Guidelines address heavier mothers-to-be

More than 60 percent of U.S. women of childbearing age are overweight or obese – a significant increase from 20 years ago. And recent studies strongly suggest that either too much or too little nutrition in utero can increase a fetus’ chance of becoming an overweight child and overweight adult.

Such data on the increasing girth of pregnant women and the growing rates of obesity in children led to pressure on the Institute of Medicine to revise a set of 1990 guidelines that were written primarily to prevent the birth of excessively small infants.

On Thursday, the institute’s advisory committee – a task force of doctors and researchers – issued the updated recommendations. But with the exception of a few areas, such as putting a limit on how much weight obese women should gain, the new guidelines are the old guidelines wrapped up in a lecture.

The panel said the existing guidelines are essentially fine. It’s women and their doctors, the members said, who need to try harder – often much harder – to reach a normal weight before pregnancy and to avoid excessive weight gain during pregnancy.

“Although not dramatically different, fully implementing the guidelines will represent a change in the care provided to women of childbearing age,” said Kathleen Rasmussen, chairwoman of the committee and a professor of nutrition at Cornell University.

The report was requested by six major health organizations so that doctors could better advise and care for their patients. Although nothing in the report is mandatory, health care professionals are likely to acknowledge and implement at least some of the panel’s recommendations. The report includes tools, such as weight charts, that doctors can use to better monitor patients’ weights.

But several leading experts on maternal obesity and child health expressed disappointment with the document. A growing contingent of doctors say that obese women – which includes one pregnant woman in every five – need to gain little or no weight during pregnancy.

“In my opinion, the Institute of Medicine is missing an opportunity to address the issue of the obesity epidemic and the contribution that pregnancy makes to that epidemic,” said Dr. Raul Artal, chairman of the department of obstetrics, gynecology and women’s health at Saint Louis University.

The recommendations call for a gestational weight gain of 28 to 40 pounds for underweight women, 25 to 35 pounds for normal weight women, 15 to 25 pounds for overweight women and 11 to 20 pounds for obese women. The only change is for obese women, who were previously advised to gain at least 15 pounds, with no upper limit.

The weight categories are defined by body mass index.

The report notes that the rate of complications in pregnancy, such as preterm birth, gestational diabetes and Cesarean sections, have increased greatly in the last decade and calls on health professionals to help women achieve a normal weight before becoming pregnant.