Advisers to the Nation on Science, Engineering, and Medicine

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. Wm. A. Wulf 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 responsibility 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 National 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. Wm. A. Wulf are chair and vice chair, respectively, of the National Research Council.

www.national-academies.org

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This volume summarizes a one and a half day workshop convened in May 2006 that reviewed U.S. trends in maternal weight (prior to, during, and after pregnancy) among different populations of women; examined the emerging research findings related to the complex relationship of the biological, behavioral, psychological, and social interactions that affect maternal and pregnancy weight on maternal and child health outcomes; and discussed interventions that use this complex relationship to promote appropriate weight during pregnancy and postpartum.

Given the unprecedented environment in the United States in which two-thirds of the adult population meet the criteria for being overweight or obese, the implications for women in the reproductive age period are unique in the history of the country. The concerns for maternal and infant health are real. The questions and answers tackled by committee members and workshop participants were not easy. Nevertheless, having an opportunity to explore what is known, examine the gaps in knowledge, and explore what to do now and in the future builds a pathway for further inquiry and action. This report summarizes the workshop proceedings and highlights key themes that deserve further attention.

The overarching goal of the workshop was for participants to describe what is known about recent trends in maternal weight gain and the impact of maternal weight during pregnancy on the health of mothers and their children. The workshop provided a valuable opportunity to assess trends that have occurred since the publication of an earlier study by the Institute of Medicine (IOM), which included guidelines for recommended weight

gain during pregnancy.¹ This report seeks to inform the efforts of Title V maternal and child health programs to foster adherence to the IOM recommendations for recommended weight gain during pregnancy as well as contribute to understanding whether there is a substantial need to reexamine these recommendations in light of recent demographic and health trends.

The genesis of the workshop began with a proposal that was reviewed and refined by the National Research Council-IOM Board on Children, Youth, and Families and the IOM Food and Nutrition Board. The Maternal and Child Health Bureau of the U.S. Department of Health and Human Services subsequently funded an activity that included the formation of a program committee that met once to help plan and convene the workshop. The efforts of the planning committee members and the workshop participants fostered a collaboration that began the unraveling of a challenging and multifaceted area of study.

We are particularly grateful for the contributions of the expert presenters, speakers, and discussants who contributed to the meeting (see the Appendix for the workshop agenda and list of participants). Special appreciation also goes to the members of the planning committee, who volunteered their time and intellectual efforts to shape the workshop program and identify themes and contributors. In addition, we give special thanks to Margaret Feerick, who prepared a comprehensive draft of the workshop report; Leslie Sim, who directed the planning and workshop preparation and the production of the final publication; and Wendy Keenan, who assisted with preparation of the workshop and the final report. Although the workshop report was prepared by the committee, it does not represent findings or recommendations that can be attributed to the committee members.

This workshop report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the Report Review Committee of the National Research Council. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the charge. The review comments and draft manuscript remain confidential to protect the integrity of the process. We thank the following individuals for their review of this report: Esa M. Davis, Department of Family Medicine-Research Division, Case Western Reserve University/ University Hospital of Cleveland; Calvin J. Hobel, Department of Obstet-

rics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA; Christine M. Olson, Division of Nutritional Sciences, Cornell University; Magda G. Peck, Department of Pediatrics, University of Nebraska Medical Center; Kathryn Peppe, Program and Policy Office, Association of Maternal and Child Health Programs, Washington, DC; Nicolas Stettler, Department of Pediatrics and Epidemiology, The Children’s Hospital of Philadelphia; and Brian Wrotniak, Department of Pediatrics and Epidemiology, The Children’s Hospital of Philadelphia.

Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the content of the report nor did they see the final draft of the report before its release. The review of this report was overseen by Thomas DeWitt, Division of General and Community Pediatrics, Cincinnati Children’s Hospital Medical Center. Appointed by the National Research Council, he was responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authors and the institution.

Maxine Hayes, Chair

Committee on the Impact of Pregnancy Weight on Maternal and Child Health

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