# Weight gain in pregnancy above or below the recommended range Risk factor · id `maternal:gestational-weight-gain-outside-range` · Maternal & Newborn Atlas · release `c7fb95f1d15a7d13` (public) > General information from published sources, not medical advice, and not reviewed by clinicians. Check the cited source before relying on anything here. The atlas's own text and curation may be reused under Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0, https://creativecommons.org/licenses/by-nc/4.0/): credit the atlas, and do not use it commercially. See the atlas About page. Text quoted from a source stays under that source's own terms, given as the source's reuse\_basis. The atlas's reuse terms do not cover it. The downloads list each quotation with its source in third\_party\_quotations. Browse, life stage: Pregnancy Browse, care area: Routine pregnancy care ## In plain language Pregnant people are given a range for healthy weight gain that depends on their weight before pregnancy. A large review of studies found that gaining less than the range went with more preterm births and more small babies, and gaining more than the range went with more large babies and more caesarean births, but fewer preterm births and fewer small babies. The review could not say anything about gestational diabetes. US guidance advises offering counseling to help pregnant people gain weight in a healthy way. ## Technical summary Sources: a 2017 JAMA meta-analysis of 23 observational studies (1 309 136 women) against the 2009 Institute of Medicine ranges, and the USPSTF 2021 recommendation on behavioral counseling for pregnant adolescents and adults in primary care (a B recommendation). The link to preterm birth is a navigation link and not a risk link, because the direction depends on the side of the range: gain above the range went with lower odds of preterm birth in the same review. The review lists 23% of pregnancies with gain below and 47% above the ranges. These are associations from observational studies. ## Claims, with the population each applies to ## Context: Infants born to women in 23 observational studies of gestational weight gain (2017 meta-analysis) Recipient: Newborn; Population: Infants of 1 309 136 women in 23 observational studies, grouped by prepregnancy body mass index. The exposure is the mother’s total gestational weight gain compared with the 2009 Institute of Medicine (IOM) ranges. The outcomes in this context are counted in the baby: small for gestational age, preterm birth and large for gestational age.; Care setting: Not stated in the PubMed abstract; Geography: Not stated in the PubMed abstract; Life stage: Pregnancy and birth; Gestational age: Not reported; Postnatal age: Not reported; Follow-up: Not stated in the PubMed abstract ### A 2017 systematic review and meta-analysis of 23 observational studies (1 309 136 women) compared gestational weight gain with the 2009 IOM ranges. Gain was below the range in 23% of pregnancies and above it in 47%. Gain below the range was associated with higher odds of preterm birth (odds ratio 1.70, 95% CI 1.32 to 2.20) and of a small-for-gestational-age baby (OR 1.53, 95% CI 1.44 to 1.64), and with lower odds of a large-for-gestational-age baby (OR 0.59, 95% CI 0.55 to 0.64). Gain above the range was associated with lower odds of preterm birth (OR 0.77, 95% CI 0.69 to 0.86) and of a small-for-gestational-age baby (OR 0.66, 95% CI 0.63 to 0.69), and with higher odds of a large-for-gestational-age baby (OR 1.85, 95% CI 1.76 to 1.95). - Category: Description - Evidence stage: Evidence synthesis - Certainty: Certainty not assessed - Applies to: Recipient: Newborn; Population: Infants of 1 309 136 women in 23 observational studies, grouped by prepregnancy body mass index. The exposure is the mother’s total gestational weight gain compared with the 2009 Institute of Medicine (IOM) ranges. The outcomes in this context are counted in the baby: small for gestational age, preterm birth and large for gestational age.; Care setting: Not stated in the PubMed abstract; Geography: Not stated in the PubMed abstract; Life stage: Pregnancy and birth; Gestational age: Not reported; Postnatal age: Not reported; Follow-up: Not stated in the PubMed abstract - Limitations: These are associations from observational studies, not proof that gaining more or less causes the outcome. The abstract says gestational diabetes could not be evaluated because of the nature of the available data. Maternal outcomes are outside this newborn claim: for cesarean delivery the abstract reports no significant difference when gain was below the range (OR 0.98, 95% CI 0.96 to 1.02) and higher odds above it (OR 1.30, 95% CI 1.25 to 1.35). The IOM ranges used were 12.5 to 18 kg for underweight women (BMI under 18.5), 11.5 to 16 kg for normal weight (18.5 to 24.9), 7 to 11 kg for overweight (25 to 29.9) and 5 to 9 kg for obese women (30 or more). Only the PubMed abstract was read; the full text copy is not in the PMC open access subset. - Last checked: 2026-10-14 - Sources: 1. Supports: Association of Gestational Weight Gain With Maternal and Infant Outcomes: A Systematic Review and Meta-analysis (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities, fetched 2026-10-14. The full text and the version of record were not fetched.) Locator: Abstract, RESULTS, sentence 1. Retrieved 2026-10-14T18:18:20Z. Source state: Current. Snapshot hash: a3fe64b05a81131457484314f20e2da752bf03ded3aec280e93f3947334de224. How it applies: PubMed abstract of the JAMA 2017 meta-analysis. 