Crane, J. M. G., White, J., Murphy, P., Burrage, L., & Hutchens, D. (2009).Journal of Obstetrics and Gynaecology Canada, 31(1), 28-35.

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Obesity is an increasingly common problem among pregnant women, associated with an increased risk of maternal and perinatal complications. In 1990 and again in 2009, the Institute of Medicine recommended that weight gain during pregnancy be based on prepregnancy body mass index (BMI), and Health Canada adopted similar guidelines in 1999. The purpose of this study was to evaluate the effects of gestational weight gain on maternal and neonatal outcomes according to women's prepregnancy BMI. This was a population-based cohort study of 5,377 women with singleton pregnancies who delivered between 2001 and 2007 in the Canadian province of Newfoundland and Labrador, using the provincial perinatal program database. BMIs (in kg/m²) were divided into the following categories: underweight (<18.5), normal weight (18.5-24.9), overweight (25.0-29.9), obese (30.0-39.9) and morbidly obese (>=40.0). The investigators controlled for potential confounders such as maternal age, parity, smoking status, and gestational age. Over half the women (52.3%) gained more than the recommended amount of weight during pregnancy. In women with normal or overweight prepregnancy BMI, excess weight gain was associated with increased rates of gestational hypertension and birth weight >= 4000 grams. In women who were obese or morbidly obese, excess weight gain was associated with increased rates of birth weight >= 4000 grams, neonatal metabolic abnormality, and a trend toward increased rates of cesarean birth. Pregnancy weight gains of 25 to 35 pounds in women with a normal BMI, 15 to 25 pounds in overweight and obese women, and less than 15 pounds in morbidly obese women were associated with a reduction in the risk of adverse outcomes. Nurses need to advise women on the recommended weight gain during pregnancy, and encourage women not to gain more than this recommended amount to ensure optimal pregnancy outcomes.

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