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Suggested Citation:"Index." Institute of Medicine and National Research Council. 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press. doi: 10.17226/12584.
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Index*

A

Acculturation, 114115

Acetoacetate, 100, 102

Adipokines, 94

Adiponectin, 94, 138139

Adolescent pregnancy

birth rate trends, 46

GWG-related risks, 121122

individual patterns of GWG, 76

infant mortality risk, 205

mean GWG ranges, 101

postpartum weight retention, 122

prepregnant BMI cutoff values, 251252

recommendations for weight gain during pregnancy, 34, 121, 260

social support as GWG determinant, 145

total GWG, 72, 155

trends, 6465

Adrenocorticotropic hormone, 94

Age at pregnancy

birth weight trends and, 57

breastfeeding rates and, 62

depression risk, 5152

gestational diabetes risk and, 5253

GWG in older women, 122123, 155

GWG patterns and trends, 3031, 34f, 124t, 126t

health risks for older women, 173

infant mortality risk, 205

prevalence of weight loss attempts during pregnancy, 146

trends, 1, 15, 46, 6465

See also Adolescent pregnancy

Age of fetal viability, 86

Agency for Healthcare Research and Quality, 5, 18, 173

Alcohol consumption, 151152

Allergy/asthma, GWG and, 226227, 230

Amniochorionic-decidual inflammation, 213, 214

Amniotic fluid changes in pregnancy, 9192, 102

Amphetamine abuse, 152

Angiotensin, 94

Anorexia nervosa, 140141

Apgar score, 225

Attention deficit hyperactivity disorder, 228, 230

*

Page numbers followed by f refer to figures and page numbers followed by t refer to tables.

Suggested Citation:"Index." Institute of Medicine and National Research Council. 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press. doi: 10.17226/12584.
×

B

Bariatric surgery, 141142, 271

Basal metabolic rate, 135138, 139

Basal oxygen consumption, 83

Bioimpedance analysis, 78

Biomarker predictors of birth outcomes, 156

Birth certificates

GWG and prepregnancy BMI data from, 2933

recommendations for revision, 5, 33, 66

shortcomings of data from, 30

Birth weight

child health outcomes, 198

classification, 86, 87, 206207

determinants, 206

fetal growth and, 206

genetic factors in, 129133

gestational age and, 87, 88f

high altitude effects, 117

infants born to incarcerated mothers, 154

maternal body composition and, 102

maternal body water accretion and, 78

maternal plasma volume and, 78

maternal substance use and, 151

maternal weight gain and, 73f, 198, 208211

multiple fetus pregnancies, 8889

optimal, 86

patterns and trends, 57, 58f, 8788

prepregnancy weight and, 73f, 207

rate of GWG and, 7677

See also Large-for-gestational age infants;

Low-birth weight babies;

Small-for-gestational age infants

Bone mineral, 8083

Breast cancer, 186, 227228, 230

Breastfeeding

GWG-related outcomes, 187, 216217

trends, 62

See also Lactation

Bulimia nervosa, 140141

C

Caloric intake, 48

Cancer, GWG and

birth weight and, 227

evidence for linkage, 186, 227228, 230

hormonal system, 227228

recommendations for research, 8, 188

Carbohydrate metabolism, 95

Cardiovascular health

long-term outcomes of GWG, 185, 186187

maternal changes during pregnancy, 9293

recommendations for research, 8, 188

Centers for Disease Control and Prevention, 9, 270

Cesarean delivery

evidence for GWG linkage, 186, 187

as GWG-related outcome, 7, 180181

maternal obesity and, 5455, 72, 180181

risks for women of small stature, 3

trends, 54, 65

Childhood health

allergy/asthma, 226227

cancer, 227228, 230

long-term outcomes, 258259

neurodevelopmental, 222226, 229, 230

recommendations for research, 8, 230231

See also Childhood obesity;

