.). Gestational weight gain and obesity have long-term consequences for infants.
What are the childhood consequences of excessive gestational weight gain and obesity?
In one study both prepregnant BMI and excessive GWG were associated with childhood obesity and adiposity among African American and Dominican children in the Bronx and northern Manhattan (Widen et al., 2015). Odds of childhood obesity were almost three times as great for children whose mothers had excessive GWG. Minority women are at increased risk of excessive GWG (Arinze, Karp, & Gesell, 2015). Total GWG has been found to be positively associated with childhood size and adiposity, but only marginally associated with obesity. Similar findings were reported by Poston (2012). Maternal prepregnant weight and GWG influence weight outcomes of infants later in life. Effects of excessive GWG are not limited to child size and adiposity. Hrolfsdottir et al. (2015) report modest adverse associations between GWG in women who were normal weight starting pregnancy and select biomarkers of cardiovascular health in their children. Interestingly, this association was limited to male children. In female children, GWG was inversely associated with levels of total cholesterol and low-density lipoprotein levels. Poston (2012) reports that greater GWG is associated with higher blood pressure in 3-year-old children and at 21 years of age; GWG also may be associated with an increased risk of inherited Type 1 diabetes.
What does this information mean for nurses?
Nurses interact with women in a variety of settings and situations. Frequently those interactions occur when women are not pregnant. Taking advantage of the opportunity in every patient interaction to discuss benefits of a healthy weight, one that falls within a normal weight BMI category, is one way to reinforce the critical role that prepregnant weight, as well as GWG, play on future outcomes for the woman and her child. Such discussions become even more important given recent evidence that "overweight and obese women still have personal weight gain targets in excess of clinical guidelines" (Arinze et al., 2015, np), even when healthcare providers discussed appropriate weight gain parameters.
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