From the Journals

Weight gain in pregnancy: Too much and too little can be harmful

Publish date: June 6, 2017

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How to combat the ‘eating for two’ message

The findings by Goldstein et al. raise the question: Can clinicians change the amount of weight women gain in pregnancy?

Behavioral economics has demonstrated that loss avoidance is a stronger motivator than the promise of a gain. So rather than positive incentives for adherent behavior, emphasizing how a pregnant woman’s nonadherent behavior will lead to greater harm to her developing baby may be more effective in changing behavior. Sending a message that gaining too much weight could potentially lead to an increased risk of obesity in her child and that gaining too little weight could lead to growth restriction in the child may be better than a simple positive message that eating well leads to greater health for both the mother and infant.

Given the overwhelming environment of constant advertising of high-caloric foods that pregnant women are exposed to, such reminders need to be delivered persistently and frequently – perhaps with the enhanced messaging capacity of social media and public health campaigns.

Aaron B. Caughey, MD, PhD, is in the department of ob.gyn. at Oregon Health & Science University, Portland. He reported having no relevant financial disclosures. These remarks are adapted from an accompanying editorial (JAMA 2017;317[21]:2175-6).

FROM JAMA

Both high and low gestational weight gain, compared with the recommended weight gain, are associated with increased risks of adverse perinatal outcomes, according to a systematic review and meta-analysis.

Researchers reviewed 302 studies that categorized women by their prepregnancy body mass index and followed them for gestational weight gain, as well as maternal and neonatal outcomes. They included in their meta-analysis 23 cohort studies involving 1,309,136 pregnancies in 10 countries. Only studies assessing singleton pregnancies in women aged 18 years and older were included.

^{Stephanie Horrocks/iStockphoto}

Gestational weight gain was below 2009 Institute of Medicine guidelines in 23% of these pregnancies, within recommended guidelines in 30%, and above recommended guidelines in 47%, said Rebecca F. Goldstein, MBBS, of Monash University, Victoria, Australia, and her associates.

Compared with the recommended gestational weight gain, low weight gain was associated with a 5% higher risk of a small-for-gestational-age (SGA) neonate and a 5% higher risk of preterm birth. However, low weight gain reduced the risks of a large-for-gestational-age (LGA) neonate and macrosomia.

Compared with the recommended gestational weight gain, high weight gain was associated with a 4% higher risk of cesarean delivery, a 4% higher risk of a LGA neonate, and a 6% higher risk of macrosomia. However, high weight gain reduced the risk of an SGA neonate by 3% and that of preterm birth by 2%, the researchers reported (JAMA. 2017;317[21]:2207-25).

These increases and decreases in risks remained consistent regardless of the mother’s prepregnancy BMI, they noted.

The effect of either high or low gestational weight gain on the risk of gestational diabetes could not be determined because of inconsistencies across the 23 cohort studies concerning definitions and treatments.

The Australian Department of Education and Training and the Australian National Health and Medical Research Council supported the study. Dr. Goldstein reported having no relevant financial disclosures; one of her associates reported serving on the Women’s Health Global Advisory Board for Pfizer.

Weight gain in pregnancy: Too much and too little can be harmful

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