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Weight Gain During Pregnancy: Reexaming the Guidelines
Index*
A
Acculturation, 114–115
Acetoacetate, 100, 102
Adipokines, 94
Adiponectin, 94, 138–139
Adolescent pregnancy
birth rate trends, 46
GWG-related risks, 121–122
individual patterns of GWG, 76
infant mortality risk, 205
mean GWG ranges, 101
postpartum weight retention, 122
prepregnant BMI cutoff values, 251–252
recommendations for weight gain during pregnancy, 3–4, 121, 260
social support as GWG determinant, 145
total GWG, 72, 155
trends, 64–65
Adrenocorticotropic hormone, 94
Age at pregnancy
birth weight trends and, 57
breastfeeding rates and, 62
depression risk, 51–52
gestational diabetes risk and, 52–53
GWG in older women, 122–123, 155
GWG patterns and trends, 30–31, 34f, 124t, 126t
health risks for older women, 173
infant mortality risk, 205
prevalence of weight loss attempts during pregnancy, 146
trends, 1, 15, 46, 64–65
See also Adolescent pregnancy
Age of fetal viability, 86
Agency for Healthcare Research and Quality, 5, 18, 173
Alcohol consumption, 151–152
Allergy/asthma, GWG and, 226–227, 230
Amniochorionic-decidual inflammation, 213, 214
Amniotic fluid changes in pregnancy, 91–92, 102
Amphetamine abuse, 152
Angiotensin, 94
Anorexia nervosa, 140–141
Apgar score, 225
Attention deficit hyperactivity disorder, 228, 230
*
Page numbers followed by f refer to figures and page numbers followed by t refer to tables.
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B
Bariatric surgery, 141–142, 271
Basal metabolic rate, 135–138, 139
Basal oxygen consumption, 83
Bioimpedance analysis, 78
Biomarker predictors of birth outcomes, 156
Birth certificates
GWG and prepregnancy BMI data from, 29–33
recommendations for revision, 5, 33, 66
shortcomings of data from, 30
Birth weight
child health outcomes, 198
classification, 86, 87, 206–207
determinants, 206
fetal growth and, 206
genetic factors in, 129–133
gestational age and, 87, 88f
high altitude effects, 117
infants born to incarcerated mothers, 154
maternal body composition and, 102
maternal body water accretion and, 78
maternal plasma volume and, 78
maternal substance use and, 151
maternal weight gain and, 73f, 198, 208–211
multiple fetus pregnancies, 88–89
optimal, 86
patterns and trends, 57, 58f, 87–88
prepregnancy weight and, 73f, 207
rate of GWG and, 76–77
See also Large-for-gestational age infants;
Low-birth weight babies;
Small-for-gestational age infants
Bone mineral, 80–83
Breast cancer, 186, 227–228, 230
Breastfeeding
GWG-related outcomes, 187, 216–217
trends, 62
See also Lactation
Bulimia nervosa, 140–141
C
Caloric intake, 48
Cancer, GWG and
birth weight and, 227
evidence for linkage, 186, 227–228, 230
hormonal system, 227–228
recommendations for research, 8, 188
Carbohydrate metabolism, 95
Cardiovascular health
long-term outcomes of GWG, 185, 186–187
maternal changes during pregnancy, 92–93
recommendations for research, 8, 188
Centers for Disease Control and Prevention, 9, 270
Cesarean delivery
evidence for GWG linkage, 186, 187
as GWG-related outcome, 7, 180–181
maternal obesity and, 54–55, 72, 180–181
risks for women of small stature, 3
trends, 54, 65
Childhood health
allergy/asthma, 226–227
cancer, 227–228, 230
long-term outcomes, 258–259
neurodevelopmental, 222–226, 229, 230
recommendations for research, 8, 230–231
See also Childhood obesity;
Infant health
Childhood obesity
acculturation effects, 114
associated health risks, 199–201
developmental programming model, 198–199
GWG linkage, 199–201, 230
as GWG-related outcome, 7, 15, 216, 217–221, 229, 230
infant weight gain patterns and, 216
maternal glucose metabolism and, 200
trends, 62–63, 64f
Cholesterol, 97
