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Welcome back for another episode. Today we are going to be covering maternal weight gain recommendations in pregnancy. Before I jump in, I wanted to remind you that there is one more date available to attend my live training, the Intern's Guide to Managing labor, where I teach you how to calculate and implement the Bishop score and then use that to manage labor induction and augmentation from start to finish. I've hosted two already and there was a great turnout with positive feedback. People were saying it was helpful. So if you want to be in on that, then go ahead and click the link in the Episode show notes or type into your search bar subscribepage IO interntraining All right, let's jump in. So a few decades back in 1990, the Institute of Medicine made recommendations for the appropriate amount of weight to gain during pregnancy and and in 2009 those same recommendations were updated and these are what I'll be referring to today. So what was the point of these recommendations? Well, over the years it became evident in the literature that women with low pre pregnancy body mass indices and low gestational weight gain had an increased risk for preterm birth, having small for gestational age infants and perinatal mortality. At the same time, if those same women gained excessive weight, they they were then at an increased risk for large for gestational age infants and were more likely to retain more weight postpartum. So the idea was to solidify some parameters that could potentially reduce the incidence of these types of outcomes. Before I get into these parameters, let's review the WHO Body Mass Index classification system. There are six categories. The underweight BMI category include values less than 18.5 kg per meter squared. The normal weight category include values between 18.5 to 24.9 the overweight category include values between 25 to 29.9. The class one obese category include values between 30 to 34.9. Class two obesity include 35 to 39.9 and class three obesity encompass all of those with a BMI of 40 or greater. Conveniently, you only need to remember the weight gain parameters for four of those categories underweight, normal, overweight and obese altogether, because so far we don't have enough data to support refined recommendations for each class of obesity, be that class one, class two or class three. So what are the recommendations? Underweight patients should gain 28 to 40 pounds, normal weight patients should gain 25 to 35 pounds, overweight patients should gain 15 to 25 pounds, and obese patients should gain 11 to 20 pounds. Now you might be thinking Wouldn't it make sense to have even lower parameters for patients with increasingly high body mass indices? Well, that 11 to 20 pound parameter primarily reflects the physiologic weight gain of pregnancy itself, which is about 12 to 14 pounds of water to 2 pounds of protein and some adipose tissue. Additionally, some studies have found that overweight and obese women with inadequate weight gain outside of those parameters were more likely to bear infants that were small for gestational age. That being said, if you have an overweight or obese patient that is gaining less weight than recommended, but their fetus is appropriately grown, there is no evidence to suggest that having them increase their weight gain just to fit those parameters will improve improve maternal or neonatal outcomes. Now we have the weight gain recommendations for singleton pregnancies, but what about multifetal pregnancies? Well, in 2009, the Institute of Medicine updated their recommendations to include parameters for twin pregnancies. Normal weight patients with twin pregnancies should gain 37 to 54 pounds, overweight patients should gain 31 to 50 pounds, and obese patients should gain 25 to 42 pounds. Unsurprisingly, there are no recommendations for higher order gestations given the lack of data. All right, that's it for today. But if you feel like it's too hard to memorize these parameters from a podcast episode, head over to the link in my show notes where you can screenshot the written parameters and save them to your phone as well as view the references. Have a great week and I'll be back next Saturday.