Although the guidelines developed as part of this committee process are not dramatically different from those published previously (IOM, 1990), fully implementing them would represent a radical change in the care provided to women of childbearing age. In particular, the committee recognizes that full implementation of these guidelines would mean:
Offering preconceptional services, such as counseling on diet and physical activity as well as access to contraception, to all overweight or obese women to help them reach a healthy weight before conceiving. This may reduce their obstetric risk and normalize infant birth weight as well as improve their long-term health.
Offering services, such as counseling on diet and physical activity, to all pregnant women to help them achieve the guidelines on GWG contained in this report. This may also reduce their obstetric risk, reduce postpartum weight retention, improve their long-term health, normalize infant birth weight, and offer an additional tool to help to reduce childhood obesity.
Offering services, such as counseling on diet and physical activity, to all postpartum women. This may help them to eliminate postpartum weight retention and, thus, to be able to conceive again at a healthy weight as well as improve their long-term health.
The increase in overweight and obesity among American women of childbearing age and failure of many pregnant women to gain within the IOM (1990) guidelines alone justify this radical change in care as women clearly require assistance to achieve the recommendations in this report in the current environment. However, the reduction in future health problems among both women and their children that could possibly be achieved by meeting the guidelines in this report provide additional justification for the committee’s recommendations.
These new guidelines are based on observational data, which consistently show that women who gained within the IOM (1990) guidelines experienced better outcomes of pregnancy than those who did not (see Chapters 5 and 6). Nonetheless, these new guidelines require validation from experimental studies. To be useful, however, such validation through intervention studies must have adequate statistical power not only to determine if a given intervention helps women to gain within the recommended range but also to determine if doing so improves their outcomes. In the future, it will be important to reexamine the trade-offs between women and their children in pregnancy outcomes related to prepregnancy BMI as well as GWG, and also to be able to estimate the cost-effectiveness of interventions designed to help women meet these recommendations.