Regarding the third question—What should the future look like?—several options can be considered:

•     Modify current prenatal approaches to reverse the current pattern of prenatal care visits. Currently, visits tend to be backloaded so that women are seen more frequently toward the end of pregnancy and less frequently in the beginning. Changing this approach so that women are seen more frequently at the beginning of pregnancy could be considered, especially in light of data showing that once women exceed weight gain guidelines, it is difficult to get them back within the recommendations.

•     Classify pregnancies in overweight and obese women as high risk. This might open the door for more intensive and frequent contact.

•     Remember normal-weight women. Given the link between excessive weight gain in normal-weight women and their risk of obesity and overweight later in life, it is important to ensure that programs are also available for this group. Most of the ongoing research is targeting overweight and obese women in pregnancy, but programs to help normal weight women are also valuable.

•     Provide multidisciplinary training for practitioners in methods to prevent excessive gestational weight gain and in strategies that encompass the life-course approach.

•     Ensure financial coverage to support such programs.

QUESTION-AND-ANSWER SESSION

Catalano moderated the question-and-answer session following the presentations. He opened the discussion by asking about the accuracy of pre-pregnancy weights reported by Fit for Delivery study participants. Phelan replied that, contrary to her expectations, the reported weights were reasonably accurate. The study team compared self-reported pre-pregnancy weight and chart-abstracted measured weights, and the correlation was 0.96.

Andrea Sharma stated that she is using data from the Pregnancy Risk Assessment Monitoring System to conduct analyses of serial measured weights during pregnancy. The analysis is showing that first trimester gains are much higher than the assumed five-pound range. She wondered what could be done to catch those women early, regardless of their BMI if they are already above the first trimester weight gain threshold, and get them into nutrition counseling. Phelan strongly agreed and stated that



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