Objective
The body mass index (BMI) and gestational weight gain can affect the health of the pregnant woman and her newborn, and optimal maternal and neonatal outcomes occur when weight gain is less than the Institute of Medicine (IOM) recommendations. In 2013, the American College of Obstetricians and Gynecologists (ACOG) published a committee opinion on weight gain during pregnancy, which is based on updated 2009 IOM guidelines. The objective of this study was to review adherence with these ACOG/IOM guidelines in American and German pregnant women.
Study Design
United States data in this report are based on single term (37 weeks or longer) nulliparous births from 2011 to 2012 Centers for Disease Control and Prevention birth certificate data (n = 2,082,279). German data are based on single term nulliparous participants from 2004 and 2013 of the German BabyCare Program as well as available medical records at delivery (n = 1656). Weight gains for German and American pregnancies were calculated for each BMI group for those staying below, within, and above the recommended gestational weight recommendations by ACOG/IOM.
Study Design
United States data in this report are based on single term (37 weeks or longer) nulliparous births from 2011 to 2012 Centers for Disease Control and Prevention birth certificate data (n = 2,082,279). German data are based on single term nulliparous participants from 2004 and 2013 of the German BabyCare Program as well as available medical records at delivery (n = 1656). Weight gains for German and American pregnancies were calculated for each BMI group for those staying below, within, and above the recommended gestational weight recommendations by ACOG/IOM.
Results
Before pregnancy, 4% of all American women were underweight, 47% were normal, and 48% were overweight, whereas 4% of German women were underweight before pregnancy, 72% were normal, and 24% were overweight ( P < .001). Table shows the distribution of pregnancy weight gains by BMI groups and below, within, and above ACOG/IOL weight gain recommendations. Only 32% of American pregnancies were within recommended weight gains, 48% were above, and 20% were below. Only 34% of German pregnancies were within the IOM recommended weight gain, 27% were above, and 39% were below ( P < .001). American women exceeded weight gain recommendations from 23% to 61% of pregnancies as compared with 5%-58% of German women.
| Gestational weight gain recommendations | United States | Germany | ||||
|---|---|---|---|---|---|---|
| Below | Within | Above | Below | Within | Above | |
| Overall | 20% | 32% | 48% | 39% | 34% | 27% |
| Underweight | ||||||
| BMI, <18.5 kg/m 2 | 32% | 45% | 23% | 49% | 28% | 23% |
| Normal weight | ||||||
| BMI, 18.5–24.9 kg/m 2 | 24% | 39% | 47% | 42% | 40% | 18% |
| Overweight | ||||||
| BMI, 25–29.9 kg/m 2 | 13% | 24% | 61% | 25% | 17% | 58% |
| Obese BMI class 3 | ||||||
| BMI, 30–34.9 kg/m 2 | 15% | 24% | 41% | 30% | 20% | 50% |
| Obese BMI class 2 | ||||||
| BMI, 35–39.9 kg/m 2 | 23% | 27% | 50% | 37% | 17% | 46% |
| Obese BMI class 3 | ||||||
| BMI, ≥40 kg/m 2 | 32% | 27% | 41% | 62% | 33% | 5% |
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