More than 60% of U.S. women of childbearing age are overweight or obese -- a significant increase from 20 years ago. And recent studies strongly suggest that either too much or too little nutrition in utero can increase a fetus' chance of becoming an overweight child and overweight adult.
Such data on the increasing girth of pregnant women and the growing rates of obesity in children led to pressure on the Institute of Medicine to revise a set of 1990 guidelines that were written primarily to prevent excessively low infant birth weights. Numerous medical journal articles in recent years have called the guidelines irrelevant to today's obstetrics patients.
On Thursday, the institute's advisory committee -- a task force of doctors and researchers -- issued the updated recommendations. But with few exceptions, such as putting a limit on how much weight obese women should gain, the new guidelines are the old guidelines wrapped up in a lecture.
The panel said that the existing guidelines were essentially fine. It's women and their doctors, the members said, who need to try harder -- often much harder -- to help the women reach a normal weight before pregnancy and avoid excessive weight gain during pregnancy.
"Although not dramatically different, fully implementing the guidelines will represent a change in the care provided to women of childbearing age," said Kathleen Rasmussen, chairwoman of the committee and a professor of nutrition at Cornell University.
The report was requested by six major health organizations so that doctors could better advise and care for their patients. Although nothing in the report is mandatory, healthcare professionals are expected to acknowledge and implement at least some of the panel's recommendations.
But several leading experts on maternal obesity and child health expressed disappointment with the document. A growing contingent of doctors says that obese women -- which includes one in every five pregnant women -- should gain little or no weight.
"In my opinion, the Institute of Medicine is missing an opportunity to address the issue of the obesity epidemic and the contribution that pregnancy makes to that epidemic," said Dr. Raul Artal, chairman of the department of obstetrics, gynecology and women's health at St. Louis University.
