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