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Inappropriate Gestational

Weight Gain Issues:


Adverse Outcomes,
Prevention, and
Management
By: Eden Goykadosh

The Issue
57% of pregnant women gain more
weight than recommended by the
Institute of Medicine
Those at greatest risk for complications
related to EGWG:
-overweight
-low-income
-no nutrition counseling/exercise

Todays Objectives
Attendees will be able to:
1.Identify several of the adverse
outcomes associated with
inappropriate gestational weight
gain (IGWG).
2. Explain to WIC participants
methods to prevent or manage
IGWG.

Part 1: Introduction

Institute of Medicine
Weight Gain
Recommendations

Misconception- Eating
for 2
Need to change the norm of eating
for 2
Pregnancy is a time when women feel
that they can gain weight freely
without criticism
Most behaviors that contribute to
EGWG are a direct, although
misguided, result of womens concern
to support a healthy pregnancy

Improving Pregnancy
Outcomes
Components leading to healthy
pregnancy outcome include healthy prepregnancy weight, appropriate
weight gain and physical activity
during pregnancy, consumption of a
wide variety of foods, appropriate
vitamin and mineral supplementation,
avoidance of alcohol and other harmful
substances, and safe food handling.

General Energy
Recommendations
Additional energy needs per day based on
trimester:
1st trimester- no higher than the EER for nonpregnant women
2nd trimester- extra 340 kcal
3rd trimester- extra 452 kcal

Use 2010 Dietary Guidelines to help


pregnant women select a food plan based on
age, physical activity, trimester, weight gain,

General Physical Activity


Recommendations
At least 150 minutes of
moderate-intensity aerobic
activity spread throughout
the week
or
30 minutes of exercise on
most days of the week.

(Source: "Practice Paper: Nutrition and Lifestyle for

Part 2: Adverse Outcomes


Related to Inappropriate
Gestational Weight Gain

Risks Associated with


Excessive Gestational
Weight Gain
-Pregnancy and labor complications
- Postpartum weight retention
-Macrosomia
-Gestational hypertension and diabetes
-Preeclampsia
-Cesarean delivery
--Large for gestational age
-Long-term obesity in the child

Risks Associated with


Inadequate Gestational
Weight Gain
-Low infant birth weight
-Small for gestational age infant
-Spontaneous preterm birth

Part 3: Interventions

SMS Texts for Appropriate


GWG
Participants chosen based on prepregnancy BMI of 25-40
(overweight/obese)
Randomly divided into tailored
SMS intervention group (Preg CHAT
text) or a generic texting group
(Text4baby)
Preg CHAT text group had an
estimated mean gain of six pounds
less than participants in the
Txt4Baby arm
Follow-up is critical

Dietary Counseling +
Probiotics
Can dietary counseling + probiotic
capsules affect maternal
anthropometric measurements?
Probiotics can help prevent weight
gain
3 groups:
1) Diet/probiotics
2) Diet/placebo
3) Control/placebo
Central
adiposity (waist circumference of 80 or
more cm) was lower in the diet/probiotics group
compared to the control/placebo and diet/placebo
group.

Clinical + Mailed Patient


Education
How effective would
be continuous
monitoring of weight gain and
receiving educational materials via
mail to prevent EGWG?
Guidance about GWG via graph +
received materials in mail about
healthy eating and weight gain
Encouraged to respond with their
behavioral goals and questions.
Only the low-income participants
receiving the intervention had a
significantly reduced risk of EGWG.

Behavioral Intervention
Study
Behavioral Intervention vs. Usual
Care

Intervention group- received


education about weight gain,
healthy eating, and exercise and
individual graphs of their weight
gain.
Intervention significantly
decreased number of normal-weight
women who exceeded IOM
recommendations.
Postpartum weight retention was
strongly related to weight gain

Fit for Delivery Study


Behavioral Intervention vs.
Standard Care
Intervention- one face-to-face
visit; weekly mailed materials that
promoted appropriate weight gain,
healthy eating, and exercise;
individual graphs of weight gain;
and telephone-based feedback.
The Intervention Group Fewer participants (NW)
exceeded weight recommendations
Increased percentages of NW
and OW/ OB women return to their
pregravid weights or below by 6

Examination of Dietary/PA
Habits
Cohort study evaluating current
diet/PA habits of pregnant women
and risk for EGWG.
Total energy intake, dairy, and
fried foods were directly associated
with excessive GWG.
Walking and vigorous physical
activities were inversely associated
with EGWG.
Implications- nutritionist should
have a patient-centered approach in
promoting behavior change, while

Tips for Healthy Dietary


Intake

Dont forget breakfast.


