et al., 1988). Nielsen et al. (2006) showed that birth weight outcomes improved in all prepregnancy BMI groups when GWG increased from below to within the lower half of the weight gain recommended by the IOM (1990) in a cohort of 815 pregnant African American adolescents. Further gains were not beneficial, particularly for infants of adolescents with a high prepregnancy BMI.

The possibility that adolescents who gained at the upper end of the range for their BMI category might have an excess risk of postpartum weight retention or the later development of obesity was not considered in formulating the 1990 guidelines, but has long been recognized as a possible downside of recommending relatively high weight gains for them (McAnarney and Stevens-Simon, 1993). Adolescents who have given birth are heavier (Gigante et al., 2005) with more adipose tissue (Gunderson et al., 2009) than adolescents who have not. Gestational weight gain was a significant predictor of increase in BMI 6 and 9 years post delivery in all prepregnancy BMI categories among the 330 primiparous black adolescents studied by Groth (2008). In addition, those who gained above the IOM (1990) guidelines were more likely to have become obese by 9 years post delivery than those who gained within the guidelines.

In summary, the relationship of GWG to fetal and birth outcomes, postpartum weight retention, and risk for future overweight/obesity appears to be generally similar to that for adult women. However, information on these subjects is more limited for pregnancy among adolescents, particularly younger adolescents, than it is for adult women. Data generated since the IOM (1990) report, particularly related to the risk of developing postpartum weight retention and obesity in adult women who had been pregnant as young adolescents, support the recommendation that “until more is known, adolescents less than two years post-menarche should be advised to stay within the IOM-recommended BMI-specific weight range without either restricting weight or encouraging weight gain at the upper end of the range” (Suitor, 1997).

Gestational Weight Gain in Older Women

Increased maternal age is significantly associated with risk for adverse pregnancy outcomes, including stillbirth (Fretts, 2005; Reddy et al., 2006), low birth weight, preterm birth, and small-for-gestational age (SGA) birth (Cnattingius et al., 1992; Delpisheh et al., 2008). In addition to poor outcomes, pregnancy in older women is also associated with increased risk for pregnancy complications, e.g., hypertension, diabetes, placenta previa, and placental abruption (Joseph et al., 2005).

In a study of obese and non-obese women who were pregnant, Gross et al. (1980) found that a greater proportion of obese subjects were older

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