Infant health

Childhood obesity

acculturation effects, 114

associated health risks, 199201

developmental programming model, 198199

GWG linkage, 199201, 230

as GWG-related outcome, 7, 15, 216, 217221, 229, 230

infant weight gain patterns and, 216

maternal glucose metabolism and, 200

trends, 6263, 64f

Cholesterol, 97

Chorionicity, in multiple fetus pregnancies, 88, 89

Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults, 16

Cocaine use, 152

Cognitive functioning

GWG outcomes in childhood, 225226

neurodevelopmental outcomes of SGA infants, 222225

Contraceptive services, 9, 270, 276

Corticosteroid-binding globulin, 93

Suggested Citation:"Index." Institute of Medicine and National Research Council. 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press. doi: 10.17226/12584.
×

Cortisol levels, 9394

Cost-effectiveness of strategies for achieving GWG recommendations, 10, 11, 277

Crohn’s disease, 139140

Cutoff points, BMI, 5, 2829, 66, 250251, 256, 259

Cytokines, 85, 95, 98, 138139

D

Dehydroepiandrosterone sulfate, 94

Department of Health and Human Services, recommendations for, 5, 10, 6566, 156, 277278

Depression, 5152, 143144, 185, 186

Developmental programming, 133134, 197199

Diabetes, gestational

childhood developmental outcomes and, 200

evidence for GWG linkage, 175, 176177, 186

fetal growth and, 87, 91

metabolic changes during pregnancy, 9596, 176

placental development and, 8586

risk, 176

trends, 1, 15, 5253, 65, 176

Diet and nutrition

access to healthy foods, 118119, 275

basal metabolic rate and, 137

caloric intake as GWG determinant, 146147, 258

challenges to achieving recommendations for, 264

clinical implementation of GWG guidelines, 3, 274

cultural influences, 114115

dieting practices, 49, 65

effectiveness of GWG advice, 115116, 267

fasting effects on maternal metabolism, 99100, 102

food insecurity, 49, 127, 156

glycemic load as GWG determinant, 148

goals of pregnancy counseling, 11, 276

GWG in older women, 123

information resources for pregnant women, 274

intake patterns and trends, 4749, 65

interpersonal support during pregnancy and, 120

media influence, 113114

metabolic changes during pregnancy and, 9495

nutrient intake as GWG determinant, 147148

preconception counseling, 9, 270, 276

preterm birth risk, 214

prevalence of weight loss attempts during pregnancy, 146

protein supplementation, 207

psychological stress and, 144145

research needs, 65, 102103, 155, 156, 271

significance of, in GWG, 154

for successful pregnancy and lactation, 49

Dietitians, 10, 274

E

Eating disorders, 140141

Eclampsia. See Preeclampsia and hypertensive disorders

Ecological perspective, 111, 275276

Edema, 78

Educational attainment

breastfeeding rates and, 62

GWG and, 125, 126t

physical activity patterns, 5051

trends, 46

Educational interventions

to achieve GWG recommendations, 9, 271, 277

effectiveness of GWG advice, 115116, 267

media campaigns, 114

See also Preconception counseling

Endocrine function, 9394, 97

Epidemiological field model of health behaviors and outcomes, 112

Epigenetic influences

on GWG, 134, 188

on postnatal outcomes, 197

Estrogen, 95, 98, 227228

Exercise. See Physical activity

Extracellular fluid, 78

Suggested Citation:"Index." Institute of Medicine and National Research Council. 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press. doi: 10.17226/12584.
×

F

Family-level determinants of GWG, 119, 120

Fat accretion during pregnancy

clinical significance, 102

depression and, 144

fetal, 89, 91

maternal, 7983, 90

physical activity and, 150

postpartum retention, 80, 182

recommendations for research, 231

Fat-free mass accretion during pregnancy fetal, 90

maternal, 7879, 8083, 90

Federal Human Nutrition Research and Information Management System Database, 156

Fetal development

age of viability, 86

body composition, 8991

determinants, 86

gender differences, 87

growth patterns, 8688

GWG linkages to fetal growth, 206212, 230, 257258

high altitude effects, 87, 91, 117

maternal characteristics associated with, 211212

maternal glucose metabolism and, 199200

maternal health and, 87

measurement and classification, 86, 87

in multiple fetus pregnancy, 8889

neonatal body composition, 215216, 230

neurophysiology, 222226

placental physiology, 9799

placental weight and, 8384

racial/ethnic differences, 87, 206207

research challenges, 86

risks in adolescent pregnancy, 121122

stillbirth risk, 203, 229

toxin exposure, 117118

water content, 85

See also Birth weight;

