Weight Gain In Pregnancy: Why It Matters And How To Gain the "Right" Amount?

​Emily Goldsmith, MA

I remember my grandmother talking about always being hungry during her four pregnancies. This makes sense: the advice at the time was to restrict gestational weight gain (GWG) to no more than 15 pounds. Flash forward to my own mother’s pregnancy when she was encouraged to “eat for two” and gain around 30 pounds regardless of starting weight. Now, during my first pregnancy, it’s my turn to grapple with the question of how much weight to gain. 

​Fortunately, the guidance has evolved to be more tailored to individual circumstances and the ideal range for weight gain is now tied to starting Body Mass Index (BMI): ​

*above table from https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pregnancy-weight-gain.htm
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These guidelines are based on evolving findings linking weight gain during pregnancy with pregnancy outcomes and longer-term health for mothers and children. One research study, Project Viva, based out of the Harvard Pilgrim Health Care Institute’s Division of Chronic Disease Research Across the Lifecourse (CoRAL) has been a pivotal source of this evidence. Project Viva is a 20-year longitudinal research study of women and children; the study began enrolling pregnant women in 1999 and has been collecting data from the women and their children ever since. What have they found in this long period of observation? In a 2019 study, higher pre-pregnancy BMI and GWG were associated with a higher risk of pregnancy complications like pre-eclampsia, gestational diabetes, and large for gestational age at birth. A 2009 study found that greater GWG might lead to more substantial postpartum weight retention and child obesity.

While research shows the importance of managing weight gain during pregnancy, putting this into practice can be very challenging. A 2008 study showed that a misperception of pre-pregnancy weight was associated with excessive GWG. This suggests that one simple intervention could be to ensure that women have an accurate understanding of their pre-pregnancy weight in order to accurately gauge what they should aim to gain during pregnancy. 
To avoid excessive gestational weight gain, research also shows that the same strategies (healthy diet and regular exercise) used to maintain a healthy weight outside of pregnancy hold true during pregnancy. A 2009 study showed that physical activity, like walking, was associated with lower levels of excessive GWG. In addition, higher overall caloric intake and specifically eating fried foods and dairy were associated with excessive weight gain.

​Pregnancy is an exciting time, but it also a time of stress, change, and unpredictability. Helping women to understand healthy gestational weight gain could go a long way in relieving some of this stress and uncertainty. We are starting to learn what strategies can be used to help women like me achieve weight gain goals. We’ve come a long way from my grandmother’s experience. But we need to take the next step and have clear policies and program that can help set pregnant women on the right path to minimizing excessive GWG for a healthy pregnancy and beyond.  

About the author:

Emily Goldsmith, MA, joined CoRAL in June 2020 as the Operations Project Manager for Project Viva. Previously, she worked for two global health organizations, Pathfinder International and Management Sciences for Health, where she managed reproductive health and maternal and child health programs. In addition, she managed community health projects while serving as a Peace Corps Volunteer in Togo. She holds an MA in Law and Diplomacy from Tufts University and a BS in Development Sociology from Cornell University. She grew up in the Boston area and genuinely enjoys all 4 seasons and the different activities each provide; her favorites being winter skiing and late summer/early fall hiking (once the bugs are gone!).