Siega-Riz Examines Gestational Weight Gain Recommendations

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Anna Maria Siega-Riz, dean of the School of Public Health and Health Sciences and an expert in nutritional epidemiology, is the lead author of “The Current Understanding of Gestational Weight Gain Among Women with Obesity and the Need for Future Research,” a discussion paper appearing in “NAM Perspectives,” the journal of the National Academy of Medicine (NAM). Discussion papers are article-length reviews of issues of prominence or emerging prominence to health, medicine, biomedical science and related policy. Their aim is to define and fully describe the key elements shaping an issue, summarize and assess the nature of the evidence base, and present a strategy or priority options for addressing the issue.

Siega-Riz and co-authors Lisa M. Bodnar, Naomi E. Stotland and Jamie Stang were speakers on a Roundtable on Obesity Solutions webinar held in June 2018 by the National Academies of Sciences, Engineering, and Medicine. Their webinar focused on the impacts on maternal and child health among women with obesity and explored new evidence that has emerged since the 2009 Institute of Medicine (IOM) and National Research Council (NRC) gestational weight gain (GWG) recommendations were released.

In a follow-up to that webinar, Siega-Riz and co-authors present a summary of how those 2009 recommendations were made and the major data gap that existed at that time. They note that since the publication of that report, more evidence has emerged about weight gain in pregnancy among women with class II obesity (BMI of 35–39.9) and class III obesity (BMI of 40 or greater). New evidence includes trends in weight gains and associated health outcomes, as well as promising interventions, including digital health tools and group prenatal care.

The authors also provide a discussion of the research gaps that need to be addressed before new recommendations can be made for these groups of women. They suggest that future research employ stronger study designs, include diverse participants, collect more frequent and detailed data, examine differences in GWG by class of obesity, and assess both physiological and socio-economic constructs of health that may impact weight status before and during pregnancy. These types of studies, they note, will be required to examine the complex associations between race, ethnicity, SES, culture, residency status, and stressors and weight status among women of reproductive age.

Siega-Riz and her co-authors also recommend that interventions should be developed with the involvement and engagement of the communities they will serve. “Based on available evidence, the best diet to reduce GWG is any reasonably healthful diet that reduces calories and is acceptable to the woman,” they write. “It is important to listen to patients and communities about their priorities for health when developing interventions for gestational weight gain. Such interventions will be most effective when they are wanted and valued by patients and when their development is informed by communities.”

The National Academy of Medicine’s “NAM Perspectives” health periodical provides a venue for leading health, medical, science, and policy experts to reflect on issues and opportunities important to the advancement of the NAM’s mission.