Preterm birth

Follicle-stimulating hormone, 94

Food. See Diet and nutrition

Free fatty acid, 100

G

Gender differences, fetal growth, 87, 91

Genetic factors in GWG, 128133, 155

Gestational weight gain (GWG)

in adolescents, 121122

amniotic fluid changes and, 9192, 102

among vulnerable populations, 153154, 155

attitudes toward weight gain and, 145146

birth weight and, 198

childhood obesity and, 199201

clinical significance, 243

conceptual models for evaluating determinants of, 111112

conceptual models for evaluating outcomes of, 174175, 196197

cultural influences, 114115

data needs to assess trends, 31t, 66

data sources, 29, 32t, 173174

determinants, 21, 111, 112, 113f, 154155

developmental programming as factor in, 133134

dietary intake and, 146148

distribution among components of, 77

effectiveness of health services counseling, 115116

environmental determinants, 117118

epigenetic influences, 134

fetal body composition and, 90, 91

fetal components, 8691

genetic factors, 128133, 155

hormonal factors, 98, 138

individual patterns of, 7577, 255256

infant health outcomes related to, 7, 8, 175, 202215, 222229

interpersonal determinants, 119120

labor and delivery complications associated with, 179181

lifestyle factors in, 4651

linkage with maternal health risks, 175179

long-term child health outcomes and, 215221, 222225, 230

maternal age and, 124t

maternal body composition and, 7883

maternal components of, 7778

maternal determinants, 120121

Suggested Citation:"Index." Institute of Medicine and National Research Council. 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press. doi: 10.17226/12584.
×

maternal health outcomes related to, 57, 8, 15, 52, 75, 173, 174, 186187, 242

mean ranges, 101, 264

media influence, 113114

metabolic changes and, 9697, 135138

monitoring individual pregnancy, 256, 271272

in multiple fetus pregnancies, 101102

neighborhood/community determinants, 118119, 275276

new recommendations, 23

in older women, 122123

outcomes data, 173174

parity and, 253

physical activity and, 149151

placental changes in, 8386, 98

placental metabolism in, 71

policy factors, 116117

population patterns and trends, 1, 21, 25, 2940, 101

postpartum weight retention and, 41, 42, 44, 45, 187

pre-existing morbidities and, 139143, 173

prepregnancy BMI and, 3133, 3536, 3739f, 72, 75, 102, 135, 136t, 246247, 265t, 266f

psychological factors in, 5152, 143146

research needs, 5, 78, 6566

societal/institutional determinants, 112113

sociodemographic differences, 121127

substance abuse and, 151152

total weight gain, 7275, 101

in unintended pregnancies, 152153

See also Guidelines for weight gain during pregnancy;

Monitoring individual weight changes during pregnancy;

Weight loss or low weight gain during pregnancy

Glomerular filtration rate, 93

Glucocorticoid levels, 133

Glucokinase, 130

Glucose metabolism

fat mass accretion during pregnancy and, 83

fetal development risks, 199200

gestational diabetes risk, 176

GWG and, 176

ketonuria/ketonemia risk, 100, 101

placental transport function, 97

pregnancy course, 95

recommendations for research, 8, 188

See also Insulin and insulin sensitivity

Growth hormone, 94

GSG. See Gestational weight gain

Guidelines for weight gain during pregnancy applicability, 2, 242

challenges to achieving recommendations for, 263264, 270

clinical implementation, 3, 255256

conceptual approach for review and development of, 45, 6f, 14, 1819, 20f, 111, 241242, 249251, 270

data sources in development of, 2, 57, 18, 21, 25, 29, 32t, 249250, 258, 310313t

demographic and clinical trends indicating review and revision, 1, 1416

effectiveness of interventions to promote, 267269

evolution of, 1314

goals for review and revision, 12, 1618

implementation problems, 16, 267

implementation rationale, 11, 276277

new recommendations, 23, 254255, 256259

previous approaches for developing, 243247, 248t

previous strategies for implementation, 266267

promoting public awareness of, 9, 271

recommendations for special populations, 34, 251254, 260

research goals, 12

research needs for future improvements, 89, 11, 277

single target approach, 243

strategies for achieving

recommendations, 910, 11, 260, 270276

trade-offs between maternal and child health in, 242, 243245, 258

H

Health care providers

attitudes toward GWG recommendations, 155156

Suggested Citation:"Index." Institute of Medicine and National Research Council. 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press. doi: 10.17226/12584.
×