Chorionicity, in multiple fetus pregnancies, 88, 89
Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults, 16
Cocaine use, 152
Cognitive functioning
GWG outcomes in childhood, 225–226
neurodevelopmental outcomes of SGA infants, 222–225
Contraceptive services, 9, 270, 276
Corticosteroid-binding globulin, 93
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Cortisol levels, 93–94
Cost-effectiveness of strategies for achieving GWG recommendations, 10, 11, 277
Crohn’s disease, 139–140
Cutoff points, BMI, 5, 28–29, 66, 250–251, 256, 259
Cytokines, 85, 95, 98, 138–139
D
Dehydroepiandrosterone sulfate, 94
Department of Health and Human Services, recommendations for, 5, 10, 65–66, 156, 277–278
Depression, 51–52, 143–144, 185, 186
Developmental programming, 133–134, 197–199
Diabetes, gestational
childhood developmental outcomes and, 200
evidence for GWG linkage, 175, 176–177, 186
fetal growth and, 87, 91
metabolic changes during pregnancy, 95–96, 176
placental development and, 85–86
risk, 176
trends, 1, 15, 52–53, 65, 176
Diet and nutrition
access to healthy foods, 118–119, 275
basal metabolic rate and, 137
caloric intake as GWG determinant, 146–147, 258
challenges to achieving recommendations for, 264
clinical implementation of GWG guidelines, 3, 274
cultural influences, 114–115
dieting practices, 49, 65
effectiveness of GWG advice, 115–116, 267
fasting effects on maternal metabolism, 99–100, 102
food insecurity, 49, 127, 156
glycemic load as GWG determinant, 148
goals of pregnancy counseling, 11, 276
GWG in older women, 123
information resources for pregnant women, 274
intake patterns and trends, 47–49, 65
interpersonal support during pregnancy and, 120
media influence, 113–114
metabolic changes during pregnancy and, 94–95
nutrient intake as GWG determinant, 147–148
preconception counseling, 9, 270, 276
preterm birth risk, 214
prevalence of weight loss attempts during pregnancy, 146
protein supplementation, 207
psychological stress and, 144–145
research needs, 65, 102–103, 155, 156, 271
significance of, in GWG, 154
for successful pregnancy and lactation, 49
Dietitians, 10, 274
E
Eating disorders, 140–141
Eclampsia. See Preeclampsia and hypertensive disorders
Ecological perspective, 111, 275–276
Edema, 78
Educational attainment
breastfeeding rates and, 62
GWG and, 125, 126t
physical activity patterns, 50–51
trends, 46
Educational interventions
to achieve GWG recommendations, 9, 271, 277
effectiveness of GWG advice, 115–116, 267
media campaigns, 114
See also Preconception counseling
Endocrine function, 93–94, 97
Epidemiological field model of health behaviors and outcomes, 112
Epigenetic influences
on GWG, 134, 188
on postnatal outcomes, 197
Estrogen, 95, 98, 227–228
Exercise. See Physical activity
Extracellular fluid, 78
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F
Family-level determinants of GWG, 119, 120
Fat accretion during pregnancy
clinical significance, 102
depression and, 144
fetal, 89, 91
maternal, 79–83, 90
physical activity and, 150
postpartum retention, 80, 182
recommendations for research, 231
Fat-free mass accretion during pregnancy fetal, 90
maternal, 78–79, 80–83, 90
Federal Human Nutrition Research and Information Management System Database, 156
Fetal development
age of viability, 86
body composition, 89–91
determinants, 86
gender differences, 87
growth patterns, 86–88
GWG linkages to fetal growth, 206–212, 230, 257–258
high altitude effects, 87, 91, 117
maternal characteristics associated with, 211–212
maternal glucose metabolism and, 199–200
maternal health and, 87
measurement and classification, 86, 87
in multiple fetus pregnancy, 88–89
neonatal body composition, 215–216, 230
neurophysiology, 222–226
placental physiology, 97–99
