Leveraging Action to
Support Dissemination of the
Pregnancy Weight Gain Guidelines

Workshop Summary

Committee on Implementation
of the IOM Pregnancy Weight Gain Guidelines

Board on Children, Youth, and Families
Food and Nutrition Board

Anne Brown Rodgers and Ann L. Yaktine, Rapporteurs



Washington, D.C.


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Committee on Implementation of the IOM Pregnancy Weight Gain Guidelines Board on Children, Youth, and Families Food and Nutrition Board Anne Brown Rodgers and Ann L. Yaktine, Rapporteurs

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THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001 NOTICE: The workshop that is the subject of this workshop summary was ap- proved by the Governing Board of the National Research Council, whose mem- bers are drawn from the councils of the National Academy of Sciences, the Na- tional Academy of Engineering, and the Institute of Medicine. This activity was supported by Contract/Grant No. HHSH250200976014I be- tween the National Academy of Sciences and the Maternal and Child Health Bureau of the U.S. Department of Health and Human Services (HHS), and Con- tract/Grant No. HHSP233201000561P between the National Academy of Sci- ences and the Office on Women’s Health of HHS. The views presented in this publication do not necessarily reflect the views of the organizations or agencies that provided support for the activity. International Standard Book Number-13: 978-0-309-28966-5 International Standard Book Number-10: 0-309-28966-1 Additional copies of this workshop summary are available for sale from the Na- tional Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu. Copyright 2013 by the National Academy of Sciences. All rights reserved. Printed in the United States of America The serpent has been a symbol of long life, healing, and knowledge among al- most all cultures and religions since the beginning of recorded history. The ser- pent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin. Suggested citation: IOM (Institute of Medicine) and NRC (National Research Council). 2013. Leveraging action to support dissemination of the pregnancy weight gain guidelines: Workshop summary. Washington, DC: The National Academies Press.

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The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. C. D. Mote, Jr., is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the re- sponsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the Nation- al Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. C. D. Mote, Jr., are chair and vice chair, respectively, of the National Research Council. www.national-academies.org

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COMMITTEE ON IMPLEMENTATION OF THE IOM PREGNANCY WEIGHT GAIN GUIDELINES1 KATHLEEN M. RASMUSSEN (Chair), Division of Nutritional Sciences, Cornell University LINDA BEARINGER, Center for Adolescent Nursing Leadership, School of Nursing, University of Minnesota SARAH S. BROWN, The National Campaign to Prevent Teen and Unwanted Pregnancy PATRICK M. CATALANO, Department of Obstetrics and Gynecology, Case Western Reserve University DEBBIE I. CHANG, Nemours, Policy and Prevention ESA M. DAVIS, Department of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh MARVIN E. GOLDBERG, Department of Marketing, Smeal College of Business, Pennsylvania State University RAFAEL PÉREZ-ESCAMILLA, Office of Community Health, School of Public Health, Yale University ANNA MARIA SIEGA-RIZ, Department of Epidemiology, School of Public Health, University of North Carolina, Chapel Hill IOM Staff ANN L. YAKTINE, Senior Program Officer KAREN CAMPION, Research Assistant WENDY KEENAN, Program Associate 1 Institute of Medicine planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published workshop summary rests with the workshop rapporteurs and the institution. v

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REVIEWERS This workshop summary has been reviewed in draft form by individ- uals chosen for their diverse perspectives and technical expertise, in ac- cordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published workshop summary as sound as possible and to en- sure that the workshop summary meets institutional standards for objec- tivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integri- ty of the process. We wish to thank the following individuals for their review of this workshop summary: Lisa Bodnar, Department of Epidemiology, University of Pittsburgh Patrick M. Catalano, Department of Obstetrics and Gynecology, Case Western Reserve University Susan Gennaro, William F. Connell School of Nursing, Boston College Patricia C. MacNeil, Center for Nutrition Policy and Promotion, U.S. Department of Agriculture Andrea Sharma, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention Catherine Spong, Pregnancy and Perinatology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development Although the reviewers listed above have provided many construc- tive comments and suggestions, they did not see the final draft of the workshop summary before its release. The review of this workshop summary was overseen by Nancy E. Adler, University of California, San Francisco. Appointed by the Institute of Medicine, she was responsi- ble for making certain that an independent examination of this workshop summary was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this workshop summary rests entirely with the rap- porteurs and the institution. vii

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CONTENTS 1 INTRODUCTION 1 Background and Charge to the Committee, 1 2 KEYNOTE ADDRESSES 5 Michael Lu, Health Resources and Services Administration, 5 Jeanne Conry, Kaiser Permanente Medical Group and President-Elect of the American Congress of Obstetricians and Gynecologists, 10 Question-and-Answer Session, 12 References, 18 3 SESSION 1: COMMUNICATING THE PREGNANCY WEIGHT GAIN GUIDELINES 19 Kathleen Rasmussen, Cornell University, 19 Anna Maria Seiga-Riz, University of North Carolina, Chapel Hill, 22 Question-and-Answer Session, 24 Reference, 24 4 SESSION 2: PANEL DISCUSSION: WHAT ARE WE DOING TO SUPPORT BEHAVIOR CHANGE? 31 Panel Discussion, 31 Question-and-Answer Session, 38 5 SESSION 3: IMPLEMENTING THE GUIDELINES 41 Marta Kealey, Food and Nutrition Service, USDA, 41 Michele Lawler, Maternal and Child Health Bureau, HRSA, 43 Suzanne Phelan, California Polytechnic State University, 47 Question-and-Answer Session, 52 References, 54 6 PRESENTATION ON THE FIRST THOUSAND DAYS PROGRAM 55 Richard Sass, Chairman, Contact Wellness Foundation, 55 ix

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x CONTENTS 7 SESSION 4: COLLABORATING FOR ACTION 57 Leading Implementation of the Guidelines: Action Steps, 57 Facilitated Conversation, 58 8 FINAL THOUGHTS 65 Kathleen Rasmussen, Cornell University, 65 APPENDIXES A WORKSHOP AGENDA 69 B WORKSHOP PARTICIPANTS 73 C SPEAKER BIOGRAPHIES 77 D WORKSHOP STATEMENT OF TASK 85