charts for monitoring weight changes, 10, 272274

effectiveness of GWG advice, 115116, 267

effectiveness of interventions to promote healthy GWG, 267269

recommendations for data collection, 66, 256

strategies for achieving GWG recommendations, 910, 266267, 271276, 277

See also Preconception counseling

Health field model of health behaviors and outcomes, 111112

Healthy People 2010, 49, 50

Height, maternal, 257

Hepatocyte nuclear factor 4 alpha, 131132

Hepatocyte nuclear factor 1 beta, 131

High altitude effects, 87, 91, 117

Hormonal system

breast cancer and, 227228

changes in pregnancy, 9394, 95

in GWG, 138

placental development and, 85, 9899

research needs, 103

Human placental lactogen, 98

β-Hydroxybutyrate, 100, 101, 102

beta-Hydroxybutyrate, 100, 101, 176

Hyperemesis gravidarum, 140, 179

Hypertension. See Preeclampsia and hypertensive disorders

Hypothalamic-pituitary-adrenal response

in GWG, 133

preterm birth pathogenesis, 213, 214

I

Immune system

GWG–asthma linkage, 226227

preterm birth pathogenesis, 214

Individualized attention to women during pregnancy, 10, 256, 271275

Induced labor, 179180

Infant Feeding Practices Study, 4244, 45, 174175, 310311t

Infant health

Apgar score, 225

birth defect risk, 204

birth weight as risk factor, 198

conceptual approach to review and development of GWG guidelines, 21, 241242

developmental plasticity, 197

developmental programming model of GWG effects, 197199

findings of previous GWG studies, 243247

GWG-related outcomes, 7, 8, 15, 202203, 222230

model of GWG linkage, 196197

mortality, 56, 57, 65, 204206

neonatal body composition, 215216, 230

neurodevelopment, 222226

potential mechanisms of GWG linkage, 197

preterm birth, 212215, 229, 230

recommendations for research, 8, 188, 230231

reduced maternal food intake and, 146

research challenges, 195196

research needs, 259260

weight gain, 216

weight loss or low GWG during pregnancy and, 8, 204205, 212, 229

See also Childhood health;

Childhood obesity;

Fetal development;

Large-for-gestational age infants;

Low-birth weight babies;

Small-for-gestational age infants

Inflammatory bowel disease, 139140

Inflammatory response

metabolic changes during pregnancy, 9596, 103

nutrient utilization and, 102

placental development and, 85

placental regulation, 71

preterm birth pathogenesis, 214

syncytiotrophoblast microparticles in, 99

Influence of Pregnancy Weight on Maternal and Child Health,17

Insulin and insulin sensitivity

adiponectin levels and, 94, 139

fat mass accretion during pregnancy and, 83

in fetal development, 89

fetal development risks, 199200

GWG and, 9697, 138

hypothalamic-pituitary-adrenal hyperactivity and, 133

Suggested Citation:"Index." Institute of Medicine and National Research Council. 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press. doi: 10.17226/12584.
×