placental weight and, 83–84
racial/ethnic differences, 87, 206–207
research challenges, 86
risks in adolescent pregnancy, 121–122
stillbirth risk, 203, 229
toxin exposure, 117–118
water content, 85
See also Birth weight;
Preterm birth
Follicle-stimulating hormone, 94
Food. See Diet and nutrition
Free fatty acid, 100
G
Gender differences, fetal growth, 87, 91
Genetic factors in GWG, 128–133, 155
Gestational weight gain (GWG)
in adolescents, 121–122
amniotic fluid changes and, 91–92, 102
among vulnerable populations, 153–154, 155
attitudes toward weight gain and, 145–146
birth weight and, 198
childhood obesity and, 199–201
clinical significance, 243
conceptual models for evaluating determinants of, 111–112
conceptual models for evaluating outcomes of, 174–175, 196–197
cultural influences, 114–115
data needs to assess trends, 31t, 66
data sources, 29, 32t, 173–174
determinants, 21, 111, 112, 113f, 154–155
developmental programming as factor in, 133–134
dietary intake and, 146–148
distribution among components of, 77
effectiveness of health services counseling, 115–116
environmental determinants, 117–118
epigenetic influences, 134
fetal body composition and, 90, 91
fetal components, 86–91
genetic factors, 128–133, 155
hormonal factors, 98, 138
individual patterns of, 75–77, 255–256
infant health outcomes related to, 7, 8, 175, 202–215, 222–229
interpersonal determinants, 119–120
labor and delivery complications associated with, 179–181
lifestyle factors in, 46–51
linkage with maternal health risks, 175–179
long-term child health outcomes and, 215–221, 222–225, 230
maternal age and, 124t
maternal body composition and, 78–83
maternal components of, 77–78
maternal determinants, 120–121
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maternal health outcomes related to, 5–7, 8, 15, 52, 75, 173, 174, 186–187, 242
mean ranges, 101, 264
media influence, 113–114
metabolic changes and, 96–97, 135–138
monitoring individual pregnancy, 256, 271–272
in multiple fetus pregnancies, 101–102
neighborhood/community determinants, 118–119, 275–276
new recommendations, 2–3
in older women, 122–123
outcomes data, 173–174
parity and, 253
physical activity and, 149–151
placental changes in, 83–86, 98
placental metabolism in, 71
policy factors, 116–117
population patterns and trends, 1, 21, 25, 29–40, 101
postpartum weight retention and, 41, 42, 44, 45, 187
pre-existing morbidities and, 139–143, 173
prepregnancy BMI and, 31–33, 35–36, 37–39f, 72, 75, 102, 135, 136t, 246–247, 265t, 266f
psychological factors in, 51–52, 143–146
research needs, 5, 7–8, 65–66
societal/institutional determinants, 112–113
sociodemographic differences, 121–127
substance abuse and, 151–152
total weight gain, 72–75, 101
in unintended pregnancies, 152–153
See also Guidelines for weight gain during pregnancy;
Monitoring individual weight changes during pregnancy;
Weight loss or low weight gain during pregnancy
Glomerular filtration rate, 93
Glucocorticoid levels, 133
Glucokinase, 130
Glucose metabolism
fat mass accretion during pregnancy and, 83
fetal development risks, 199–200
gestational diabetes risk, 176
GWG and, 176
ketonuria/ketonemia risk, 100, 101
placental transport function, 97
pregnancy course, 95
recommendations for research, 8, 188
See also Insulin and insulin sensitivity
Growth hormone, 94
GSG. See Gestational weight gain
Guidelines for weight gain during pregnancy applicability, 2, 242
challenges to achieving recommendations for, 263–264, 270
clinical implementation, 3, 255–256
conceptual approach for review and development of, 4–5, 6f, 14, 18–19, 20f, 111, 241–242, 249–251, 270
data sources in development of, 2, 5–7, 18, 21, 25, 29, 32t, 249–250, 258, 310–313t
