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Prepregnancy Weight and Pregnancy Weight Gain in the US

Prepregnancy Weight and Pregnancy Weight Gain in the US. Richard R. Nugent MD, MPH Department of OBGYN, UAMS. Learning Objective. Improved ability to discuss Prepregnancy BMI Gestational weight gain Recent guidelines for these changes

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Prepregnancy Weight and Pregnancy Weight Gain in the US

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  1. Prepregnancy Weight andPregnancy Weight Gainin the US Richard R. Nugent MD, MPH Department of OBGYN, UAMS

  2. Learning Objective • Improved ability to discuss • Prepregnancy BMI • Gestational weight gain • Recent guidelines for these changes • Their impacts on pregnancy outcome and long term health of the offspring

  3. Prepregnancy Weight • Prepregnancy weight status • Underweight is associated with • Low birth weight • Obesity is associated with • Pre-eclampsia • Gestational diabetes • Cesarean delivery • Failure to initiate breast feeding Source: Dalenius K, et al, Division of Nutrition, Physical Activity and Obesity, NCCDPHP, CDC

  4. IOM Guidelines, 2009 vs. 1990 • Prepregnancy weight status • Body Mass Index (BMI) levels* 20091990 • Underweight: <18.5 kg/m2<19.8 • Normal weight: 18.5 to 24.9 19.8 to 26.0 • Overweight: 25.0 to 29.9 26.1 to 29.0 • Obese: 30.0 or more 29.0 or more *These apply to pregnant adults and teens Source:Dalenius K, et al, Division of Nutrition, Physical Activity and Obesity, NCCDPHP, CDC

  5. US Prepregnancy Population Data Trends in Prevalence* of Overweight and Underweight *Prevalence: Overweight = BMI > 25.0 (Overweight and Obese) Underweight = BMI < 18.5 Source: Dalenius K, et al, Division of Nutrition, Physical Activity and Obesity, NCCDPHP, CDC

  6. Pregnancy Weight Gain • Women gaining less than recommended • Associated with low birth weight Therefore, poor outcomes • Women gaining more than recommended • Associated with high birth weight Therefore, difficult deliveries • Associated with difficulty returning to prepregnancy weight Therefore, chronic weight gain

  7. IOM Guidelines, 2009 • Gestational weight gain recommendations • Underweight: 28 to 40 pounds • Normal weight: 25 to 35 • Overweight: 15 to 25 • Obese: 11 to 20* * Changed from at least 15 pounds in 1990 Source:Dalenius K, et al, Division of Nutrition, Physical Activity and Obesity, NCCDPHP, CDC

  8. US Maternity Population Data Maternal Weight Gain by Prepregnancy Body Mass Index Less than ideal gain More than ideal gain Source: Dalenius K, et al, Division of Nutrition, Physical Activity and Obesity, NCCDPHP, CDC

  9. Long Term Impacts on Offspring • Maternal adiposity and offspring change in BMI Very recently (Accepted Article, doi 10.1002, 2013) Gabriella Lawrence, et al, in Israel: Comparing change in BMI between ages 17 and 32 (∆BMI) of 1400 sons in the Israeli military linked to their mother’s prepregnancy BMI and gestational weight gain: “A one SD change in mothers’ BMI and gestational weight gain was associated with a 0.83 and a 0.75 kg/m2 increase in the sons’ ∆BMI, respectively.”

  10. Long Term Impacts on Offspring • Maternal adiposity and offspring change in BMI (Continued) “The association … was slightly attenuated (12%) with the addition of genetic scores..” [derived from genotyping blood samples of offspring.] Showing mother’s BMI and gestational weight gain to be related to weight gain in the offspring, mostly for reasons other than genetics. BEHAVIORAL HEALTH

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