Prenatal care providers are advised to evaluate maternal weight at each regularly
scheduled prenatal visit, monitor progress toward meeting weight gain goals, and provide
individualized counseling if significant deviations from a woman’s goals occur. Today,
nearly 50% of women exceed their weight gain goals with overweight and obese women
having the highest prevalence of excessive weight gain. Risks of inadequate weight
gain include low birthweight and failure to initiate breast-feeding whereas the risks
of excessive weight gain include cesarean deliveries and postpartum weight retention
for the mother and large-for-gestational-age infants, macrosomia, and childhood overweight
or obesity for the offspring. Prenatal care providers have many resources and tools
to incorporate weight and other health behavior counseling into routine prenatal practices.
Because many women are motivated to improve health behaviors, pregnancy is often considered
the optimal time to intervene for issues related to eating habits and physical activity
to prevent excessive weight gain. Gestational weight gain is a potentially modifiable
risk factor for a number of adverse maternal and neonatal outcomes and meta-analyses
of randomized controlled trials report that diet or exercise interventions during
pregnancy can help reduce excessive weight gain. However, health behavior interventions
for gestational weight gain have not significantly improved other maternal and neonatal
outcomes and have limited effectiveness in overweight and obese women.
Key words
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References
- Special leaflets for use in controlling toxemia and excessive weight gain in pregnancy.Am J Public Health Nations Health. 1950; 40: 194-200
- Maternal nutrition and the course of pregnancy.National Academy of Sciences, Washington (DC)1970
Institute of Medicine. Nutrition during pregnancy. Washington (DC); 1990.
Institute of Medicine. Weight gain during pregnancy: reexamining the guidelines. Washington (DC); 2009.
- Weight gain during pregnancy. Committee opinion no. 548.Obstet Gynecol. 2013; 121: 210-212
American Academy of Pediatrics, American College of Obstetricians and Gynecologists. Guidelines for perinatal care. 7th ed. Washington (DC); 2012.
- Validity of self-reported height and weight in women of reproductive age.Matern Child Health J. 2007; 11: 137-144
- Pregnancy outcomes with weight gain above or below the 2009 Institute of Medicine guidelines.Obstet Gynecol. 2013; 121: 969-975
National Institute for Health and Clinical Excellence. Weight management before, during, and after pregnancy. July 2010. NICE public health guidance 27.
Institute of Obstetricians and Gynecologists Royal College of Physicians of Ireland. Obesity and pregnancy clinical practice guideline. Guideline no. 2, June 2011, revised June 2013.
The Australian and New Zealand College of Obstetricians and Gynecologists. C-Obs 49 management of obesity in pregnancy. 2013.
- Energy requirements during pregnancy based on total energy expenditure and energy deposition.Am J Clin Nutr. 2004; 79: 1078-1087
- Dynamic energy-balance model predicting gestational weight gain.Am J Clin Nutr. 2012; 95: 115-122
- A systematic review and metaanalysis of energy intake and weight gain in pregnancy.Am J Obstet Gynecol. 2016; 214: 465-483
- Nutritional support in obstetrics and gynecology.Clin Obstet Gynecol. 1976; 19: 489-513
- Prevalence and characteristics associated with gestational weight gain adequacy.Obstet Gynecol. 2015; 125: 773-781
- Prevalence of childhood and adult obesity in the United States, 2011-2012.JAMA. 2014; 311: 806-814
- Exploring potential health disparities in excessive gestational weight gain.J Womens Health (Larchmt). 2013; 22: 494-500
- Racial differences in gestational weight gain and pregnancy-related hypertension.Ann Epidemiol. 2014; 24: 441-447
- Maternal pre-pregnancy weight and gestational weight gain and their association with birthweight with a focus on racial differences.Matern Child Health J. 2013; 17: 85-94
- The effect of race/ethnicity on gestational weight gain.J Immigr Minor Health. 2015; 17: 325-332
- The influence of weight gain patterns in pregnancy on fetal growth using cluster analysis in an obese and nonobese population.Obesity (Silver Spring). 2013; 21: 1416-1422
- The association between inadequate gestational weight gain and infant mortality among US infants born in 2002.Matern Child Health J. 2012; 16: 119-124
- Pregnancy as a window to future health: excessive gestational weight gain and obesity.Semin Perinatol. 2015; 39: 296-303
- Pregnancy weight gain and risk of neonatal complications: macrosomia, hypoglycemia, and hyperbilirubinemia.Obstet Gynecol. 2006; 108: 1153-1161
