Weight Gain During Pregnancy: Reexamining the Guidelines Kathleen M. Rasmussen and Ann L. Yaktine, Editors Committee to Reexamine IOM Pregnancy Weight Guidelines Food and Nutrition Board and Board on Children, Youth, and Families PREPUBLICATION COPY: UNCORRECTED PROOFS THE NATIONAL ACADEMIES PRESS 500 Fifth Street, N.W. Washington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. This study was supported by Contract No. HHSH250200446009I TO HHSH240G5806 between the National Academy of Sciences and U.S. Department of Health and Human Services Health Resources and Services Administration; Contract No. 200-2007-M-21619 between the National Academy of Sciences and Centers for Disease Control and Prevention Division of Nutrition and Physical Activity and Obesity; Contract No. N01-OD-4-2139 TO 192 between the National Academy of Sciences and National Institutes of Health Institute of Child Health and Human Development; Contract No. N01-OD-4-2139 TO 192 between the National Academy of Sciences and National Institutes of Health National Institute of Diabetes and Digestive and Kidney Diseases; Contract No. HHSP23300700522P between the National Academy of Sciences and U.S. Department of Health and Human Services Office on Women’s Health; Contract No. HHSP23320070071P between the National Academy of Sciences and U.S. Department of Health and Human Services Office of Disease Prevention and Health Promotion; and Contract No. 21- FY07-576 between the National Academy of Sciences and March of Dimes. Additional support came from U.S. Department of Health and Human Services Office of Minority Health and the National Minority AIDS Council. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project. International Standard Book Number 0-309-XXXXX-X (Book) International Standard Book Number 0-309- XXXXX -X (PDF) Library of Congress Control Number: 00 XXXXXX Additional copies of this report are available from the National Academies Press, 500 Fifth Street, N.W., Lockbox 285, Washington, DC 20055; (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area); Internet, http://www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu. Copyright 2009 by the National Academy of Sciences. All rights reserved. Printed in the United States of America. The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin. Suggested citation: IOM (Institute of Medicine). 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press. PREPUBLICATION COPY: UNCORRECTED PROOFS PREPUBLICATION COPY: UNCORRECTED PROOFS The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of the National Research Council. www.national-academies.org PREPUBLICATION COPY: UNCORRECTED PROOFS COMMITTEE ON THE REEXAMINATION OF IOM PREGNANCY WEIGHT GUIDELINES KATHLEEN M. RASMUSSEN (Chair), Professor of Nutrition, Division of Nutritional Sciences, Cornell University, Ithaca, NY BARBARA ABRAMS, Professor, School of Public Health, University of California–Berkeley LISA M. BODNAR, Assistant Professor, Department of Epidemiology, University of Pittsburgh, PA CLAUDE BOUCHARD, Executive Director and George A. Bray Chair in Nutrition, Pennington Biomedical Research Center, Baton Rouge, LA NANCY BUTTE, Professor of Pediatrics, Baylor College of Medicine, Houston, TX PATRICK M. CATALANO, Chair, Department of Obstetrics and Gynecology, Case Western Reserve University, Cleveland, OH MATTHEW GILLMAN, Professor, Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, MA FERNANDO A. GUERRA, Director of Health, San Antonio Metropolitan Health District, TX PAULA A. JOHNSON, Executive Director, Connors Center for Women’s Health and Gender Biology, Chief, Division of Women’s Health, Brigham and Women’s Hospital, Boston, MA MICHAEL C. LU, Associate Professor of Obstetrics, Gynecology, and Public Health, Schools of Medicine and Public Health, University of California–Los Angeles ELIZABETH R. McANARNEY, Professor and Chair Emerita, Department of Pediatrics, School of Medicine and Dentistry, University of Rochester, NY RAFAEL PEREZ-ESCAMILLA, Professor of Nutritional Sciences & Public Health, Director, NIH EXPORT Center for Eliminating Health Disparities among Latinos, University of Connecticut, Storrs DAVID A. SAVITZ, Charles W. Bluhdorn Professor of Community & Preventive Medicine, Director, Epidemiology, Biostatistics, and Disease Prevention Institute, Mount Sinai School of Medicine, New York, NY ANNA MARIA SIEGA-RIZ, Associate Professor, Department of Epidemiology, School of Public Health, University of North Carolina–Chapel Hill Study Staff ANN L. YAKTINE, Senior Program Officer HEATHER B. DEL VALLE, Research Associate M. JENNIFER DATILES, Senior Program Assistant ANTON BANDY, Financial Officer GERALDINE KENNEDO, Administrative Assistant LINDA D. MEYERS, Food and Nutrition Board Director ROSEMARY CHALK, Director, Board on Children, Youth, and Families PREPUBLICATION COPY: UNCORRECTED PROOFS v PREPUBLICATION COPY: UNCORRECTED PROOFS vi Reviewers This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council's (NRC’s) Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report: Haywood Brown, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC Cutberto Garza, Boston College, MA Susan Gennaro, William F. Connell School of Nursing, Boston College, MA William Goodnight, Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of North Carolina–Chapel Hill School of Medicine Erica P. Gunderson, Division of Research, Kaiser Permanente, Oakland, CA Maxine Hayes, Department of Health, State of Washington, Tumwater Lorraine V. Klerman, The Heller School for Social Policy and Management, Brandeis University, Waltham, MA Kristine G. Koski, School of Dietetics and Human Nutrition,