Leveraging Action to Support Dissemination of the Pregnancy Weight Gain Guidelines: Workshop Summary (2013)

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1 Introduction1 BACKGROUND AND CHARGE TO THE COMMITTEE Since 1990, when the last guidelines for weight gain during pregnan- cy were issued, the average body weight of women entering their childbearing years has increased considerably, with a greater percentage of these women now classified as overweight or obese. Women of childbearing age are also more likely to have chronic conditions such as high blood pressure or diabetes and to be at risk for poor maternal and child health outcomes. All of these factors increase the likelihood of poor pregnancy outcomes for women and their infants. In light of this situa- tion and the resulting need to address the changing lifestyle and demo- graphic factors that affect weight gain during pregnancy, in 2009 the In- stitute of Medicine (IOM) and the National Research Council (NRC) released the report Weight Gain During Pregnancy: Reexamining the Guidelines. That report recommended a set of revised pregnancy weight gain guidelines directed at four different categories of women: normal weight, underweight, overweight, and obese. The 2009 report also identified evidence that preconception counsel- ing and certain practices, such as charting weight gain trends during pregnancy, can lead to risk-reducing behaviors as well as to improved 1 The planning committee’s role was limited to planning the workshop, and the workshop summary has been prepared by the workshop rapporteurs as a factual summary of what occurred at the workshop. Statements, recommendations, and opinions expressed are those of individual presenters and participants and are not necessarily endorsed or veri- fied by the Institute of Medicine, and they should not be construed as reflecting any group consensus. 1 

2 DISSEMINATION OF THE PREGNANCY WEIGHT GAIN GUIDELINES choices concerning nutrition and physical activity. However, many women still do not receive adequate pre- or post-conception advice about weight and about pregnancy weight gain. Among the barriers to women maintaining more appropriate weight during pregnancy are that many women and even health professionals remain unaware of the recommended pregnancy weight guidelines and that even those women who are aware of the guidelines may find it diffi- cult to obtain informed guidance that can help them achieve those guide- lines. Developing information resources that are evidence-based and easy to use could help health professionals as well as community leaders in their efforts to assist women achieve a healthy pre-pregnancy weight and to gain within recommended ranges during pregnancy. Although dissem- ination materials were developed following the publication of the earlier 1990 IOM pregnancy weight gain guidelines, those materials are no longer adequate to address the challenges faced by women today. Therefore, in response to the need to enhance the dissemination of the revised pregnancy weight gain guidelines in the 2009 report, the Ma- ternal and Child Health Bureau (MCHB) of the Health Resources and Services Administration (HRSA) of the Department of Health and Hu- man Services asked the IOM and the NRC to develop a series of infor- mation resources to support guidance based on the recommendations of that report. The information resources were to be aimed at three major audiences: health care providers, public health agencies, and community- based organizations and women’s groups. The project team, which worked with the sponsoring organizations, was asked to identify up to five key partnership groups within each audience that could collaborate in the creation of a core set of materials (an “information toolbox”) which were to include print, electronic, and possibly video resources. In addition, a planning committee was asked to organize a workshop to pre- sent the toolbox of resource materials and to discuss other issues related to ensuring a wide dissemination of the pregnancy weight gain guidelines (see Appendix D for the pregnancy weight gain guidelines dissemination Statement of Task). On March 1, 2013, the IOM and the NRC convened a 1-day work- shop, in Washington, DC, to engage interested stakeholders, organiza- tions, and federal agencies in a discussion of issues related to encourag- ing behavior change that would reflect the updated guidelines on weight gain during pregnancy. The workshop, Leveraging Action to Support Dissemination of Pregnancy Weight Gain Guidelines, was attended by health professionals; women’s health organizations and associations; providers from the Special Supplemental Program for Women, Infants, 

INTRODUCTION 3 and Children (WIC); representatives from other federal agencies, includ- ing the Center for Nutrition Policy and Promotion and the National Insti- tute of Food and Agriculture, both within the U.S. Department of Agri- culture, and the National Institutes of Health; and a number of individu- als who joined by webcast. The workshop featured conceptual products as well as products de- veloped for dissemination, panel discussions on ways to facilitate and support behavior change to achieve healthy weight pre- and post- pregnancy, a town hall discussion on how to put the weight gain guide- lines into action, and a presentation on innovative ways to reach women and implement change. This document summarizes the keynote address and the various presentations and discussions from the workshop, high- lighting issues raised by presenters and attendees. Dr. Kathleen Rasmussen, professor of nutrition in the Division of Nutritional Sciences at Cornell University and chair of the IOM Commit- tee on Implementation of the IOM Pregnancy Weight Guidelines, opened the workshop. She welcomed those participating in person as well as those participating over the Internet, and she introduced the two keynote speakers, Michael Lu and Jeanne Conry. Lu is currently the associate administrator of MCHB/HRSA. His experience includes maternal and child health research, practice, and policy. An obstetrician by training, Lu is recognized for his research on racial and ethnic disparities in birth outcomes. Lu was a member of the Committee to Reexamine IOM Preg- nancy Weight guidelines, which in 2009 produced the most recent guide- lines on appropriate weight gain during pregnancy. Conry is associate physician-in-chief at the Kaiser Permanente Med- ical Group in Sacramento-Roseville, California. She also is the president- elect of the American Congress of Obstetricians and Gynecologists. Conry’s clinical interests include well-women health care and preconcep- tion health care. She currently oversees health and wellness activities, focusing on the health and well-being of Kaiser members and employees and members of the Sacramento community through focused wellness activities.