- Gestational weight gain and adverse neonatal outcome among term infants.Obstet Gynecol. 2006; 108: 635-643
- Gestational weight gain and child adiposity at age 3 years.Am J Obstet Gynecol. 2007; 196: 322.e1-322.e8
- Fetal programming of adult disease: implications for prenatal care.Obstet Gynecol. 2011; 117: 978-985
- The relationship of maternal prepregnancy body mass index and pregnancy weight gain to neurocognitive function at age 10 years among children born extremely preterm.J Pediatr. 2017;
- Associations of maternal prepregnancy body mass index and gestational weight gain with adult offspring cardiometabolic risk factors: the Jerusalem Perinatal Family Follow-up Study.Circulation. 2012; 125: 1381-1389
- The impact of change in pregnancy body mass index on the development of gestational hypertensive disorders.J Perinatol. 2014; 34: 181-185
- The impact of change in pregnancy body mass index on macrosomia.Obesity (Silver Spring). 2014; 22: 1997-2002
- The impact of change in pregnancy body mass index on cesarean delivery.J Matern Fetal Neonatal Med. 2014; 27: 795-800
- Obesity and pregnancy: clinical management of the obese gravida.Am J Obstet Gynecol. 2011; 204: 106-119
- The impact of group prenatal care on pregnancy and postpartum weight trajectories.Am J Obstet Gynecol. 2015; 213: 688.e1-688.e9
- Prepregnancy weight, weight gain, and birth weight.Am J Obstet Gynecol. 1986; 154: 503-509
- Pregnancy outcome and weight gain recommendations for the morbidly obese woman.Obstet Gynecol. 1998; 91: 97-102
- Effects of gestational weight gain and body mass index on obstetric outcome in Sweden.Int J Gynaecol Obstet. 2006; 93: 269-274
- Gestational weight gain and pregnancy outcomes in obese women: how much is enough?.Obstet Gynecol. 2007; 110: 752-758
- Optimal gestational weight gain ranges for the avoidance of adverse birth weight outcomes: a novel approach.Am J Clin Nutr. 2009; 90: 1552-1558
- Excessive weight gain among obese women and pregnancy outcomes.Am J Perinatol. 2010; 27: 333-338
- Maternal and neonatal outcomes among obese women with weight gain below the new Institute of Medicine recommendations.Obstet Gynecol. 2011; 117: 1065-1070
- Associations of gestational weight gain with short- and longer-term maternal and child health outcomes.Am J Epidemiol. 2009; 170: 173-180
- Gestational weight gain and obesity: is 20 pounds too much?.J Womens Health (Larchmt). 2011; 20: 1405
- Severe obesity, gestational weight gain, and adverse birth outcomes.Am J Clin Nutr. 2010; 91: 1642-1648
- Newborn size among obese women with weight gain outside the 2009 Institute of Medicine recommendation.Obstet Gynecol. 2011; 117: 812-818
- Inadequate weight gain in overweight and obese pregnant women: what is the effect on fetal growth?.Am J Obstet Gynecol. 2014; 211: 137.e1-137.e7
- Motivational interviewing: a tool for behavior change. Committee opinion no. 423.Obstet Gynecol. 2009; 113: 243-246
- The effect of physician behavior on the collection of data.Ann Intern Med. 1984; 101: 692-696
- Interventions designed to limit gestational weight gain: a systematic review of theory and meta-analysis of intervention components.Obes Rev. 2013; 14: 435-450
- Physical activity and exercise during pregnancy and the postpartum period. Committee opinion no. 650.Obstet Gynecol. 2015; 126: e135-e142
- Exercise during pregnancy in normal-weight women and risk of preterm birth: a systematic review and meta-analysis of randomized controlled trials.Am J Obstet Gynecol. 2016; 215: 561-571
- A systematic review investigating healthy lifestyle interventions incorporating goal setting strategies for preventing excess gestational weight gain.PLoS One. 2012; 7: e39503
- Improving gestational weight gain counseling through meaningful use of an electronic medical record.Matern Child Health J. 2014; 18: 2188-2194
- Family practice residents' identification and management of obesity.Int J Obes Relat Metab Disord. 1992; 16: 335-340
- Long-term weight loss maintenance for obesity: a multidisciplinary approach.Diabetes Metab Syndr Obes. 2016; 9: 37-46
- Diet or exercise, or both, for preventing excessive weight gain in pregnancy.Cochrane Database Syst Rev. 2015; 6: CD007145
- Low glycemic index diet in pregnancy to prevent macrosomia (ROLO study): randomized control trial.BMJ. 2012; 345: e5605
- Prevention of gestational diabetes: feasibility issues for an exercise intervention in obese pregnant women.Diabetes Care. 2010; 33: 1457-1459
- Effect of lifestyle intervention on dietary habits, physical activity, and gestational weight gain in obese pregnant women: a randomized controlled trial.Am J Clin Nutr. 2010; 91: 373-380
