Guideline 2: Prenatal Weight Assessment
Purpose
Supporting healthy weight gain during pregnancy promotes healthy birth outcomes. Clients with either a rapid or slow weight gain during later pregnancy are at increased risk for preterm births. Those with high pre-pregnancy BMI have increased risk for gestational diabetes, hypertension, and preeclampsia, among other risks. Using the World Health Organization BMI calculations, the Institute of Medicine recommends total pregnancy weight gain be based upon pre-pregnancy weight or weight at the first prenatal care appointment.
Process (Singleton Pregnancy)
- Calibrated scales are recommended: assure that scales are calibrated at least annually, or per manufacturer recommendations.
- Document client self-report of pre-pregnancy weight.
- Measure height, without shoes, during initial assessment. If the home visitor has no means to measure height, use client self-report or obtain information from pregnancy care provider.
- If a scale is available, weigh client and document weight at every prenatal visit. If reliable scales are not available, work with pregnancy care provider to ensure weight is measured. A weight from the last provider visit or self-report is acceptable if noted in medical record.
- Appropriate weight gain should be:
- 1 to 4 pounds total in first 3 months
- 2 to 4 pounds each month from 4 months to delivery
- Using pre-pregnancy weight, compute BMI using NIH website:
https://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmi-m.htm - Plot weight gain using the following
grids, by pre-pregnancy BMI.
- Ensure provider is alerted if client is losing weight or gaining weight excessively.
Table 1: Weight Gain for Singleton Pregnancy
* IOM for overweight and obese people have raised concerns among physicians; ACOG statement is that the relationship between pregnancy weight gain, fetal weight gain and pregnancy outcomes is complex. It may be reasonable for clients who are overweight or obese to gain less weight than recommended, per their provider guidelines (3). Process (Twin Pregnancy):
- Calibrated scales are recommended: assure that scales are calibrated at least annually, or per manufacturer recommendations.
- Document client self-report of pre-pregnancy weight.
- Measure height, without shoes, during initial assessment. If the home visitor has no means to measure height, use client self-report or obtain information from pregnancy care provider.
- If a scale is available, weigh client and document weight at every prenatal visit. If reliable scales are not available, work with pregnancy care provider to ensure weight is measured. A weight from the last provider visit or self-report is acceptable if noted in medical record.
- Using pre-pregnancy weight, compute BMI. Use the NIH website:
https://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmi-m.htm
- Alert prenatal care provider if client is losing weight or gaining weight excessively (see Table 2) .
- Support clients in maintaining a healthy weight between pregnancies. Weight should be assessed via scale, self-report, or primary care office up to 12 weeks post-partum.
Table 2: Weight Gain for Twin Pregnancy
References
- Institute of Medicine & National Research Council. (2009). Weight gain during pregnancy: Reexamining the guidelines. The National Academies Press.
https://doi.org/10.17226/12584
- Centers for Disease Control and Prevention. (2017). Weight gain during pregnancy. Retrieved October, 2024, from
https://www.cdc.gov/maternal-infant-health/pregnancy-weight/?CDC_AAref_Val=https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pregnancy-weight-gain.htm
- American College of Obstetricians and Gynecologists. (2013). Weight gain during pregnancy: Committee opinion no. 548. Obstetrics & Gynecology, 121(1), 210–212. doi: 10.1097/01.aog.0000425668.87506.4c.
- Academy of Breastfeeding Medicine. (2017). Supplementation protocol. Breastfeeding Medicine, 17(3). Retrieved from
https://abm.memberclicks.net/assets/DOCUMENTS/PROTOCOLS/3-supplementation-protocol-english.pdf