Implications of the Institute of Medicine weight gain recommendations for preventing adverse pregnancy outcomes in Black and White women

Objectives. This study examined the relation between gestational weight gain and risk of delivering a small-for-gestational-age or large-for- gestational-age infant by race, along with the implications of gaining weight according to the Institute of Medicine guidelines. Methods. Logistic regression methods were used to identify risk factors for small- and large- for-gestational-age births among 2617 Black and 1253. White women delivering at the Johns Hopkins Hospital between 1987 and 1989. Results. Rate of total weight gain was related to risk of small- and large for-gestational-age births; the relationship differed according to maternal body mass index but not race. No differences in outcome by race were evident for women with low body mass indexes, among those with average or high indexes, however. Black women were at higher risk of small-for-gestational-age births and at lower risk of large-for-gestational-age births. Conclusions. Having Black women gain at the upper end of the recommended range is unlikely to produce measurable reductions in small-for-gestational-age births. Some beneficial reductions in the risk of large-for-gestational-age births may occur if weight gain recommendations are lowered for average-weight and overweight White women.