1. NuPAFP Conference October 13-14, 2010 Color Me Healthy Gestational Weight Gain Paula Garrett, MS, RD

2. Background American Women are: Older when they become pregnant More diverse Having more twin and triplet pregnancies

3. New Guidelines Based upon World Health Organization (WHO) cut-off points for BMI categories Specific, relatively narrow range of recommended weight gain for obese women

4. Determinants Maternal Factors –Socio-demographic Adolescent Older mothers Race/Ethnicity Socio-economic Status

5. Determinants Interpersonal/Family –Family Violence –Marital Status –Partner and Family Support

6. Determinants Anthropometric and Physiological Factors –Pregravid BMI –Basal Metabolic Rate (BMR)

7. Determinants Medical Factors –Pre-existing Morbidities –Hyperemesis Gravidarum –Anorexia & Bulimia Nervosa –Bariatric Surgery

8. Determinants Psychological Factors –Depression –Stress –Social Support –Attitudes Towards Weight Gain and Loss

9. Determinants Neighborhood/Community Factors –Access to Healthy Food –Opportunities for Physical Activity

10. Determinants Behavioral Factors –Diet –Physical Activity

11. Components of Gestational Weight Gain ComponentIncrease at Term (kg) Fetus3.40 (2.5-5.0) Placenta.65 Amniotic Fluid.80 Maternal Tissue1.38 Blood Volume1.45 Maternal Fat Stores3.35 Extracellular/Extravascular Fluid1.48 Total12.5

12. New Weight Gain Guidelines Pre-pregnancy BMI Category Total Weight Gain (lbs.) Underweight28-40 Normal Weight25-35 Overweight15-25 Obese11-20

13. Provisional Guidelines for Women-Twins Pre-Pregnancy BMI Category Weight Gain at Term (lbs.) Normal weight37-54 Overweight31-50 Obese25-42

14. New Approaches to the Development of the Guidelines Considered outcomes for the mother, not just the infant, and the inevitable trade-offs between them

15. Consequences for the Mother During Pregnancy –Gestational Diabetes Mellitus & Impaired Glucose Tolerance –Hypertensive Disorders

16. Consequences for the Mother During Delivery –Induction of Labor –Length of Labor –Mode of Delivery –Maternal Mortality

17. Consequences for the Mother Post-Partum –Lactation –Post-partum Weight Retention –Post-partum Depression Long-Term

18. Consequences for the Child Stillbirth Birth defects Fetal Growth Pre-term Birth

19. Consequences for the Child Long-Term –Neonatal Body Composition –Infant Weight Gain –Breastfeeding Initiation & Maintenance –Effects on Obesity

20. Recommendation for Action Federal agencies, private voluntary organizations and medical and public health organizations should adopt these new guidelines and publicize them to their members and women of childbearing age

21. Recommendation for Action Those who provide prenatal care to women should offer them counseling, such as guidance on dietary intake and physical activity that is tailored to their lifestyle

22. Risk Revision 10 Policy Revision Updated the following risks: –#101-Underweight(Women) –#111-Overweight (Women) –#131-Low Maternal Weight Gain –#133-High Maternal Weight Gain –#335-Multi-Fetal Gestation

23. Weight Gain Grid Printed four prenatal weight gain grids –Underweight –Normal –Overweight –Obese Will be placed on Orbit order form

24. Questions/Comments