Maternal & Newborn Atlas
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Weight gain in pregnancy above or below the recommended range

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.

  • Risk factor
  • In this atlas

Overview

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.

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).

Type
Exposure

Contexts

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
Eligibility: 1 inclusion criterion; 1 exclusion criterion
Included
  • Observational studies stratified by prepregnancy BMI category and total gestational weight gain
Excluded
  • Not stated in the PubMed abstract

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)
Eligibility: 1 inclusion criterion; 1 exclusion criterion
Included
  • Pregnant adolescents and adults in primary care settings
Excluded
  • Not stated in the PubMed abstract

Claims and evidence

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
Eligibility: 1 inclusion criterion; 1 exclusion criterion
Included
  • Observational studies stratified by prepregnancy BMI category and total gestational weight gain
Excluded
  • Not stated in the PubMed abstract

  • Description Evidence synthesis Certainty not assessed

    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).

    Applies to Newborn
    • 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.
    • Not stated in the PubMed abstract
    • Not stated in the PubMed abstract
    • Pregnancy and birth
    • Gestational age Not reported
    • Postnatal age Not reported
    Follow-up Not stated in the PubMed abstract
    Certainty method
    Not assessed
    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
    Next evidence check due
    Not scheduled
    Sources and citations (10)

    1. Supports Association of Gestational Weight Gain With Maternal and Infant Outcomes: A Systematic Review and Meta-analysis

      Publication · JAMA · 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. · Published 2017-06-06 · DOI: 10.1001/jama.2017.3635 · PMID: 28586887 · PMCID: PMC5815056

      Locator
      Abstract, RESULTS, sentence 1
      How it applies
      PubMed abstract of the JAMA 2017 meta-analysis.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      a3fe64b05a81131457484314f20e2da752bf03ded3aec280e93f3947334de224
      Reuse basis
      PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.

    2. Supports Association of Gestational Weight Gain With Maternal and Infant Outcomes: A Systematic Review and Meta-analysis

      Publication · JAMA · 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. · Published 2017-06-06 · DOI: 10.1001/jama.2017.3635 · PMID: 28586887 · PMCID: PMC5815056

      Locator
      Abstract, RESULTS, sentence 2
      How it applies
      PubMed abstract of the JAMA 2017 meta-analysis.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      a3fe64b05a81131457484314f20e2da752bf03ded3aec280e93f3947334de224
      Reuse basis
      PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.

    3. Supports Association of Gestational Weight Gain With Maternal and Infant Outcomes: A Systematic Review and Meta-analysis

      Publication · JAMA · 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. · Published 2017-06-06 · DOI: 10.1001/jama.2017.3635 · PMID: 28586887 · PMCID: PMC5815056

      Locator
      Abstract, RESULTS, sentence 3
      How it applies
      PubMed abstract of the JAMA 2017 meta-analysis.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      a3fe64b05a81131457484314f20e2da752bf03ded3aec280e93f3947334de224
      Reuse basis
      PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.

    4. Supports Association of Gestational Weight Gain With Maternal and Infant Outcomes: A Systematic Review and Meta-analysis

      Publication · JAMA · 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. · Published 2017-06-06 · DOI: 10.1001/jama.2017.3635 · PMID: 28586887 · PMCID: PMC5815056

      Locator
      Abstract, RESULTS, sentence 4
      How it applies
      PubMed abstract of the JAMA 2017 meta-analysis.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      a3fe64b05a81131457484314f20e2da752bf03ded3aec280e93f3947334de224
      Reuse basis
      PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.

    5. Background Association of Gestational Weight Gain With Maternal and Infant Outcomes: A Systematic Review and Meta-analysis

      Publication · JAMA · 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. · Published 2017-06-06 · DOI: 10.1001/jama.2017.3635 · PMID: 28586887 · PMCID: PMC5815056

      Locator
      Abstract, RESULTS, sentence 5
      How it applies
      Scope, outcomes, search and the authors’ conclusion.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      a3fe64b05a81131457484314f20e2da752bf03ded3aec280e93f3947334de224
      Reuse basis
      PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.

    6. Background Association of Gestational Weight Gain With Maternal and Infant Outcomes: A Systematic Review and Meta-analysis

      Publication · JAMA · 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. · Published 2017-06-06 · DOI: 10.1001/jama.2017.3635 · PMID: 28586887 · PMCID: PMC5815056

      Locator
      Abstract, OBJECTIVE, sentence 1
      How it applies
      Scope, outcomes, search and the authors’ conclusion.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      a3fe64b05a81131457484314f20e2da752bf03ded3aec280e93f3947334de224
      Reuse basis
      PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.

    7. Background Association of Gestational Weight Gain With Maternal and Infant Outcomes: A Systematic Review and Meta-analysis

      Publication · JAMA · 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. · Published 2017-06-06 · DOI: 10.1001/jama.2017.3635 · PMID: 28586887 · PMCID: PMC5815056

      Locator
      Abstract, MAIN OUTCOMES AND MEASURES, sentence 1
      How it applies
      Scope, outcomes, search and the authors’ conclusion.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      a3fe64b05a81131457484314f20e2da752bf03ded3aec280e93f3947334de224
      Reuse basis
      PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.

    8. Background Association of Gestational Weight Gain With Maternal and Infant Outcomes: A Systematic Review and Meta-analysis

      Publication · JAMA · 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. · Published 2017-06-06 · DOI: 10.1001/jama.2017.3635 · PMID: 28586887 · PMCID: PMC5815056

      Locator
      Abstract, DATA SOURCES AND STUDY SELECTION, sentence 1
      How it applies
      Scope, outcomes, search and the authors’ conclusion.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      a3fe64b05a81131457484314f20e2da752bf03ded3aec280e93f3947334de224
      Reuse basis
      PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.

