Sponsors asked the IOM's Food and Nutrition Board and the Division of Behavioral and Social Sciences and Education Board on Children, Youth, and Families to review and update the IOM (1990) recommendations for weight gain during pregnancy and recommend ways to encourage their adoption through consumer education, strategies to assist practitioners, and public health strategies.The committee was asked to address the following tasks: 1. Review evidence on the relationship between weight gain patterns before, during, and after pregnancy and maternal and child health outcomes, with particular attention to the prevalence of maternal obesity racial/ethnic and age differences, components of GWG, and implications of weight during pregnancy on postpartum weight retention, maternal and child obesity, and later child health. 2. Within a life-stage framework consider factors in relation to GWG that are associated with maternal health outcomes such as lactation performance, postpartum weight retention, cardiovascular disease, metabolic processes including glucose and insulin-related issues, and risk of other chronic diseases; for infants and children, in addition to low birth weight, consider early developmental impacts and obesity-related consequences (e.g., mental health, diabetes). 3. Recommend revisions to the existing guidelines, where necessary, including the need for specific pregnancy weight guidelines for underweight, normal weight, and overweight and obese women and adolescents and women carrying twins or higher-order multiples. 4. Consider a range of approaches to promote appropriate weight gain, including: individual (behavior), psychosocial, community, health care, and health systems; timing and components of interventions; and ways to enhance awareness and adoption of the guidelines, including interdisciplinary approaches, consumer education to men and women, strategies to assist practitioners to use the guidelines, and public health strategies. 5. Identify gaps in knowledge and recommend research priorities.

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Weight Gain During Pregnancy: Reexamining the Guidelines

Preface Abstract 1. Basis of ICRP Reference Values 2. Summary of Reference Values 3. Embryo and Fetus 4. Total Body 5. Respiratory System 6. Alimentary System 7. Circulatory and Lymphatic Systems 8. Urogenital System 9. Skeletal System 10. Integumentary System 11. Additional Organs and Tissues 12. Pregnant Woman: Anatomical and Physiological Changes 13. Elemental Composition of the Body Reference

Basic anatomical and physiological data for use in radiological protection : reference values

Available standard intrauterine growth curves based on birthweights underestimate foetal growth in preterm period. New growth curves are presented based on data from four Scandinavian centres for 759 ultrasonically estimated foetal weights in 86 uncomplicated pregnancies. Mean weight of boys exceeded that of girls by 2-3%. A uniform SD value of 12% of the mean weight was adopted for the standard curves as the true SD varied non-systematically between 9.1 and 12.4%. Applied to an unselected population of 8663 singleton births, before 210 days of gestation, 32% of birthweights were classified as small-for-gestational age (SGA; i.e. below mean - 2 SD); the corresponding figures were 11.1% for gestational ages between 210 and 258 days, and 2.6% for ages of 259 days or longer. The new growth curves reveal better the true distribution of SGA foetuses and neonates, and are suggested for use in perinatological practice.

Intrauterine growth curves based on ultrasonically estimated foetal weights.

Inadequate maternal vascular response to placentation in pregnancies complicated by pre-eclampsia and by small-for-gestational age infants.

During human evolutionary history, there were "trade-offs" between expending time and energy on child-rearing and mating, so both men and women evolved conditional mating strategies guided by cues signaling the circumstances. Many short-term matings might be successful for some men; others might try to find and keep a single mate, investing their effort in rearing her offspring. Recent evidence suggests that men with features signaling genetic benefits to offspring should be preferred by women as short-term mates, but there are trade-offs between a mate's genetic fitness and his willingness to help in child-rearing. It is these circumstances and the cues that signal them that underlie the variation in short- and long-term mating strategies between and within the sexes.

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The evolution of human mating: Trade-offs and strategic pluralism

The assessment of fetal growth.

The physiology of human pregnancy

List of Contributors Foreword Preface to third edition Part 1: The Cardiovascular and Respiratory Systems: 1. Very Early Changes in Cardiovascular Physiology 2. The Cardiovascular System 3. The Haematological System 4. The Respiratory System 5. The Immune System Part 2: Nutrition and Metabolism: 6. Nutrition 7. Carbohydrate Metabolism 8. Calcium Metabolism 9. Pharmacokinetics Part 3: The Urogenital System: 10. The Urinary System 11. The Genital System Part 4: The Endocrine System 12. The Hypothalamus and Pituitary Gland 13. The Thyroid Gland 14. The Adrenal Gland 15. The Ovary Part 5: The Placenta: 16. Placental Metabolism Part 6: The Fetus 17. Conception to Implantation 18. Fetal Nutrition and Growth Index

Clinical physiology in obstetrics

1. Skinfold thicknesses at seven sites were measured during and after pregnancy in eighty- four women; in forty-eight of these, total body water was measured concurrently.2. Early in pregnancy (10 weeks) the skinfold measurements were highly correlated with each other and with maternal weight, ratio of observed weight to standard weight-for-height,‘dry’ (water-free) weight, and with calculated estimates of body fat.3. At nearly all sites, skinfold thicknesses increased up to about 30 weeks of pregnancy. Increases were greater at ‘central’ and least at ‘peripheral’ sites, and were not proportional to the initial skinfold thickness.4. From 30 to 38 weeks of pregnancy, the patterns were variable: the mid-thigh skinfold continued to increase and at the other sites there was little change or a decrease.5. All sites decreased by a surprisingly large amount between 38 weeks of pregnancy and the end of the first post-partum week. The evidence suggests that this change, which was not related to the presence or absence of oedema, occurred about the time of parturition.6. From the end of the first post-partum week to 6–8 weeks post partum, the changes were again variable.7. The increase of skinfolds during pregnancy was greater in underweight than in overweight women, and in primiparae than in multiparae. The pattern of change was not affected in any consistent manner by oedema.8. The changes in skinfold thicknesses during pregnancy, especially up to about 30 weeks, showed patterns similar to those of total body-weight and ‘dry’ body-weight. A formula is given by means of which ‘dry’ weight can be predicted from five skinfolds, height and duration of gestation.

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F. E. Hytten

Papers

The assessment of fetal growth.

The physiology of human pregnancy

Clinical physiology in obstetrics

Changes in skinfolds during pregnancy

The weight of the placenta in relation to birthweight