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Weight Gain During Pregnancy: Reexaming the Guidelines
individual and social characteristics of the provider as contrasted with those of the pregnant woman, and racial/ethnic and socioeconomic disparities in weight gain advice.
For the purpose of this report, policy is defined broadly to include principles, guidelines, or plans adopted by an organization to guide decisions, actions, and other matters. An example of how policy can influence GWG is the weight gain recommendations from the report, Nutrition During Pregnancy (IOM, 1990) and subsequent endorsement of the report’s recommendations and guidelines by obstetric organizations in the United States and many other countries.
In some cases, it is not clear what type of advice is being provided. For example, in a 2005 cross-sectional survey mailed to 1,806 practicing members of the American College of Obstetricians and Gynecologists (ACOG), more than 85 percent of the 900 respondents reported counseling their patients about GWG often or most of the time (ACOG, 2005). The survey did not, however, assess the respondents’ knowledge of the IOM (1990) guidelines or the content of counseling (Power et al., 2006).
The few studies that have examined the advice given for GWG, however, have shown that women often receive inconsistent or erroneous advice. In a survey of approximately 2,300 women, Cogswell et al. (1999) reported that, of the 1,643 women who recalled weight gain advice, 14 percent reported being advised to gain less than the recommended levels, and 22 percent were advised to gain more and that provider advice to gain either below or above the recommended levels was associated with actual weight gain below the recommendations, respectively (both associations had an adjusted odds ratio of 3.6). So about one-third of women in this study reported receiving no advice or inappropriate advice from health professionals regarding GWG, and they followed that advice. Added to that, 27 percent of women reported receiving no advice about GWG. Altogether nearly two-thirds (63 percent) of women in this study reported receiving either inappropriate advice or no advice at all. Only 39 percent recalled receiving advice that fell within the IOM (1990) guidelines.
In a more recent study, Stotland et al. (2005) found that 79 percent of the nearly 1,200 women reported a target GWG (i.e., how much weight women think they should gain during pregnancy) that fell within the IOM (1990) guidelines. The authors speculated that their figures were higher than those reported in Cogswell et al. (1999). Still, Stotland et al. (2005) found that one-third (33 percent) of women received no advice from health professionals regarding GWG, and less than half (49 percent) reported receiving advice within guidelines.