    9. Background Association of Gestational Weight Gain With Maternal and Infant Outcomes: A Systematic Review and Meta-analysis

      Publication · JAMA · 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. · Published 2017-06-06 · DOI: 10.1001/jama.2017.3635 · PMID: 28586887 · PMCID: PMC5815056

      Locator
      Abstract, CONCLUSIONS AND RELEVANCE, sentence 1
      How it applies
      Scope, outcomes, search and the authors’ conclusion.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      a3fe64b05a81131457484314f20e2da752bf03ded3aec280e93f3947334de224
      Reuse basis
      PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.

    10. Background Association of Gestational Weight Gain With Maternal and Infant Outcomes: A Systematic Review and Meta-analysis

      Publication · JAMA · 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. · Published 2017-06-06 · DOI: 10.1001/jama.2017.3635 · PMID: 28586887 · PMCID: PMC5815056

      Locator
      Abstract, CONCLUSIONS AND RELEVANCE, sentence 2
      How it applies
      Scope, outcomes, search and the authors’ conclusion.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      a3fe64b05a81131457484314f20e2da752bf03ded3aec280e93f3947334de224
      Reuse basis
      PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.

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)
Eligibility: 1 inclusion criterion; 1 exclusion criterion
Included
  • Pregnant adolescents and adults in primary care settings
Excluded
  • Not stated in the PubMed abstract

  • Recommendation Guidance Certainty not assessed

    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.

    Applies to Maternal
    • Pregnant adolescents and adults in primary care settings.
    • Primary care settings.
    • United States (statement of the US Preventive Services Task Force); the abstract names no country.
    • Pregnancy
    • Gestational age Not reported
    • Postnatal age Not reported
    Follow-up Not applicable (recommendation context)
    Certainty method
    Not assessed
    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
    Next evidence check due
    Not scheduled
    Sources and citations (6)

    1. Supports Behavioral Counseling Interventions for Healthy Weight and Weight Gain in Pregnancy: US Preventive Services Task Force Recommendation Statement

      Publication · JAMA · 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. · Published 2021-05-25 · DOI: 10.1001/jama.2021.6949 · PMID: 34032823

      Locator
      Abstract, RECOMMENDATION, sentence 1
      How it applies
      PubMed abstract of the USPSTF 2021 statement.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      3074a6ab3e539b67e48bd9561427f24f907c357a0ad56b5c433e5e0ad8f44b68
      Reuse basis
      PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.

    2. Supports Behavioral Counseling Interventions for Healthy Weight and Weight Gain in Pregnancy: US Preventive Services Task Force Recommendation Statement

      Publication · JAMA · 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. · Published 2021-05-25 · DOI: 10.1001/jama.2021.6949 · PMID: 34032823

      Locator
      Abstract, RECOMMENDATION, sentence 2
      How it applies
      PubMed abstract of the USPSTF 2021 statement.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      3074a6ab3e539b67e48bd9561427f24f907c357a0ad56b5c433e5e0ad8f44b68
      Reuse basis
      PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.

    3. Supports Behavioral Counseling Interventions for Healthy Weight and Weight Gain in Pregnancy: US Preventive Services Task Force Recommendation Statement

      Publication · JAMA · 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. · Published 2021-05-25 · DOI: 10.1001/jama.2021.6949 · PMID: 34032823

      Locator
      Abstract, EVIDENCE ASSESSMENT, sentence 1
      How it applies
      PubMed abstract of the USPSTF 2021 statement.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      3074a6ab3e539b67e48bd9561427f24f907c357a0ad56b5c433e5e0ad8f44b68
      Reuse basis
      PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.

    4. Background Behavioral Counseling Interventions for Healthy Weight and Weight Gain in Pregnancy: US Preventive Services Task Force Recommendation Statement

      Publication · JAMA · 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. · Published 2021-05-25 · DOI: 10.1001/jama.2021.6949 · PMID: 34032823

      Locator
      Abstract, POPULATION, sentence 1
      How it applies
      Population, status as a new recommendation and background.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      3074a6ab3e539b67e48bd9561427f24f907c357a0ad56b5c433e5e0ad8f44b68
      Reuse basis
      PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.

    5. Background Behavioral Counseling Interventions for Healthy Weight and Weight Gain in Pregnancy: US Preventive Services Task Force Recommendation Statement

      Publication · JAMA · 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. · Published 2021-05-25 · DOI: 10.1001/jama.2021.6949 · PMID: 34032823

      Locator
      Abstract, OBJECTIVE, sentence 2
      How it applies
      Population, status as a new recommendation and background.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      3074a6ab3e539b67e48bd9561427f24f907c357a0ad56b5c433e5e0ad8f44b68
      Reuse basis
      PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.

    6. Background Behavioral Counseling Interventions for Healthy Weight and Weight Gain in Pregnancy: US Preventive Services Task Force Recommendation Statement

      Publication · JAMA · 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. · Published 2021-05-25 · DOI: 10.1001/jama.2021.6949 · PMID: 34032823

      Locator
      Abstract, IMPORTANCE, sentence 4
      How it applies
      Population, status as a new recommendation and background.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      3074a6ab3e539b67e48bd9561427f24f907c357a0ad56b5c433e5e0ad8f44b68
      Reuse basis
      PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.

Record details

Record id
maternal:gestational-weight-gain-outside-range
Content hash
d9b1e760fe8a8d11efe9d010917c502ca02c6d980097ba3710025a08f17f8557