Gestational Weight Gain in Pregnant People with Obesity

Purpose of ReviewWith rising rates of obesity and related maternal morbidity in the US, gestational weight gain in pregnant people with obesity represents an important modifiable risk factor for perinatal morbidity. The purpose of this review is to evaluate the most recent evidence for gestational weight gain, the association of excessive gestational weight gain with adverse perinatal outcomes, and approaches and interventions to mitigate excessive gestational weight gain in pregnant people with obesity.Recent FindingsSince the 2009 Institute of Medicine guidelines recommended a total gestational weight gain between 11 and 20 pounds in pregnant people with obesity, several studies have evaluated adverse perinatal outcomes associated with weight gain outside the guidelines among pregnant people with obesity, including hypertensive disorders of pregnancy, gestational diabetes, abnormal fetal growth, cesarean delivery, preterm birth, postpartum weight retention, and childhood obesity. Multiple studies have further investigated the efficacy of traditional diet and exercise behavioral health interventions, as well as meal replacement therapies, digital and mobile health technology, and group prenatal care, in controlling gestational weight gain in pregnant people with obesity, with mixed results.SummarySeveral investigators have proposed that gestational weight gain should be even more restrictive among pregnant people with obesity than that recommended by the Institute of Medicine guidelines, but adapting more restrictive weight gain recommendations remains premature in this population. Future research on gestational weight gain and lifestyle interventions in pregnant people with obesity requires close attention to longitudinal study designs among socioeconomically diverse people with outcomes stratified by class of obesity.