demographic and clinical trends indicating review and revision, 1, 14–16
effectiveness of interventions to promote, 267–269
evolution of, 13–14
goals for review and revision, 1–2, 16–18
implementation problems, 16, 267
implementation rationale, 11, 276–277
new recommendations, 2–3, 254–255, 256–259
previous approaches for developing, 243–247, 248t
previous strategies for implementation, 266–267
promoting public awareness of, 9, 271
recommendations for special populations, 3–4, 251–254, 260
research goals, 1–2
research needs for future improvements, 8–9, 11, 277
single target approach, 243
strategies for achieving
recommendations, 9–10, 11, 260, 270–276
trade-offs between maternal and child health in, 242, 243–245, 258
H
Health care providers
attitudes toward GWG recommendations, 155–156
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charts for monitoring weight changes, 10, 272–274
effectiveness of GWG advice, 115–116, 267
effectiveness of interventions to promote healthy GWG, 267–269
recommendations for data collection, 66, 256
strategies for achieving GWG recommendations, 9–10, 266–267, 271–276, 277
See also Preconception counseling
Health field model of health behaviors and outcomes, 111–112
Healthy People 2010, 49, 50
Height, maternal, 257
Hepatocyte nuclear factor 4 alpha, 131–132
Hepatocyte nuclear factor 1 beta, 131
High altitude effects, 87, 91, 117
Hormonal system
breast cancer and, 227–228
changes in pregnancy, 93–94, 95
in GWG, 138
placental development and, 85, 98–99
research needs, 103
Human placental lactogen, 98
β-Hydroxybutyrate, 100, 101, 102
beta-Hydroxybutyrate, 100, 101, 176
Hyperemesis gravidarum, 140, 179
Hypertension. See Preeclampsia and hypertensive disorders
Hypothalamic-pituitary-adrenal response
in GWG, 133
preterm birth pathogenesis, 213, 214
I
Immune system
GWG–asthma linkage, 226–227
preterm birth pathogenesis, 214
Individualized attention to women during pregnancy, 10, 256, 271–275
Induced labor, 179–180
Infant Feeding Practices Study, 42–44, 45, 174–175, 310–311t
Infant health
Apgar score, 225
birth defect risk, 204
birth weight as risk factor, 198
conceptual approach to review and development of GWG guidelines, 21, 241–242
developmental plasticity, 197
developmental programming model of GWG effects, 197–199
findings of previous GWG studies, 243–247
GWG-related outcomes, 7, 8, 15, 202–203, 222–230
model of GWG linkage, 196–197
mortality, 56, 57, 65, 204–206
neonatal body composition, 215–216, 230
neurodevelopment, 222–226
potential mechanisms of GWG linkage, 197
preterm birth, 212–215, 229, 230
recommendations for research, 8, 188, 230–231
reduced maternal food intake and, 146
research challenges, 195–196
research needs, 259–260
weight gain, 216
weight loss or low GWG during pregnancy and, 8, 204–205, 212, 229
See also Childhood health;
Childhood obesity;
Fetal development;
Large-for-gestational age infants;
Low-birth weight babies;
Small-for-gestational age infants
Inflammatory bowel disease, 139–140
Inflammatory response
metabolic changes during pregnancy, 95–96, 103
nutrient utilization and, 102
placental development and, 85
placental regulation, 71
preterm birth pathogenesis, 214
syncytiotrophoblast microparticles in, 99
Influence of Pregnancy Weight on Maternal and Child Health,17
Insulin and insulin sensitivity
adiponectin levels and, 94, 139
fat mass accretion during pregnancy and, 83
in fetal development, 89
fetal development risks, 199–200
GWG and, 96–97, 138
hypothalamic-pituitary-adrenal hyperactivity and, 133
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ketonuria/ketonemia risk, 100
leptin and, 139
long-term outcomes of GWG, 185
metabolic changes during pregnancy, 95–96
patterns of, 96
placental regulation, 71, 85, 98
