Gestational weight gain greater than or less than guideline recommendations from the Institute of Medicine is associated with an increased risk of adverse maternal and infant outcomes, according to data published in JAMA.

Guidelines from the Institute of Medicine recommend a weight gain of 12.5 to 18 kg for underweight women (BMI <18.5), 11.5 to 16 kg for normal-weight women (BMI 18.5 to 18 kg), 7 to 11 kg for overweight women (BMI 25 to 29.9 kg), and 5 to 9 kg for obese women (BMI ≥30).

Helena J. Teede, MBBS, FRACP, PhD, from Monash University in Melbourne, Australia, and colleagues conducted a meta-analysis including 1,309,136 women from 23 observational studies to determine the associations between gestational weight gain above or below the recommended levels and maternal and infant outcomes.

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The results showed that gestational weight gain was below the current recommendations in 23% of pregnancies and was above the recommended levels in 47% of pregnancies.

Gestational weight gain below the recommendations was associated with a higher risk of infants being small for gestational age (odds ratio [OR], 1.53; absolute risk difference [ARD], 5%) and preterm birth (OR, 1.70; ARD, 5%). Weight gain below the recommendations was also associated with lower risk of infants being large for gestational age (OR, 0.59; ARD, -2%) and macrosomia (OR, 0.60; ARD, -2%).

The investigators also found that gestational weight gain above the current recommendations was associated with a lower risk of infants being small for gestational age (OR, 0.66; ARD, -3%) and preterm birth (OR, 0.77; ARD, -2%). Weight gain above the recommendations was linked to a higher risk of infants being large for gestational age (OR, 1.85; ARD, 4%), macrosomia (OR, 1.95; ARD, 6%), and cesarean delivery (OR, 1.30; ARD, 4%).

In an editorial, Aaron B. Caughey, MD, PhD, from the Department of Obstetrics and Gynecology at Oregon Health and Science University in Portland, notes that sending a message that gaining too much weight could lead to a higher risk of obesity for the child and that gaining too little weight could lead to growth restriction may be more effective than a positive message that eating well leads to greater health for the mother and infant.

“Without additional and effective approaches to change human behavior, the obesity epidemic is likely to continue expanding worldwide,” stated Dr Caughey. “For pregnancy, during which the negative health effects of excessive weight gain are realized more rapidly, an increasing range of complications involving mothers and their infants may occur. Improved interventions and behaviors that result in appropriate amounts of gestational weight gain are needed to mitigate these harms.”


  1. Caughey AB. Gestational weight gain and outcomes for mothers and infants. JAMA. 2017;317(21):2175-2176. doi:10.1001/jama.2017.6265
  2. Goldstein RF, Abell SK, Ranasinha S, et al. Association of gestational weight gain with maternal and infant outcomes. JAMA. 2017;317(21):2207-2225. doi:10.1001/jama.2017.3635