the WHO cutoff points for adults, in part because of the impracticality of using pediatric growth charts in obstetric practices. Adolescents who follow adult BMI cutoff points will likely be categorized in a lighter group and thus advised to gain more; however, younger adolescents often need to gain more to improve birth outcomes.

Racial or Ethnic Groups

Although an increasing proportion of pregnant U.S. women are members of racial or ethnic minority groups, the limited data available to the committee from commissioned analyses suggested that membership in one of these groups did not modify the association between GWG and the outcome of pregnancy. As a result, the committee concluded that its recommendations should be generally applicable to the various racial or ethnic subgroups that make up the American population, although additional research is needed to confirm this approach.

Women with Multiple Fetuses

Recent data suggest that the weight gain of women with twins who have good outcomes varies with prepregnancy BMI as is clearly the case for women with singleton fetuses. Inasmuch as the committee was unable to conduct the same kind of analysis for women with twins as it did for women with singletons, the committee offers the following provisional guidelines: normal weight women should gain 17-25 kg (37-54 pounds), overweight women, 14-23 kg (31-50 pounds), and obese women, 11-19 kg (25-42 pounds) at term. Insufficient information was available with which to develop even a provisional guideline for underweight women with multiple fetuses. These provisional guidelines reflect the interquartile (25th to 75th percentiles) range of cumulative weight gain among women who delivered their twins, who weighed ≥ 2,500 g on average, at 37-42 weeks of gestation.


The committee worked from the perspectives that the reproductive cycle begins before conception and continues through the first year postpartum and that maternal weight status throughout the entire cycle affects both the mother and her child. To inform its review of the literature and to guide the organization of its report, the committee reevaluated the conceptual framework that guided the development of the IOM (1990) report.

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