Current recommendations developed by the Institute of Medicine in 1990 suggest women should gain at least 15 pounds during pregnancy and places no upper limit on pregnancy weight gain.

Not a good idea, says Raul Artal, M.D., chairman of the department of obstetrics, gynecology and women’s health at Saint Louis University School of Medicine.

“Guidelines for nutrition during pregnancy at that time were based solely on expert opinion and not on scientific data. Obesity was not the problem it is now,” Dr. Artal says.

A new study led by Artal,published in the October issue of Obstetrics & Gynecology, found that women of different weights should gain or even lose different amounts of weight.

Obese women who are pregnant should gain no weight and severely obese women should lose weight during pregnancy, the study finds. The research is the largest population-based study to look at the effect of weight gain during pregnancy by obese expectant mothers.

“This study confirms what we’ve suspected all along -- that obese women don’t have to gain any weight during their pregnancy,” Dr. Artal says.

They analyzed the pregnancies of more than 120,000 obese women from Missouri to see how weight gain affected preeclampsia, which is high blood pressure brought on by pregnancy; cesarean delivery; and birth size.

Limiting weight gain of obese women during pregnancy has many benefits, the study shows. Women who have a BMI of 35 and gain fewer than the currently recommended 15 pounds are less likely to develop preeclampsia, less likely to need a cesarean delivery and more likely to have a baby of normal weight. A BMI of 18.5 to 24.9 is considered normal weight.

“Obese and overweight women should gain very little weight at all,” Dr. Artal says.

“Fifty percent of Missouri’s population is either overweight or obese. The problem is also prevalent in many other states in the country. Pregnancy is a big factor in this epidemic,” he says.

“It’s been shown in the literature time and time again. Weight gain increases in subsequent pregnancies because women accumulate weight with each pregnancy and don’t lose it.”

What mom does often determines the behavior of the rest of the family, Dr. Artal adds. “This is a multi-generational problem. The behavior modification starts with mom. If mothers are overeating and not exercising, that’s how the rest of the family is likely to behave.”

Deborah W. Kiel, MSN, and Elizabeth A. Dodson, MPH, graduate students from the Saint Louis University School of Public Health, coauthored the research under the guidance of Dr. Artal.

- Saint Louis University