ketonuria/ketonemia risk, 100

leptin and, 139

long-term outcomes of GWG, 185

metabolic changes during pregnancy, 9596

patterns of, 96

placental regulation, 71, 85, 98

risk of gestational diabetes, 176, 199

Intelligence quotient, 222, 223, 224, 226

Intracellular water, 78

Intrauterine growth restriction, 207

Iron-deficiency anemia, 214

K

Ketonuria/ketonemia, 8, 100101, 102, 176, 257

L

Labor and delivery

GWG linkage with complications of, 179181

induction of labor, 179180

length of labor, 180

LGA babies, 206

See also Cesarean delivery

Lactation

dietary intake for, 49

GWG and, 181182

Large-for-gestational age infants

causes, 59, 65

definition, 7, 86, 206

delivery complications, 206

genetic risk, 129, 130

as GWG-related outcome, 7, 209, 228230, 257258

GWG-related risk among obese women, 72

placental weight and, 84

trends, 59, 60t, 65

Leptin, 98, 138139

Leukemia, 227

LGA. See Large-for-gestational age infants

Life-course perspective, 112, 196197

Lipid metabolism

changes in pregnancy, 95

placental regulation, 98

placental transport function, 97

Low-birth weight babies

causes, 57

GWG and, 208209

mortality risk, 57

trends, 57, 65

See also Birth weight

Low-income women

food insecurity, 49, 127

GWG patterns and trends, 3637

need for individualized attention during pregnancy, 10, 276

recommendations for research on guideline implementation, 10, 277278

strategies for implementing GWG guidelines, 276

Lupus erythematosus, 139140

Luteinizing hormone, 94

M

Macrosomia, 57, 200, 207, 209

Marital status, 119120, 155

Maternal health

conceptual approach to review and development of GWG guidelines, 21, 241242

conceptual framework for studying GWG outcomes, 174175

fat accretion during pregnancy, 7983

fetal body composition and, 91

fetal growth and, 87

findings of previous GWG studies, 243247

GWG among obese women and, 72

GWG-related risks, 57, 8, 15, 52, 75, 173, 186187

long-term outcomes, 259

metabolic changes during pregnancy, 9498

mortality, 5556, 65, 181, 187

physiologic changes during pregnancy, 9294

postpartum risks, 175

pre-existing morbidities related to GWG, 139143

prenatal risks, 175

protein accretion during pregnancy, 7879

recommendations for research, 188

Suggested Citation:"Index." Institute of Medicine and National Research Council. 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press. doi: 10.17226/12584.
×

research needs, 259260

risks for older women, 122123

total body water accretion during pregnancy, 78

See also Cesarean delivery;

Diabetes, gestational;

Postpartum health outcomes;

Preeclampsia and hypertensive disorders

Maternal Nutrition and the Course of Pregnancy,13, 243

Media influence of health behavior, 113114

Mental health and psychosocial functioning evidence for GWG linkage to outcomes in, 175, 178179, 187

GWG determinants, 143146, 154

long-term outcomes of GWG, 186

patterns and trends, 5152

recommendations for research, 8, 156, 188

social support as GWG factor, 145

weight gain attitudes as GWG determinant, 145146

See also Depression;

Stress

Metabolic changes during pregnancy

GWG determinants, 135138

ketonuria/ketonemia, 100101

maternal, 9497

placental–maternal interaction, 99100

research needs, 103

weight loss and, 99100

Metabolic syndrome, 133134

Methamphetamine use, 152

Migrant workers, 153

Military personnel, 153

Monitoring individual weight changes during pregnancy

BMI measurement, 66

challenges to achieving recommendations, 264

charts for, 10, 272274

rationale, 264266

recommendations for health care providers, 66, 255256

Mortality

causal classification, 181

infant, 56, 57, 65, 202f, 204206

maternal, 5556, 65, 181, 187

research needs, 56, 188

Multiple fetus pregnancy

birth weight outcomes of GWG, 7677

birth weight trends and, 57

fetal development patterns, 8889

GWG patterns, 7677, 101102, 143

placental weight in, 84

recommendations for research, 260

recommendations for weight gain during, 4, 252, 260

total GWG patterns, 7375

N

National Center for Clinical Excellence, 243

National Heart, Lung, and Blood Institute, 16, 29

National Institutes of Health, recommendations for, 5, 79, 102103, 155, 188, 230231, 260

Natural disasters, 118

Neurodevelopment, 222226, 229, 230

Nitrogen metabolism, 95

Nutrition During Lactation,15

Nutrition During Pregnancy,1314, 15, 195, 241, 264

Nutrition During Pregnancy and Lactation: An Implementation Guide,910, 14, 15, 266267, 270271