risk of gestational diabetes, 176, 199
Intelligence quotient, 222, 223, 224, 226
Intracellular water, 78
Intrauterine growth restriction, 207
Iron-deficiency anemia, 214
K
Ketonuria/ketonemia, 8, 100–101, 102, 176, 257
L
Labor and delivery
GWG linkage with complications of, 179–181
induction of labor, 179–180
length of labor, 180
LGA babies, 206
See also Cesarean delivery
Lactation
dietary intake for, 49
GWG and, 181–182
Large-for-gestational age infants
causes, 59, 65
definition, 7, 86, 206
delivery complications, 206
genetic risk, 129, 130
as GWG-related outcome, 7, 209, 228–230, 257–258
GWG-related risk among obese women, 72
placental weight and, 84
trends, 59, 60t, 65
Leptin, 98, 138–139
Leukemia, 227
LGA. See Large-for-gestational age infants
Life-course perspective, 112, 196–197
Lipid metabolism
changes in pregnancy, 95
placental regulation, 98
placental transport function, 97
Low-birth weight babies
causes, 57
GWG and, 208–209
mortality risk, 57
trends, 57, 65
See also Birth weight
Low-income women
food insecurity, 49, 127
GWG patterns and trends, 36–37
need for individualized attention during pregnancy, 10, 276
recommendations for research on guideline implementation, 10, 277–278
strategies for implementing GWG guidelines, 276
Lupus erythematosus, 139–140
Luteinizing hormone, 94
M
Macrosomia, 57, 200, 207, 209
Marital status, 119–120, 155
Maternal health
conceptual approach to review and development of GWG guidelines, 21, 241–242
conceptual framework for studying GWG outcomes, 174–175
fat accretion during pregnancy, 79–83
fetal body composition and, 91
fetal growth and, 87
findings of previous GWG studies, 243–247
GWG among obese women and, 72
GWG-related risks, 5–7, 8, 15, 52, 75, 173, 186–187
long-term outcomes, 259
metabolic changes during pregnancy, 94–98
mortality, 55–56, 65, 181, 187
physiologic changes during pregnancy, 92–94
postpartum risks, 175
pre-existing morbidities related to GWG, 139–143
prenatal risks, 175
protein accretion during pregnancy, 78–79
recommendations for research, 188
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research needs, 259–260
risks for older women, 122–123
total body water accretion during pregnancy, 78
See also Cesarean delivery;
Diabetes, gestational;
Postpartum health outcomes;
Preeclampsia and hypertensive disorders
Maternal Nutrition and the Course of Pregnancy,13, 243
Media influence of health behavior, 113–114
Mental health and psychosocial functioning evidence for GWG linkage to outcomes in, 175, 178–179, 187
GWG determinants, 143–146, 154
long-term outcomes of GWG, 186
patterns and trends, 51–52
recommendations for research, 8, 156, 188
social support as GWG factor, 145
weight gain attitudes as GWG determinant, 145–146
See also Depression;
Stress
Metabolic changes during pregnancy
GWG determinants, 135–138
ketonuria/ketonemia, 100–101
maternal, 94–97
placental–maternal interaction, 99–100
research needs, 103
weight loss and, 99–100
Metabolic syndrome, 133–134
Methamphetamine use, 152
Migrant workers, 153
Military personnel, 153
Monitoring individual weight changes during pregnancy
BMI measurement, 66
challenges to achieving recommendations, 264
charts for, 10, 272–274
rationale, 264–266
recommendations for health care providers, 66, 255–256
Mortality
causal classification, 181
infant, 56, 57, 65, 202f, 204–206
maternal, 55–56, 65, 181, 187
research needs, 56, 188
Multiple fetus pregnancy
birth weight outcomes of GWG, 76–77
birth weight trends and, 57
fetal development patterns, 88–89
GWG patterns, 76–77, 101–102, 143
placental weight in, 84
recommendations for research, 260
recommendations for weight gain during, 4, 252, 260
total GWG patterns, 73–75
N
