Explain the weight gain recommendations for pregnancy shown in the box on page 44:

• Adequate gain reduces the risk of low birth weight.

• Aim for a steady rate of weight gain: weight gain in early pregnancy goes mainly toward the mother's tissues (such as placenta, amniotic fluid, uterus, expanded blood volume, energy reserves) to support the baby's growth; weight gain in later pregnancy goes mainly toward the growth of the baby During the second and third trimesters, the recommended rate of gain is slightly more than 1 lb (0.5 kg) per week for women with low prepregnancy BMI, approximately 1 lb (0.5 kg) per week for women with moderate BMI, and 2/3 lb (0.3 kg) per week for women with high BMI.

Identify factors that may call for a higher weight gain during pregnancy (low prepregnancy weight for-height status, young age [82 years post menarche], African-American background, multiple gestation) or for weight gain at the lower end of the range (short maternal height).

Use the appropriate weight gain chart to show the range and rate of weight gain recommended.

Jointly agree upon a total weight gain goal, focusing on a range rather than a single number.

Show the woman how to plot her prepregnancy weight (if it is available) and her current weight on the weight gain chart. Offer her a chart and help her start to use it. Suggest: Please bring it with you next time.

Use the current measured weight as a baseline, and jointly set a realistic weight goal for the next visit.

Explain that: Weight can go up and down. Continue to eat well even if you think you're gaining weight too fast.