Nutrition Services in Perinatal Care,266, 271

O

Obesity

postpartum weight retention and subsequent risk for, 182, 184, 187

See Overweight and obese women

Obesogenic environment, 112

Obstetrical procedures

birth weight trends and, 57, 65

Oligohydramnios, 92

Overweight and obese women

adolescent pregnancy as risk factor, 122

bariatric surgery implications for pregnancy, 141142

body composition changes in pregnancy, 8081, 83

body composition of neonates of, 215

cesarean delivery risk, 5455

classification, 5, 29

dieting practices, 49

epidemiology, 15

Suggested Citation:"Index." Institute of Medicine and National Research Council. 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press. doi: 10.17226/12584.
×

fasting effects during pregnancy, 99100

fetal growth outcomes, 207, 208

findings of previous GWG studies, 246

food insecurity and, 127

GWG patterns, 3536, 7273, 76, 77, 101

health risks in pregnancy, 72, 173

hypertensive disorder risk in pregnancy, 177

infant mortality risk, 204205

mortality risk, 56

outcomes of multiple fetus pregnancies, 77

placental development in, 85

postpartum weight retention, 44, 45

preconception bariatric surgery, 142, 271

rate of GWG, 255

recommendations for data collection, 66

recommendations for GWG, 3, 7, 250251, 253, 259

recommendations for research, 7, 102

recommended weight gain chart, 274f

research needs, 56

risks for older pregnant women, 122123

severity prevalence, 27

trends, 1, 15, 2526, 6364

weight loss during pregnancy, 78

See also Childhood obesity

Oxygen consumption, 93

P

Parenchyma, 8485

Parity, 253

Pattern(s) of weight gain, 255256

child health outcomes, 231

new recommendations, 2t, 255

normal rate, 255

recommendations for research, 231

singleton pregnancies, 7576

statistical curve, 75

twin pregnancies, 7677

Pediatric Nutrition Surveillance System, 310311t

Physical activity

challenges to achieving recommendations for, 264

clinical implementation of GWG guidelines, 3, 274275

data sources, 51

goals of pregnancy counseling, 11, 276

as GWG determinant, 149151, 154

information resources for pregnant women, 274275

media influence, 114

neighborhood determinants of GWG, 119

patterns and trends among women, 4951, 65

preconception counseling, 276

pregnancy and birth outcomes, 148149

recommended levels, 49, 148, 275

research needs, 155, 275

sociodemographic differences, 5051

Physical Activity Guidelines Advisory Committee, 275

Placenta

composition, 8586

fetal growth and, 97, 102

function in pregnancy, 71, 97

functional changes in pregnancy, 85

growth during pregnancy, 84

hormone production, 9899, 103

insufficiency, 84

lipid content, 86

maternal metabolism and, 9798

normal development, 84

structural changes in pregnancy, 8485

transport function, 97

weight changes during pregnancy, 8384

Plasma volume, 78, 93, 94, 102

Policy formulation, 116117

Polyhydramnios, 92

Postpartum health outcomes

depression, 185

GWG-associated risks, 175, 181182, 185

long-term risks, 185187

obesity risk, 182, 184, 187

See also Postpartum weight retention

Postpartum weight retention

body composition changes, 8183

counseling goals, 11, 274, 276

data sources, 41, 42, 258259

definition, 182

fat accretion patterns, 80, 182

food insecurity during pregnancy and, 127

GWG and, 41, 42, 44, 45, 102, 182184, 187, 246247, 258

Suggested Citation:"Index." Institute of Medicine and National Research Council. 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press. doi: 10.17226/12584.
×

long-term outcomes, 258

measurement, 4041

obesity risk, 182, 184, 187

patterns and trends, 4146

psychological stress as risk factor, 144

recommendations for research, 5, 7, 6566

risk for adolescent mothers, 122

Preconception counseling

effectiveness, 271

effectiveness of GWG advice, 115116

goals, 11, 270271, 276

recommendations for, 9, 187, 277

scope, 9, 270, 271

Preeclampsia and hypertensive disorders evidence for GWG linkage, 175, 177178, 186, 187, 242