National Center for Clinical Excellence, 243
National Heart, Lung, and Blood Institute, 16, 29
National Institutes of Health, recommendations for, 5, 7–9, 102–103, 155, 188, 230–231, 260
Natural disasters, 118
Neurodevelopment, 222–226, 229, 230
Nitrogen metabolism, 95
Nutrition During Lactation,15
Nutrition During Pregnancy,13–14, 15, 195, 241, 264
Nutrition During Pregnancy and Lactation: An Implementation Guide,9–10, 14, 15, 266–267, 270–271
Nutrition Services in Perinatal Care,266, 271
O
Obesity
postpartum weight retention and subsequent risk for, 182, 184, 187
See Overweight and obese women
Obesogenic environment, 112
Obstetrical procedures
birth weight trends and, 57, 65
Oligohydramnios, 92
Overweight and obese women
adolescent pregnancy as risk factor, 122
bariatric surgery implications for pregnancy, 141–142
body composition changes in pregnancy, 80–81, 83
body composition of neonates of, 215
cesarean delivery risk, 54–55
classification, 5, 29
dieting practices, 49
epidemiology, 15
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fasting effects during pregnancy, 99–100
fetal growth outcomes, 207, 208
findings of previous GWG studies, 246
food insecurity and, 127
GWG patterns, 35–36, 72–73, 76, 77, 101
health risks in pregnancy, 72, 173
hypertensive disorder risk in pregnancy, 177
infant mortality risk, 204–205
mortality risk, 56
outcomes of multiple fetus pregnancies, 77
placental development in, 85
postpartum weight retention, 44, 45
preconception bariatric surgery, 142, 271
rate of GWG, 255
recommendations for data collection, 66
recommendations for GWG, 3, 7, 250–251, 253, 259
recommendations for research, 7, 102
recommended weight gain chart, 274f
research needs, 56
risks for older pregnant women, 122–123
severity prevalence, 27
trends, 1, 15, 25–26, 63–64
weight loss during pregnancy, 7–8
See also Childhood obesity
Oxygen consumption, 93
P
Parenchyma, 84–85
Parity, 253
Pattern(s) of weight gain, 255–256
child health outcomes, 231
new recommendations, 2t, 255
normal rate, 255
recommendations for research, 231
singleton pregnancies, 75–76
statistical curve, 75
twin pregnancies, 76–77
Pediatric Nutrition Surveillance System, 310–311t
Physical activity
challenges to achieving recommendations for, 264
clinical implementation of GWG guidelines, 3, 274–275
data sources, 51
goals of pregnancy counseling, 11, 276
as GWG determinant, 149–151, 154
information resources for pregnant women, 274–275
media influence, 114
neighborhood determinants of GWG, 119
patterns and trends among women, 49–51, 65
preconception counseling, 276
pregnancy and birth outcomes, 148–149
recommended levels, 49, 148, 275
research needs, 155, 275
sociodemographic differences, 50–51
Physical Activity Guidelines Advisory Committee, 275
Placenta
composition, 85–86
fetal growth and, 97, 102
function in pregnancy, 71, 97
functional changes in pregnancy, 85
growth during pregnancy, 84
hormone production, 98–99, 103
insufficiency, 84
lipid content, 86
maternal metabolism and, 97–98
normal development, 84
structural changes in pregnancy, 84–85
transport function, 97
weight changes during pregnancy, 83–84
Plasma volume, 78, 93, 94, 102
Policy formulation, 116–117
Polyhydramnios, 92
Postpartum health outcomes
depression, 185
GWG-associated risks, 175, 181–182, 185
long-term risks, 185–187
obesity risk, 182, 184, 187
See also Postpartum weight retention
Postpartum weight retention
body composition changes, 81–83
counseling goals, 11, 274, 276
data sources, 41, 42, 258–259
definition, 182
fat accretion patterns, 80, 182
food insecurity during pregnancy and, 127
GWG and, 41, 42, 44, 45, 102, 182–184, 187, 246–247, 258
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long-term outcomes, 258