Try fortified ready-to-eat or cooked breakfast cereals with fruit. Fortified cereals have
added nutrients, like iron or calcium.
If you are feeling sick, start with 100% whole-grain toast. Eat more food later in the
morning.
Eat foods with fiber.
Vegetables and fruits, like green peas, spinach, pears, and bananas
Whole grains, like brown rice and oatmeal
Beans, like black beans and kidney beans
Choose healthy snacks.
Low-fat or fat-free yogurt with fruit
Whole-grain crackers with fat-free or low-fat cheese
Take a prenatal vitamin with iron and folic acid every day.
Iron keeps your blood healthy. Folic acid helps prevent some birth defects. Talk with
your doctor or nurse about aprenatal vitamin thats right for you.
(Source: www.healthfinder.gov)

Tips for Healthy Dietary


Intake

Eat 8 to 12 ounces of seafood each week.


A 3-ounce serving is about the size of a deck of cards.
Eat a variety of seafood 2 to 3 times a week.
Canned light tuna has less mercury than albacore (white) tuna. If you choose albacore,
limit it to 6 ounces a week.
Fish that are low in mercury include salmon, sardines, and shrimp.
Stay away from soft cheeses and lunch meats.
Some foods may have bacteria in them that can hurt your baby. Dont eat:
Soft cheeses like feta, Brie, and goat cheese
Uncooked or undercooked meats or fish (like sushi)
Lunch meats and hot dogs, unless they are heated until steaminghot
Limit caffeine and avoid alcohol.
Drink decaffeinated coffee or tea.
Drink water or seltzer instead of soda.
Dont drink alcohol.
(Source: www.healthfinder.gov)

Part 4: Conclusion

Conclusion
Behavioral interventions to promote proper food intake
and PA has been shown to decrease risk for EGWG,
adiposity, and postpartum weight retention.
Efforts should be made to promote GWG within IOMs
recommendations to avoid adverse outcomes.
Pregnant women should be involved in setting personal
goals to prevent EGWG. They should maintain feedback
over a continued period of time.
In some studies only specific groups within the
intervention group- such as low-income, or normal
weight women- displayed the effects of gaining weight
within the IOMs recommendations.
Even getting close to the IOMs guidelines is success

Discussion
1. As a WIC nutritionist what are some
methods to help promote proper
gestational weight gain among your
clients?
1. Are there any specific negative
dietary/physical activity patterns among
the population that should be addressed
to improve outcomes?

References:
Claesson IM, Josefsson A, Cedergren M, Brynhildsen J, Jepps- son A, Nystrm F, Sydsj A, Sydsj G.
Consumer satisfaction with a weight-gain intervention programme for obese pregnant women.
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Eat Healthy During Pregnancy: Quicktips. (n.d.). Retrieved December 2, 2014, from
http://healthfinder.gov/HealthTopics/Category/pregnancy/nutrition-and-physical-activity/eat-healthyduring-pregnancy-quick-tips

Ilmonen, J., Isolauri, E., Poussa, T., & Laitinen, K. (2010). Impact of dietary counselling and probiotic
intervention on maternal anthropometric measurements during and after pregnancy: A randomized
placebo-controlled trial. Clinical Nutrition, 156-164.

Jeric, M., Roje, D., Medic, N., Strinic, T., Mestrovic, Z., & Vulic, M. (2013). Maternal pre-pregnancy
underweight and fetal growth in relation to institute of medicine recommendations for gestational
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References:
Pollak, K., Alexander, S., Bennett, G., Lyna, P., Coffman, C., Bilheimer, A., ... stbye, T. (2014).
Weight-related SMS texts promoting appropriate pregnancy weight gain: A pilot study. Patient
Education and Counseling, 256260-256260.

Polley, B., Wing, R., & Sims, C. (2002). Randomized controlled trial to prevent excessive weight gain
in pregnant women. International Journal of Obesity, 1494-1502.

Sridhar SB, Darbinian J, Ehrlich SF, et al. Maternal gestational weight gain and offspring risk for
childhood overweight or obesity. Am J Obstet Gynecol 2014;211:259.e1-8.

Stotland, N., Hopkins, L., & Caughey, A. (2004). Gestational Weight Gain, Macrosomia, And Risk Of
Cesarean Birth In Nondiabetic Nulliparas. Obstetrics & Gynecology, 671-677.

Stuebe, A., Oken, E., Rich-Edwards, J., & Gillman, M. (2009). 255: Associations of diet and physical
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Nutrition and Dietetics, 114(7), 1099-1103.