GWG-related risk among obese women, 72

recommendations for research, 8, 188

risk, 177

trends among pregnant women, 1, 5354, 65

Pregnancy Nutrition Surveillance System, 3637, 40, 41, 4546, 312313t

Pregnancy Risk Assessment Monitoring System, 3336, 40, 312313t

Prepregnancy BMI

adolescent cutoff values, 251252

adolescents, recommendations for, 34

attitudes toward weight gain as GWG determinant, 146

birth defect risk, 204

birth weight outcomes, 73f, 74, 207, 210211

body composition changes in pregnancy and, 8083

challenges to achieving recommendations for, 263264

classification, 5, 2829, 66, 250251

clinical significance, 7, 13, 259

cutoff points, 23, 5, 250251, 256, 259

data sources, 29

dietary intake as GWG determinant and, 147

fetal body composition and, 91

GWG and, 3133, 3536, 3739f, 72, 75, 102, 135, 136t, 265t, 266f

GWG recommendations as proportion of, 243

hypertensive disorder risk, 177

individual patterns of GWG and, 7576

maternal health outcomes and, 187

maternal height and, 257

neonatal health outcomes, 202

obesity prevalence, 28

physical activity as GWG determinant and, 150151

placental development and, 85

population distribution patterns, 2627t, 30t

postpartum weight retention and, 246247

preterm birth risk, 213

rate of GWG, 255

social support as GWG determinant and, 145

stillbirth risk, 203

strategies for achieving recommendations, 270271

trends, 1, 2528, 263

women of short stature, recommendations for, 3

Preterm birth

asthma risk, 226

causes, 60

frequency, 87

as GWG-related outcome, 7, 212215, 229, 230

long-term neurodevelopmental outcomes, 224225

morbidity risks associated with, 212

pathophysiology, 213214

prepregnancy BMI and, 213

racial/ethnic differences, 60, 61f

trends, 60, 61f,65

Prison population, 154

Progesterone, 95, 98

Prolactin, 94

Promoting Health: Intervention Strategies from Social and Behavioral Sciences, 275

Protein accretion during pregnancy

fetal, 90

maternal, 7879, 83

Protein metabolism, 95

Protein supplements, 207

Public awareness of GWG guidelines, 9, 271

Suggested Citation:"Index." Institute of Medicine and National Research Council. 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press. doi: 10.17226/12584.
×

R

Racial/ethnic subgroups

acculturation effects on dietary practices, 114115

birth weight patterns, 57, 58f

BMI distribution patterns and trends, 2627t

breastfeeding rates, 62

childhood obesity, 63

depression risk, 52f, 143

fetal development, 87

fetal growth measurement, 206207

GWG patterns and trends, 3031, 34f, 3637, 40f, 123125, 126t, 253

individual patterns of GWG, 76

infant mortality, 56, 57f

large-for-gestational age births, 59, 60t

maternal mortality patterns, 55

need for individualized attention during pregnancy, 10, 276

obesity risk, 26, 27, 28, 64

physical activity patterns, 50

postpartum weight retention patterns and trends, 41, 42t, 43f, 4546

preterm births, 60, 61f

prevalence of weight loss attempts during pregnancy, 146

recommendations for research on guideline implementation, 10, 277278

recommendations for weight gain during pregnancy, 4, 253, 260

research needs, 4, 1617, 156, 188, 260

small-for-gestational age births, 59

sociodemographic trends, 1, 46, 64

weight-related predictors and outcomes and, 65

Reactive oxygen species, 214

Renal function, 93

Research needs

birth data, 5, 66

determinants of GWG, 155156, 275276

dietary practices, 65, 102103, 156, 271

for future guideline development, 89, 277

health care provider attitudes and

beliefs, 155156

hormonal factor in maternal metabolism regulation, 103

infant and child health outcomes, GWG-related, 8, 230231, 259260

longer term outcomes, 259

low GWG or weight loss during pregnancy, 78

maternal characteristics associated with GWG, 8, 188

maternal health outcomes of GWG, 188, 259260

maternal mortality, 56, 188

obesity during pregnancy, 7, 102

physical activity behaviors and outcomes, 156, 275

racial/ethnic subgroups, 4

for review of GWG guidelines, 1617

strategies to achieve GWG

recommendations, 10, 277278

surveillance of GWG and postpartum weight retention, 5, 6566

weight loss or low GWG, 103

Respiratory function, maternal, 93

S

Screening

depression, 5152

See also Monitoring individual weight changes during pregnancy;