measurement, 40–41
obesity risk, 182, 184, 187
patterns and trends, 41–46
psychological stress as risk factor, 144
recommendations for research, 5, 7, 65–66
risk for adolescent mothers, 122
Preconception counseling
effectiveness, 271
effectiveness of GWG advice, 115–116
goals, 11, 270–271, 276
recommendations for, 9, 187, 277
scope, 9, 270, 271
Preeclampsia and hypertensive disorders evidence for GWG linkage, 175, 177–178, 186, 187, 242
GWG-related risk among obese women, 72
recommendations for research, 8, 188
risk, 177
trends among pregnant women, 1, 53–54, 65
Pregnancy Nutrition Surveillance System, 36–37, 40, 41, 45–46, 312–313t
Pregnancy Risk Assessment Monitoring System, 33–36, 40, 312–313t
Prepregnancy BMI
adolescent cutoff values, 251–252
adolescents, recommendations for, 3–4
attitudes toward weight gain as GWG determinant, 146
birth defect risk, 204
birth weight outcomes, 73f, 74, 207, 210–211
body composition changes in pregnancy and, 80–83
challenges to achieving recommendations for, 263–264
classification, 5, 28–29, 66, 250–251
clinical significance, 7, 13, 259
cutoff points, 2–3, 5, 250–251, 256, 259
data sources, 29
dietary intake as GWG determinant and, 147
fetal body composition and, 91
GWG and, 31–33, 35–36, 37–39f, 72, 75, 102, 135, 136t, 265t, 266f
GWG recommendations as proportion of, 243
hypertensive disorder risk, 177
individual patterns of GWG and, 75–76
maternal health outcomes and, 187
maternal height and, 257
neonatal health outcomes, 202
obesity prevalence, 28
physical activity as GWG determinant and, 150–151
placental development and, 85
population distribution patterns, 26–27t, 30t
postpartum weight retention and, 246–247
preterm birth risk, 213
rate of GWG, 255
social support as GWG determinant and, 145
stillbirth risk, 203
strategies for achieving recommendations, 270–271
trends, 1, 25–28, 263
women of short stature, recommendations for, 3
Preterm birth
asthma risk, 226
causes, 60
frequency, 87
as GWG-related outcome, 7, 212–215, 229, 230
long-term neurodevelopmental outcomes, 224–225
morbidity risks associated with, 212
pathophysiology, 213–214
prepregnancy BMI and, 213
racial/ethnic differences, 60, 61f
trends, 60, 61f,65
Prison population, 154
Progesterone, 95, 98
Prolactin, 94
Promoting Health: Intervention Strategies from Social and Behavioral Sciences, 275
Protein accretion during pregnancy
fetal, 90
maternal, 78–79, 83
Protein metabolism, 95
Protein supplements, 207
Public awareness of GWG guidelines, 9, 271
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R
Racial/ethnic subgroups
acculturation effects on dietary practices, 114–115
birth weight patterns, 57, 58f
BMI distribution patterns and trends, 26–27t
breastfeeding rates, 62
childhood obesity, 63
depression risk, 52f, 143
fetal development, 87
fetal growth measurement, 206–207
GWG patterns and trends, 30–31, 34f, 36–37, 40f, 123–125, 126t, 253
individual patterns of GWG, 76
infant mortality, 56, 57f
large-for-gestational age births, 59, 60t
maternal mortality patterns, 55
need for individualized attention during pregnancy, 10, 276
obesity risk, 26, 27, 28, 64
physical activity patterns, 50
postpartum weight retention patterns and trends, 41, 42t, 43f, 45–46
preterm births, 60, 61f
prevalence of weight loss attempts during pregnancy, 146
recommendations for research on guideline implementation, 10, 277–278
recommendations for weight gain during pregnancy, 4, 253, 260
research needs, 4, 16–17, 156, 188, 260
small-for-gestational age births, 59
sociodemographic trends, 1, 46, 64
weight-related predictors and outcomes and, 65
Reactive oxygen species, 214
Renal function, 93
Research needs
birth data, 5, 66
determinants of GWG, 155–156, 275–276
