Weight gain recommendations in pregnancy and the obesity epidemic.

Excessive gestational weight gain and obesity have been recognized as independent risk factors for maternal and fetal complications of pregnancy with significant lifelong consequences. These associations call into question the recently released Institute of Medicine (IOM) gestational weight gain recommendations, particularly for obese women. The IOM recommendation of a single standard of weight gain for all obesity classes is also of concern, because higher body mass index levels are associated with more severe pregnancy complications, such as preeclampsia and gestational diabetes. The IOM recommendations retained the 1990 focus on the theoretical association between poor gestational weight gain and low birth weight (LBW). Low gestational weight gain may often be a consequence and not the cause of LBW, and there is a lack of evidence in developed countries that dietary supplementation increases birth weight. Current obstetric practice allows for accurate and timely diagnosis of and intervention for LBW. We submit that gestational weight gain recommendations should be more individualized especially for obese women. Obese pregnant women should not be precluded from partaking in healthy lifestyle modifications in pregnancy that include physical activities, modified, judicious diets, and limited weight gain.