- Lifestyle intervention on diet and exercise reduced excessive gestational weight gain in pregnant women under a randomized controlled trial.BJOG. 2012; 119: 70-77
- Reducing excessive weight gain in pregnancy: a randomized controlled trial.Med J Aust. 2009; 191: 429-433
- Preventing excessive weight gain during pregnancy through dietary and lifestyle counseling: a randomized controlled trial.Obstet Gynecol. 2009; 113: 305-312
- Improving diet and exercise in pregnancy with Video Doctor counseling: a randomized trial.Patient Educ Couns. 2011; 83: 203-209
- Randomized trial of a behavioral intervention to prevent excessive gestational weight gain: the Fit for Delivery Study.Am J Clin Nutr. 2011; 93: 772-779
- Randomized controlled trial to prevent excessive weight gain in pregnant women.Int J Obes Relat Metab Disord. 2002; 26: 1494-1502
- Dietary and lifestyle advice for pregnant women who are overweight or obese: the LIMIT randomized trial.Ann Nutr Metab. 2014; 64: 197-202
- The LiP (Lifestyle in Pregnancy) study: a randomized controlled trial of lifestyle intervention in 360 obese pregnant women.Diabetes Care. 2011; 34: 2502-2507
- The Treatment of Obese Pregnant Women (TOP) study: a randomized controlled trial of the effect of physical activity intervention assessed by pedometer with or without dietary intervention in obese pregnant women.Am J Obstet Gynecol. 2014; 210: 134.e1-134.e9
- Maternal obesity and metabolic risk to the offspring: why lifestyle interventions may have not achieved the desired outcomes.Int J Obes (Lond). 2015; 39: 642-649
- Systematic review of clinical trials on dietary interventions to prevent excessive weight gain during pregnancy among normal weight, overweight and obese women.BMC Pregnancy Childbirth. 2011; 11: 81
- Behavioral interventions for weight management in pregnancy: a systematic review of quantitative and qualitative data.BMC Public Health. 2011; 11: 491
- Antenatal interventions for overweight or obese pregnant women: a systematic review of randomized trials.BJOG. 2010; 117: 1316-1326
- Lifestyle interventions for overweight and obese pregnant women to improve pregnancy outcome: systematic review and meta-analysis.BMC Med. 2012; 10: 47
- Dietary interventions in overweight and obese pregnant women: a systematic review of the content, delivery, and outcomes of randomized controlled trials.Nutr Rev. 2016; 74: 312-328
- Motivational interviewing: preparing people for change.2nd ed. Guilford Press, New York2002
References for motivational interviewing
Books
- Motivational interviewing: preparing people for change.2nd ed. Guilford Press, New York (NY)2002
- Motivational interviewing in health care: helping patients change behavior.Guilford Press, New York (NY)2008
Videos
- Motivational interviewing.University of New Mexico, Albuquerque (NM)1989 (Available from the author at the Department of Psychology, University of New Mexico, Albuquerque, NM 87131; (505) 277-4121)
- Motivating pregnant women to stop drinking.Behavior Therapy Associates, Albuquerque (NM)1997 (Available from Behavior Therapy Associates, 9426 Indian School Rd NE, Suite 1, Albuquerque, NM 87112; (505) 345-6100)
Online
Motivational Interviewing Network of Trainers (MINT) is an international organization of trainers in motivational interviewing. Their central interest is to improve the quality and effectiveness of counseling and consultations with clients about behavior change. There is a calendar of available 2-day training sessions, some of which are offered on-line. Available at: http://www.motivationalinterviewing.org/about_mint
Health Sciences Institute motivational interviewing training for health care. Available at: http://www.healthsciences.org/Motivational-Interviewing-Health-Coach-Training.
Journals
- Training residents in obesity counseling: incorporating principles of motivational interviewing to enhance patient centeredness.J Grad Med Educ. 2011; 3: 408-411
- Motivational interviewing: a part of the weight loss program for overweight and obese women prior to fertility treatment.Gynecol Endocrinol. 2013; 29: 839-842
- Healthcare professionals experience with motivational interviewing in their encounter with obese pregnant women.Midwifery. 2015; 31: 678-684
- Motivational interviewing.BMJ. 2010; 340: c1900
Article info
Publication history
Published online: May 23, 2017
Accepted:
May 16,
2017
Received in revised form:
May 4,
2017
Received:
February 27,
2017
Footnotes
This article was supported by grant number K23HD076010 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (M.A.K.). The funding source had no involvement in the literature review, writing the report, or decision to submit for publication.
The authors report no conflict of interest.
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