
                         Roanoke Times
                 Copyright (c) 1995, Landmark Communications, Inc.

DATE: WEDNESDAY, November 3, 1993                   TAG: 9311030023
SECTION: EXTRA                    PAGE: 5   EDITION: METRO 
SOURCE: By JEANNE GOLDBERG, R.D., Ph.D.
DATELINE:                                 LENGTH: Medium

PREGNANCY WEIGHT-GAIN LIMITS MORE COMPLEX NOW

Advice about weight gain and careful monitoring of those added pounds have long been an integral part of every women's prenatal care. In the past few decades that advice has changed dramatically, as evidence mounts in favor of liberalizing the recommendations of how much a mother-to-be should gain.

Forty years ago obstetricians told their patients to put on a maximum of just 15 to 20 pounds, believing that too much added weight leads not only to complications during pregnancy but to obesity afterward. Not uncommonly, women who violated those recommendations were reprimanded by their doctors, who were well-intentioned if lacking in scientific support for their position.

The picture shifted in 1970 with the publication of a report by the National Academy of Sciences, which concluded that limiting maternal weight gain raised the infant's risk of low birth weight, abnormalities and death. For the next 20 years, guidelines for weight gain ranged between 20 and 27 pounds, as researchers continued to examine the apparently straightforward question of the effects of a mother's weight gain on her infant.

Two years ago, some of the fruits of that research effort translated into yet another set of recommendations from the Institute of Medicine of the National Academy of Sciences. The evidence suggested that a single recommendation was not sufficient. Instead, a woman's weight status before she became pregnant was considered.

Now women who are underweight are advised to gain between 28 and 40 pounds; those who are of normal weight, 25 to 35 pounds; and those who are overweight and obese, between 15 and 25 pounds. Even at the upper extremes of weight, the report calls for a minimum weight gain of 15 pounds.

But what about the effect of this added weight gain on the mother's health, and her long-term prospects for being overweight or obese? Researchers have begun to explore that question, and reported some of their findings in a recent issue of the American Journal of Public Health. In the large "National Maternal and Infant Survey," more than one-third of the women retained 5 1/2 pounds 10 to 18 months after they had delivered. Those who gained less than the recommended amount during pregnancy kept on just over a pound, while those who gained within the recommended range, a little over two pounds.

The study showed striking differences between black and white women. At every level of pregnancy gain, black women retained more weight than whites. Nineteen percent of white women whose pregnancy weight gain was in the normal range retained nine pounds or more compared to 45 percent of black women.

The researchers also explored differences among those who gained excessive amounts of weight, which was defined as 20 pounds heavier than pre-pregnancy weight 16 months after delivery. In both black and white women, low socioeconomic status and weight gain above the recommended range were linked to doubled risk of excessive weight retention. Thus, the true influences on risk of obesity following pregnancy are not race but cultural, social, environmental and economic factors.

by CNB