Healthy amounts of weight gain during pregnancy

As an internal medicine doctor, I'm not well-trained to manage pregnancy or deliver babies. Unlike family doctors and OB/GYN physicians, my only training to deliver babies came during my 2-month OB/GYN rotation during medical school. I remember helping to deliver around 20 babies by C-section and 20 by spontaneous vaginal delivery (the usual route) during medical school approximately 15 years ago, but none since. Throughout my career, my experience with managing the care of pregnant patients has been limited to internal medicine consultations for things such as elevated blood sugar, diabetes, thyroid disorders, high blood pressure, cardiac problems, and depression.

Recently, however, I came across an article describing the importance of preventing excessive gestational weight gain (GWG). The article interested me because I've had so many female patients through the years who have told me that their issues with weight gain primarily came after one or more pregnancies.

The article I read was called "Behavioral Counseling Interventions for Healthy Weight and Weight Gain in Pregnancy." It was a review article that provided recommendations for the United States Preventive Services Task Force (USPSTF), a government task force that provides recommendations for disease prevention. The primary recommendation that came from this article is that we as physicians should counsel our patients on limiting excess weight gain during pregnancy because it prevents bad outcomes both for the baby as well as the mother. The bottom line: preventing excessive gestational weight gain helps prevent gestational diabetes (diabetes that occurs only during pregnancy), emergency C sections, and babies that are too large. Counseling during pregnancy about gestational weight gain has been shown to reduce these bad outcomes.

The following are the recommended amounts of healthy weight gain, which depend on if the mother starts in terms of being underweight, normal weight, overweight, or obese:

Weight category prior to pregnancy	Healthy weight gain amount during pregnancy
Underweight	28 to 40 lb
Normal weight	25 to 35 lb
Overweight	15 to 25 lb
Obese	11 to 20 lb

Various interventions were studied for prevention of excessive gestational weight gain, including various diet and exercise interventions.

In my own practice, this article will effect what I do in a couple of ways:

• 1. My patients who are planning on getting pregnant and stopping the weight loss medications (weight loss medications are discontinued during pregnancy) can be counseled on a healthy amount of weight gain to strive for during pregnancy.
• 2. I can counsel my patients who are pregnant or planning to become pregnant that avoiding excessive weight gain can be good for their health and good for their baby's health, including reducing the risk for gestational diabetes, emergency C sections, and large infants.

Reference

1. US Preventive Services Task Force, Davidson KW, Barry MJ, et al. Behavioral Counseling Interventions for Healthy Weight and Weight Gain in Pregnancy: US Preventive Services Task Force Recommendation Statement. JAMA. 2021;325(20):2087-2093. doi:10.1001/jama.2021.6949