Review set for pregnancy weight advice

ATLANTA (AP) -- Before Jennifer Lepine became pregnant, she heard other soon-to-be moms say she should "eat for two." But that conflicted with what her doctor told her: Consume only 300 extra calories a day and gain no more than 35 pounds.

The slightly overweight suburban Atlanta woman decided to ignore her friends and watched what she ate after she became pregnant with her first child. The 5-foot-2, 145-pound Lepine gained 35 pounds before her son Bryson was born last year. It took her four months to drop the extra weight through healthy eating and exercise.

An influential U.S. medical panel is considering changes to the medical guidelines for how much weight a woman should gain during pregnancy. It's acting on the insistence of doctors who say heavy moms are gaining too much weight and the current recommendations do not factor in the country's obesity epidemic.

Carrying too much weight while pregnant increases the risk of complications for mother and baby, including birth defects, labor and delivery problems, fetal death and delivery of large babies, according to the March of Dimes.

A revision is long overdue, said Dr. Raul Artal of the Saint Louis University School of Medicine.

"The reality is for too long we are telling pregnant women to take it easy during pregnancy, be confined and to eat for two," he said. "This has been one factor in causing the epidemic of overweight and obesity that we see in our country."

This fall, the Institute of Medicine, a private organization that advises the federal government, is expected to begin the lengthy process of gathering scientific evidence to decide if the guidelines should be changed, said spokeswoman Christine Stencel.

"The decision ultimately should be driven by real data ... but most of us think overall the weight gain recommendations are too high and particularly for women who have high body mass indexes to begin with," said Dr. Charles Longwood of Yale University School of Medicine.

Under the institute's 1990 guidelines, those with a "normal" body mass index - a combination of height and weight - were encouraged to gain 25 to 35 pounds. Women with a higher BMI have a lower target - 15 pounds only for the most obese women. Women with a lower BMI should gain more weight during pregnancy - up to 40 pounds.

A study in the April issue of the American Journal of Obstetrics and Gynecology suggested that the current guidelines may raise the risk of mothers having overweight toddlers. Women in the study who followed the IOM's recommendations ran four times the risk of having a child who was overweight at age 3, compared to women who gained less than the advised amount.

Other countries, including Britain and France, have similar advice for pregnant women and weight gain. In Japan, doctors recommend a weight gain of about 10 pounds less than U.S. guidelines.

About one in four pregnant U.S. women gained more than 40 pounds during their pregnancy in 2003, up from about one in five in 1990 when the guidelines were issued, according to an institute report.

"If I get a patient who's gained 25 pounds throughout her entire pregnancy, I'm overjoyed," said Dr. Michael Dawson, Lepine's physician. "A lot of them will gain 50 pounds and 60 pounds and ... people are not that mindful on that impact on overall health and pregnancy complications."

Dr. Patrick Catalano of Case Western Reserve University in Cleveland, said an obese woman has nutrients stored away and doesn't need to gain weight to provide for the baby. The original guidelines were created to make sure babies weren't born small, he added.

But not everyone agrees that changes are needed, said Dr. Naomi Stotland of the University of California at San Francisco.

"People are afraid if you push too hard on the guidelines with excessive weight gain then you'll get inadequate weight gain," Stotland said.

Experts say women should follow existing guidelines while the organization studies whether any changes should be made.

Now pregnant with her second child, Lepine says she is taking a different approach with a healthier diet and participating in new form of exercise with her infant son.

"Chasing a toddler around takes a lot of energy," she said.

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On the Net:

CDC BMI calculator: http://www.cdc.gov/nccdphp/dnpa/bmi/adult-BMI/english-bmi-calculator/bmi-cal

culator.htm

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