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The Role of Weight and Obesity Before, During and After Pregnancy
Anna Maria Siega-Riz, PhD, RDProfessor of Epidemiology and Nutrition
Associate Dean for Academic AffairsUNC Gillings School of Global Public Health
Periconceptional
Women
Pregnancy
Infancy
Lactation
and feeding
Adult Health
Schematic diagram of the life cycle showing the relationships among the life stages
From March of Dimes Report :Nutrition today matters tomorrow 2002
Obesity Class BMI (kg/m2)Underweight <18.5Normal 18.5 - 24.9Overweight 25.0 - 29.9Obesity I 30.0 - 34.9
II 35.0 - 39.9Extreme obesity III 40+
Classification* of adult underweight, overweight and obesity by BMI
*National Heart Lung and Blood Institute (NHLBI), 1998
Trends in the distribution of BMI* from 1993 to 2003 among prepregnant U.S. women in the total
population and by race
*1990 cut points. SOURCE: Kim et al., 2007. (IOM Report, 2009)
Distribution of gestational weight gain by race and ethnicity
SOURCE: CDC, Pregnancy Nutrition Surveillance System. (IOM Report 2009)
Independent of Pregnancy:o Cardiovascular diseaseo Type II diabeteso Gallbladder diseaseo Osteoarthritiso Reduced fecundity and fertility
Implications of Obesity on Maternal Health Status
During Pregnancy:◦ Gestational diabetes◦ Gestational hypertension◦ Preeclampsia◦ Cesarean Delivery◦ Fetal macrosomia◦ Late fetal death◦ Early neonatal death◦ Thromboembolic Diseases◦ Birth Defects
Implications of Obesity on Maternal Health Status
Postpartum:•Postpartum weight retention•Anemia•Shorter duration of Breastfeeding
What do we know about the lifestyle behaviors of high BMI women?
Lower quality dietLess likely to participate in physical activityLess likely to take multi‐vitamin/mineral supplementsMore likely to be depressed and have lower scores on various psychosocial scalesMore likely to be food insecure
Balancing the risk and benefits of gestational weight gain
Prepregnancy BMI category
Total weight gain(lb, kg)
Rate of weight gain2nd and 3rd trimester
(lb/wk, kg/wk)
Underweight(< 18.5 kg/m2)
28-40, 12.5-18 1.0 (1.0-1.3),0.51 (0.44-0.58)
Normal-weight(18.5-24.9 kg/m2)
25-35, 11.5-16 1.0 (0.8-1.0),0.42 (0.35-0.50)
Overweight(25.0-29.9 kg/m2)
15-25, 7-11.5 0.6 (0.5-0.7),0.28 (0.23-0.33)
Obese(≥ 30.0 kg/m2)
11-20, 5-9 0.5 (0.4-0.6),0.22 (0.17-0.27)
New recommendations
*Calculations assume a first-trimester weight gain of 1.1-4.4 lb (0.5-2.0 kg)
Comparison of current GWG* and new guidelines by prepregnancy BMI category
*PRAMS 2002-03
Social‐Ecological Model
Factors Likely to Influence Weight Gain During Pregnancy‐Individual
• Dietary intake• Dieting practices• Attitudes about gaining weight
• Physical activity• Smoking status• Psychosocial status
• Conceive at a normal prepregnancy BMI– Requires preconceptional counseling, contraception, and,
for some, weight loss• Gain within the guidelines
– Inform women and their health care providers of the guidelines
– Provide individualized assistance with meeting the guidelines
• Monitor GWG, guidance on diet and exercise• Need to address the fact that women live busy lives and many time constraints
What can we do now to help women enter pregnancy healthy and have
optimal outcomes?
2009 IOM report
Food Calories (kilocalorie)
8 OZ low fat vanilla yogurt + 2 Tb almonds + ½ C berries
340†
2 OZ cheddar cheese + 5 cherry tomatoes + 5 round crackers
340†
1 medium banana + 1 ½ Tb. peanut butter + 8 FO skim milk
340†
10 medium baby carrots + 1 Tb reduced calorie ranch dressing +
1 medium apple + 2 Tb walnuts
340†
12 FO fruit smoothie(fruit, juice, lowfat yogurt) + 2 Tb trail mix
450
Educate women that they are not eating for two!
Widen and Siega‐Riz JMWH 2010