{ "release_id": "c7fb95f1d15a7d13", "id": "maternal:gestational-weight-gain-outside-range", "owner": "maternal", "kind": "risk_factor", "slug": "gestational-weight-gain-outside-range", "name": "Weight gain in pregnancy above or below the recommended range", "aliases": [], "atlases": [ "maternal" ], "summary_plain": "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.", "summary_technical": "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.", "editorial_state": "draft", "last_substantive_edit": "2026-10-14", "last_evidence_check": "2026-10-14", "next_review_due": null, "identifiers": [], "navigation": { "maternal": { "life-stage": [ "pregnancy" ], "care-area": [ "normal-pregnancy" ] } }, "payload": { "factor_type": "exposure", "definition": "Total gestational weight gain that is below or above the 2009 Institute of Medicine range for the person’s prepregnancy BMI category (for example 11.5 to 16 kg for a normal-weight woman and 5 to 9 kg for an obese woman).", "contexts": [ "maternal:ctx-gwg-meta-analysis-infants-of-women-in-23-observational-studies", "maternal:ctx-uspstf-2021-pregnant-adolescents-and-adults-in-primary-care" ] }, "content_digest": "d9b1e760fe8a8d11efe9d010917c502ca02c6d980097ba3710025a08f17f8557", "review": { "content_digest": "d9b1e760fe8a8d11efe9d010917c502ca02c6d980097ba3710025a08f17f8557", "current": [], "conflicting": [], "stale": [], "inactive": [] }, "claims": [ { "release_id": "c7fb95f1d15a7d13", "id": "maternal:claim-gwg-meta-analysis-newborn-outcomes", "owner": "maternal", "subject_entity_id": "maternal:gestational-weight-gain-outside-range", "category": "descriptive", "statement": "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).", "context": { "id": "maternal:ctx-gwg-meta-analysis-infants-of-women-in-23-observational-studies", "label": "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_note": "Pregnancy and birth", "life_stage_terms": { "maternal": [ "pregnancy", "newborn" ] }, "gestational_age_min_days": null, "gestational_age_max_days": null, "gestational_age_basis": null, "postnatal_age_min_days": null, "postnatal_age_max_days": null, "gestational_age_status": null, "postnatal_age_status": null, "followup_description": "Not stated in the PubMed abstract", "eligibility": { "inclusion": [ "Observational studies stratified by prepregnancy BMI category and total gestational weight gain" ], "exclusion": [ "Not stated in the PubMed abstract" ] } }, "evidence_stage": "synthesis", "certainty": "not_assessed", "certainty_method": null, "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.", "editorial_state": "draft", "checked_at": "2026-10-14", "next_review_due": null, "valid_from": null, "valid_to": null, "citations": [ { "evidence_role": "supports", "locator": "Abstract, RESULTS, sentence 1", "applicability_note": "PubMed abstract of the JAMA 2017 meta-analysis.", "snapshot": { "id": "maternal:pubmed-28586887-2026-10-14", "retrieved_at": "2026-10-14T18:18:20Z", "content_hash": "a3fe64b05a81131457484314f20e2da752bf03ded3aec280e93f3947334de224", "source_effective_date": null, "public_archive_url": null, "source_state": "current" }, "source": { "id": "maternal:pubmed-10-1001-jama-2017-3635", "source_type": "publication", "title": "Association of Gestational Weight Gain With Maternal and Infant Outcomes: A Systematic Review and Meta-analysis", "canonical_url": "https://doi.org/10.1001/jama.2017.3635", "identifiers": [ { "scheme": "doi", "value": "10.1001/jama.2017.3635", "normalized_value": "10.1001/jama.2017.3635", "match": "exact", "version": null, "label": null, "from_source": false }, { "scheme": "pmid", "value": "28586887", "normalized_value": "28586887", "match": "exact", "version": null, "label": null, "from_source": false }, { "scheme": "pmcid", "value": "PMC5815056", "normalized_value": "PMC5815056", "match": "exact", "version": null, "label": null, "from_source": false } ], "publication_date": "2017-06-06", "publisher": "JAMA", "edition": "PubMed record (abstract and bibliographic data) from NCBI E-utilities, fetched 2026-10-14. 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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. 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