2. Supports: Association of Gestational Weight Gain With Maternal and Infant Outcomes: A Systematic Review and Meta-analysis (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities, fetched 2026-10-14. The full text and the version of record were not fetched.) Locator: Abstract, RESULTS, sentence 2. Retrieved 2026-10-14T18:18:20Z. Source state: Current. Snapshot hash: a3fe64b05a81131457484314f20e2da752bf03ded3aec280e93f3947334de224. How it applies: PubMed abstract of the JAMA 2017 meta-analysis. 3. Supports: Association of Gestational Weight Gain With Maternal and Infant Outcomes: A Systematic Review and Meta-analysis (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities, fetched 2026-10-14. The full text and the version of record were not fetched.) Locator: Abstract, RESULTS, sentence 3. Retrieved 2026-10-14T18:18:20Z. Source state: Current. Snapshot hash: a3fe64b05a81131457484314f20e2da752bf03ded3aec280e93f3947334de224. How it applies: PubMed abstract of the JAMA 2017 meta-analysis. 4. Supports: Association of Gestational Weight Gain With Maternal and Infant Outcomes: A Systematic Review and Meta-analysis (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities, fetched 2026-10-14. The full text and the version of record were not fetched.) Locator: Abstract, RESULTS, sentence 4. Retrieved 2026-10-14T18:18:20Z. Source state: Current. Snapshot hash: a3fe64b05a81131457484314f20e2da752bf03ded3aec280e93f3947334de224. How it applies: PubMed abstract of the JAMA 2017 meta-analysis. 5. Background: Association of Gestational Weight Gain With Maternal and Infant Outcomes: A Systematic Review and Meta-analysis (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities, fetched 2026-10-14. The full text and the version of record were not fetched.) Locator: Abstract, RESULTS, sentence 5. Retrieved 2026-10-14T18:18:20Z. Source state: Current. Snapshot hash: a3fe64b05a81131457484314f20e2da752bf03ded3aec280e93f3947334de224. How it applies: Scope, outcomes, search and the authors’ conclusion. 6. Background: Association of Gestational Weight Gain With Maternal and Infant Outcomes: A Systematic Review and Meta-analysis (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities, fetched 2026-10-14. The full text and the version of record were not fetched.) Locator: Abstract, OBJECTIVE, sentence 1. Retrieved 2026-10-14T18:18:20Z. Source state: Current. Snapshot hash: a3fe64b05a81131457484314f20e2da752bf03ded3aec280e93f3947334de224. How it applies: Scope, outcomes, search and the authors’ conclusion. 7. Background: Association of Gestational Weight Gain With Maternal and Infant Outcomes: A Systematic Review and Meta-analysis (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities, fetched 2026-10-14. The full text and the version of record were not fetched.) Locator: Abstract, MAIN OUTCOMES AND MEASURES, sentence 1. Retrieved 2026-10-14T18:18:20Z. Source state: Current. Snapshot hash: a3fe64b05a81131457484314f20e2da752bf03ded3aec280e93f3947334de224. How it applies: Scope, outcomes, search and the authors’ conclusion. 8. Background: Association of Gestational Weight Gain With Maternal and Infant Outcomes: A Systematic Review and Meta-analysis (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities, fetched 2026-10-14. The full text and the version of record were not fetched.) Locator: Abstract, DATA SOURCES AND STUDY SELECTION, sentence 1. Retrieved 2026-10-14T18:18:20Z. Source state: Current. Snapshot hash: a3fe64b05a81131457484314f20e2da752bf03ded3aec280e93f3947334de224. How it applies: Scope, outcomes, search and the authors’ conclusion. 9. Background: Association of Gestational Weight Gain With Maternal and Infant Outcomes: A Systematic Review and Meta-analysis (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities, fetched 2026-10-14. The full text and the version of record were not fetched.) Locator: Abstract, CONCLUSIONS AND RELEVANCE, sentence 1. Retrieved 2026-10-14T18:18:20Z. Source state: Current. Snapshot hash: a3fe64b05a81131457484314f20e2da752bf03ded3aec280e93f3947334de224. How it applies: Scope, outcomes, search and the authors’ conclusion. 10. Background: Association of Gestational Weight Gain With Maternal and Infant Outcomes: A Systematic Review and Meta-analysis (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities, fetched 2026-10-14. The full text and the version of record were not fetched.) Locator: Abstract, CONCLUSIONS AND RELEVANCE, sentence 2. Retrieved 2026-10-14T18:18:20Z. Source state: Current. Snapshot hash: a3fe64b05a81131457484314f20e2da752bf03ded3aec280e93f3947334de224. How it applies: Scope, outcomes, search and the authors’ conclusion. ## Context: Pregnant adolescents and adults in primary care (USPSTF 2021 weight gain counseling) Recipient: Maternal; Population: Pregnant adolescents and adults in primary care settings.; Care setting: Primary care settings.; Geography: United States (statement of the US Preventive Services Task Force); the abstract