Surveillance of GWG and postpartum weight retention

Short stature, women of recommendations for weight gain during pregnancy, 3, 251, 260

risk of negative pregnancy outcomes, 3, 251

Small-for-gestational age infants

definition, 7, 59, 86, 206

developmental programming effects, 198

genetic risk, 129, 130

as GWG-related outcome, 7, 209, 210211, 228230, 257258

GWG-related risk among obese women, 72

health complications associated with, 206

long-term neurodevelopment, 222225

placental weight and, 84

trends, 59

Smoking, 46, 91, 151, 253254

Snack foods and soft drinks, 48

Suggested Citation:"Index." Institute of Medicine and National Research Council. 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press. doi: 10.17226/12584.
×

Social marketing, 114, 276

Sociocultural context of health behaviors and outcomes

assessment for obstacles to healthy GWG, 272274

conceptual models, 112

family and partner factors, 119120

GWG determinants, 112117

neighborhood/community factors, 118119, 275276

research needs, 155, 275276

social support factors, 145

Sociodemographic trends, 1, 15, 46, 47t, 6365

Socioeconomic status, 125, 127, 188.

See also Low-income women

Sodium levels, 93

Special populations

GWG among, 153154, 155

incarcerated women, 154

migrant workers, 153

military personnel, 153

See also Adolescent pregnancy;

Low-income women;

Multiple fetus pregnancy;

Racial/ethnic subgroups;

Short stature, women of

Special Supplemental Food Program for Women, Infants, and Children, 117

Stillbirth, 203, 229

Stress

developmental programming, 133

GWG and, 144145

natural and man-made disasters, 118

physiology, 133

Stretch marks, 179

Substance use, 151152

Surveillance of GWG and postpartum weight retention

individualized attention, 10

recommendations for research, 5, 6566

Syncytiotrophoblast microparticles, 99

T

Teenage mothers. See Adolescent pregnancy

Thyroid changes in pregnancy, 94

Thyroxine-binding globulin, 94

Title V programs, 1617

Total body nitrogen, 8283

Total body potassium, 78, 79, 8083, 90

Total body water accretion, 78, 8083, 90, 93

Total energy expenditure, 135138, 150151

Total GWG

singleton pregnancies, 7273

triplet and quadruplet pregnancies, 75

twin pregnancies, 7375

Toxin exposure, 117118

Twins. See Multiple fetus pregnancy

U

Unintended pregnancy, 152153

Unmarried mothers, 46, 6465

V

Violence exposure, 119, 155

W

Weight loss or low weight gain during pregnancy

among obese women, 7273

birth defect risk, 204

childhood diabetes risk, 201

dieting practices among pregnant women, 49, 65

fasting metabolism, 99100, 102

fetal growth and, 207, 208, 210, 229

health risks for obese women, 72

infant mortality risk, 204205

maternal body composition outcomes, 103

preterm birth as outcome of, 212, 229

prevalence of weight loss attempts, 146

psychological stress and, 145

recommendations for research, 78, 103

stillbirth risk, 203

World Health Organization, 23, 5, 29, 66, 250251, 259

Suggested Citation:"Index." Institute of Medicine and National Research Council. 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press. doi: 10.17226/12584.
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As women of childbearing age have become heavier, the trade-off between maternal and child health created by variation in gestational weight gain has become more difficult to reconcile. Weight Gain During Pregnancy responds to the need for a reexamination of the 1990 Institute of Medicine guidelines for weight gain during pregnancy. It builds on the conceptual framework that underscored the 1990 weight gain guidelines and addresses the need to update them through a comprehensive review of the literature and independent analyses of existing databases. The book explores relationships between weight gain during pregnancy and a variety of factors (e.g., the mother's weight and height before pregnancy) and places this in the context of the health of the infant and the mother, presenting specific, updated target ranges for weight gain during pregnancy and guidelines for proper measurement. New features of this book include a specific range of recommended gain for obese women.

Weight Gain During Pregnancy is intended to assist practitioners who care for women of childbearing age, policy makers, educators, researchers, and the pregnant women themselves to understand the role of gestational weight gain and to provide them with the tools needed to promote optimal pregnancy outcomes.

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