dietary practices, 65, 102–103, 156, 271
for future guideline development, 8–9, 277
health care provider attitudes and
beliefs, 155–156
hormonal factor in maternal metabolism regulation, 103
infant and child health outcomes, GWG-related, 8, 230–231, 259–260
longer term outcomes, 259
low GWG or weight loss during pregnancy, 7–8
maternal characteristics associated with GWG, 8, 188
maternal health outcomes of GWG, 188, 259–260
maternal mortality, 56, 188
obesity during pregnancy, 7, 102
physical activity behaviors and outcomes, 156, 275
racial/ethnic subgroups, 4
for review of GWG guidelines, 16–17
strategies to achieve GWG
recommendations, 10, 277–278
surveillance of GWG and postpartum weight retention, 5, 65–66
weight loss or low GWG, 103
Respiratory function, maternal, 93
S
Screening
depression, 51–52
See also Monitoring individual weight changes during pregnancy;
Surveillance of GWG and postpartum weight retention
Short stature, women of recommendations for weight gain during pregnancy, 3, 251, 260
risk of negative pregnancy outcomes, 3, 251
Small-for-gestational age infants
definition, 7, 59, 86, 206
developmental programming effects, 198
genetic risk, 129, 130
as GWG-related outcome, 7, 209, 210–211, 228–230, 257–258
GWG-related risk among obese women, 72
health complications associated with, 206
long-term neurodevelopment, 222–225
placental weight and, 84
trends, 59
Smoking, 46, 91, 151, 253–254
Snack foods and soft drinks, 48
OCR for page 854
Weight Gain During Pregnancy: Reexaming the Guidelines
Social marketing, 114, 276
Sociocultural context of health behaviors and outcomes
assessment for obstacles to healthy GWG, 272–274
conceptual models, 112
family and partner factors, 119–120
GWG determinants, 112–117
neighborhood/community factors, 118–119, 275–276
research needs, 155, 275–276
social support factors, 145
Sociodemographic trends, 1, 15, 46, 47t, 63–65
Socioeconomic status, 125, 127, 188.
See also Low-income women
Sodium levels, 93
Special populations
GWG among, 153–154, 155
incarcerated women, 154
migrant workers, 153
military personnel, 153
See also Adolescent pregnancy;
Low-income women;
Multiple fetus pregnancy;
Racial/ethnic subgroups;
Short stature, women of
Special Supplemental Food Program for Women, Infants, and Children, 117
Stillbirth, 203, 229
Stress
developmental programming, 133
GWG and, 144–145
natural and man-made disasters, 118
physiology, 133
Stretch marks, 179
Substance use, 151–152
Surveillance of GWG and postpartum weight retention
individualized attention, 10
recommendations for research, 5, 65–66
Syncytiotrophoblast microparticles, 99
T
Teenage mothers. See Adolescent pregnancy
Thyroid changes in pregnancy, 94
Thyroxine-binding globulin, 94
Title V programs, 16–17
Total body nitrogen, 82–83
Total body potassium, 78, 79, 80–83, 90
Total body water accretion, 78, 80–83, 90, 93
Total energy expenditure, 135–138, 150–151
Total GWG
singleton pregnancies, 72–73
triplet and quadruplet pregnancies, 75
twin pregnancies, 73–75
Toxin exposure, 117–118
Twins. See Multiple fetus pregnancy
U
Unintended pregnancy, 152–153
Unmarried mothers, 46, 64–65
V
Violence exposure, 119, 155
W
Weight loss or low weight gain during pregnancy
among obese women, 72–73
birth defect risk, 204
childhood diabetes risk, 201
dieting practices among pregnant women, 49, 65
fasting metabolism, 99–100, 102
fetal growth and, 207, 208, 210, 229
health risks for obese women, 72
infant mortality risk, 204–205
maternal body composition outcomes, 103
preterm birth as outcome of, 212, 229
prevalence of weight loss attempts, 146
psychological stress and, 145
recommendations for research, 7–8, 103
stillbirth risk, 203
World Health Organization, 2–3, 5, 29, 66, 250–251, 259
