Minnesota Title V MCH Needs Assessment Fact Sheets

Pregnant Women, Mothers and Infants

Optimal Weight Gain in Pregnancy

Summer 2004

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Size of the Problem

Minnesota has over 68,000 births annually and over 1,096,832 women of childbearing age (15 to 44 years old) in the state [1].

Seriousness

People affected by inadequate or excessive weight gain in pregnancy. National research indicates that only 30% to 40% of women actually have prenatal weight gain within the Institute of Medicine (IOM) guidelines [2]. This indicates an estimated 40,800 pregnancies each year in Minnesota that may be affected by inadequate or excessive weight gain during pregnancy

Minnesota Medical Assistance and Minnesota Care participants are assessed at different points of their pregnancy by their health care provider for a variety of health care risk factors. The Minnesota Pregnancy Assessment Form was used for over 54,000 pregnancies during the period of 1998-2001. According to data from this assessment, 9.3% of pregnant women were identified as significantly underweight or overweight during their pregnancy [3].

The Centers for Disease Control and Prevention maintains the Pregnancy Nutrition Surveillance System that collects prenatal and post-partum data on women and their infants participating in publicly funded health, nutrition and food assistance programs such as Women, Infants and Children Nutrition Program (WIC), These data indicate that inadequate prenatal weight gain is a problem for 26% of pregnant WIC participants and excess weight gain a problem for 29% of participants. The data also indicate that 10.9% were underweight and 42.3% were overweight or obese prior to their current pregnancy [4].

Inadequate Prenatal Weight Gain by Race, Minnesota 2002
Race Percentage
White
20.80%
Native American
22.50%
Asian
38.70%
Hispanic
39.50%
African-American
29.80%
All Women
26%
Source: CDC. Pregnancy Nutrition Surveillance System for 2002. 2003
N=8,527

The IOM published guidelines for prenatal weight gain based on pre-pregnancy weight in relation to height and expressed as body mass index (BMI) [5]. Subsequent studies have validated the IOM weight gain during pregnancy guidelines and documented risks for excessive and/or inadequate weight gain during pregnancy including:

  • Increased incidence of low birth weight (<2500 grams) births
  • Increased small for gestational age infants (from inadequate prenatal weight gain)
  • Large for gestational age infants (from excessive prenatal weight gain)
  • High birth weight (>4500 grams)
  • Increased cesarean deliveries; and
  • Increased preterm deliveries [6].

Disparities
Minnesota WIC pregnancy nutrition surveillance data show the following [4]:

  • 16.7% of American Indian pregnant women have high birth weight babies compared to Asians (5.4%), African Americans (8%), Hispanics (10.5%) and whites (11.3%). Obesity, high weight gain and high birth weight predispose both mother and baby to diabetes and the baby to childhood obesity.
  • 54.7% of American Indian pregnant women were more likely to be overweight prior to their current pregnancy compared to Asian (25.9%), Hispanic (41.7%), white (42.5%) and African American (47.4%) pregnant women.
Maternal Weight Gain > Ideal During Pregnancy by Race/Ethnicity, Minnesota WIC 2002
Race/Ethnicity Percentage
White
33.8%
Hispanic
19.5%
Asian
18.9%
American Indian
29.5%
African American
23.2%
Source: CDC. Pregnancy Nutrition Surveillance System for 2002. 2003

Economic
No research on the specific economic impact of inadequate or excessive prenatal weight gain was identified. Substantial research has been conducted on the high costs associated with low birth weight and preterm births.

Interventions

The IOM guidelines for adequate weight gain during pregnancy have been adopted by the national WIC Programs. These guidelines suggest:

  • Women with a low pre-pregnant weight (<19.8 BMI) should gain from 28 to 40 pounds during pregnancy;
  • Women with a BMI between 19.8 and 26.0 should gain from 25 to 35 pounds;
  • Women with a high BMI (26.1 to 29.0) should gain from 15 to 25 pounds; and
  • Obese women with a very high BMI (>29) should gain 15 pounds during pregnancy [5].

Effectiveness of Interventions
Numerous studies have documented the effectiveness of adequate prenatal weight gain on pregnancy outcome [6].

Status

Minnesota Resources
Programs and strategies that promote optimal weight gain during pregnancy include:

  • Local Women, Infants, Children (WIC) Programs
  • Public health nurse home visiting programs
  • Twin Cities Healthy Start
  • Health Plan Perinatal Programs
  • MDH’s Eliminate Disparities in Health Initiative (EHDI) addressing infant mortality reduction
  • Tribal Health initiatives.
  • Southwest MN Integrated Perinatal Programs

All efforts to get women into prenatal care early and to provide preconceptional and inter-conceptional care also address optimal weight before, during and after pregnancy.

Community Awareness
No research has documented community awareness of adequate weight gain during pregnancy in Minnesota

References

1. Minnesota Center for Health Statistics. 2003
2. Hickey CA, McNeal SF, Menefee L, Ivey S. Prenatal weight gain within upper and lower recommended ranges: effect of birthweight on black and white infants. Obstet Gynecol. 1997. 90:489-94.
3. DHS. Minnesota Pregnancy Assessment Form Report #2: Managed Care Organizations and Fee-for-Service Data for 1998-2001. September 2003.
4. CDC. Pregnancy Nutrition Surveillance System for 2002. Minnesota Data. 2003.
5. Subcommittee on Nutritional Status and Weight Gain During Pregnancy. Institute of Medicine. Nutrition During Pregnancy. Washington, DC: National Academy Press. 1990.
6. Hickey CA, Kreauter M, Bronstein J, et al. Low Prenatal Weight Gain Among Adult WIC Participants Delivering Term Singleton Infants: Variation by Maternal and program Participation Characteristics. Mat and Child Health J. 3(3): 129-140. 1999.