names no country.; Life stage: Pregnancy; Gestational age: Not reported; Postnatal age: Not reported; Follow-up: Not applicable (recommendation context) ### The USPSTF recommends that clinicians offer pregnant persons effective behavioral counseling interventions aimed at promoting healthy weight gain and preventing excess gestational weight gain in pregnancy. It grades this a B recommendation and concludes with moderate certainty that these interventions have a moderate net benefit for pregnant persons. This was a new recommendation in 2021. - Category: Recommendation - Evidence stage: Guidance - Certainty: Certainty not assessed - Applies to: Recipient: Maternal; Population: Pregnant adolescents and adults in primary care settings.; Care setting: Primary care settings.; Geography: United States (statement of the US Preventive Services Task Force); the abstract names no country.; Life stage: Pregnancy; Gestational age: Not reported; Postnatal age: Not reported; Follow-up: Not applicable (recommendation context) - Limitations: Only the PubMed abstract was read. It does not say which counseling methods worked or how large the benefit was. USPSTF certainty levels are the task force’s own wording and not a GRADE rating, so certainty is not assessed. The abstract describes excess weight at the start of pregnancy and excess gain as associated with a large-for-gestational-age infant, cesarean delivery or preterm birth. - Last checked: 2026-10-14 - Sources: 1. Supports: Behavioral Counseling Interventions for Healthy Weight and Weight Gain in Pregnancy: US Preventive Services Task Force Recommendation Statement (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities, fetched 2026-10-14. The full text and the version of record were not fetched.) Locator: Abstract, RECOMMENDATION, sentence 1. Retrieved 2026-10-14T18:18:21Z. Source state: Current. Snapshot hash: 3074a6ab3e539b67e48bd9561427f24f907c357a0ad56b5c433e5e0ad8f44b68. How it applies: PubMed abstract of the USPSTF 2021 statement. 2. Supports: Behavioral Counseling Interventions for Healthy Weight and Weight Gain in Pregnancy: US Preventive Services Task Force Recommendation Statement (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities, fetched 2026-10-14. The full text and the version of record were not fetched.) Locator: Abstract, RECOMMENDATION, sentence 2. Retrieved 2026-10-14T18:18:21Z. Source state: Current. Snapshot hash: 3074a6ab3e539b67e48bd9561427f24f907c357a0ad56b5c433e5e0ad8f44b68. How it applies: PubMed abstract of the USPSTF 2021 statement. 3. Supports: Behavioral Counseling Interventions for Healthy Weight and Weight Gain in Pregnancy: US Preventive Services Task Force Recommendation Statement (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities, fetched 2026-10-14. The full text and the version of record were not fetched.) Locator: Abstract, EVIDENCE ASSESSMENT, sentence 1. Retrieved 2026-10-14T18:18:21Z. Source state: Current. Snapshot hash: 3074a6ab3e539b67e48bd9561427f24f907c357a0ad56b5c433e5e0ad8f44b68. How it applies: PubMed abstract of the USPSTF 2021 statement. 4. Background: Behavioral Counseling Interventions for Healthy Weight and Weight Gain in Pregnancy: US Preventive Services Task Force Recommendation Statement (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities, fetched 2026-10-14. The full text and the version of record were not fetched.) Locator: Abstract, POPULATION, sentence 1. Retrieved 2026-10-14T18:18:21Z. Source state: Current. Snapshot hash: 3074a6ab3e539b67e48bd9561427f24f907c357a0ad56b5c433e5e0ad8f44b68. How it applies: Population, status as a new recommendation and background. 5. Background: Behavioral Counseling Interventions for Healthy Weight and Weight Gain in Pregnancy: US Preventive Services Task Force Recommendation Statement (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities, fetched 2026-10-14. The full text and the version of record were not fetched.) Locator: Abstract, OBJECTIVE, sentence 2. Retrieved 2026-10-14T18:18:21Z. Source state: Current. Snapshot hash: 3074a6ab3e539b67e48bd9561427f24f907c357a0ad56b5c433e5e0ad8f44b68. How it applies: Population, status as a new recommendation and background. 6. Background: Behavioral Counseling Interventions for Healthy Weight and Weight Gain in Pregnancy: US Preventive Services Task Force Recommendation Statement (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities, fetched 2026-10-14. The full text and the version of record were not fetched.) Locator: Abstract, IMPORTANCE, sentence 4. Retrieved 2026-10-14T18:18:21Z. Source state: Current. Snapshot hash: 3074a6ab3e539b67e48bd9561427f24f907c357a0ad56b5c433e5e0ad8f44b68. How it applies: Population, status as a new recommendation and background. ## Connected pages - Gain below the IOM range was associated with higher odds of preterm birth (OR 1.70, 95% CI 1.32 to 2.20) and gain above the range with lower odds (OR 0.77); the link is not a one-way risk. Gestational diabetes could not be evaluated.: Preterm birth (`maternal:preterm-birth`) - The shared obesity page: Obesity (`core:obesity`) ## Provenance Content hash: d9b1e760fe8a8d11efe9d010917c502ca02c6d980097ba3710025a08f17f8557 Last substantive edit: 2026-10-14 Evidence last checked: 2026-10-14