Weight Gain Recommendations in Pregnancy

General Guidelines

Women with normal pre-pregnancy BMI (18.5-24.9 kg/m²) should gain 11.5-16 kg during pregnancy, while overweight women (BMI 25-29.9) should gain 7-11.5 kg, and obese women (BMI ≥30) should gain only 5-9 kg, according to the American College of Obstetricians and Gynecologists 1, 2
The European Society of Cardiology recommends that obese women (BMI ≥30) should gain only 5-9 kg during pregnancy 3, 1, 2

Underweight women (BMI <18.5) should gain 12.5-18 kg during pregnancy 2
Normal-weight women (BMI 18.5-24.9) should gain 11.5-16 kg during pregnancy 1, 2
Overweight women (BMI 25-29.9) should gain 7-11.5 kg during pregnancy 2
Obese women (BMI ≥30) should gain 5-9 kg during pregnancy 3, 1, 2

Normal-weight women should gain 1.4-2.3 kg in the first trimester 2
Normal-weight women should gain 0.5-0.9 kg per week in the second and third trimesters 1, 2

Gaining more than the upper limit for the BMI category constitutes excessive weight gain and substantially increases pregnancy complications, according to the American College of Obstetricians and Gynecologists 4
Normal-weight women should not gain more than 16 kg (35 lbs) total or 0.9 kg per week after the first trimester 4
Overweight women should not gain more than 11.5 kg (25 lbs) total 4
Obese women should not gain more than 9 kg (20 lbs) total 4

Excessive weight gain is associated with gestational hypertension and preeclampsia 2, 4, 3
Excessive weight gain is associated with gestational diabetes 2, 4
Excessive weight gain is associated with large-for-gestational-age infants and birth injury 4
Excessive weight gain is associated with long-term maternal postpartum weight retention and future obesity 4
Excessive weight gain is associated with childhood obesity in offspring 4

Establish baseline pre-pregnancy weight and calculate BMI at the first prenatal visit 4
Discuss weight gain targets specific to the BMI category at the first prenatal visit 4
Counsel on nutrition: 300 kcal/day increase only in the second and third trimesters, protein 0.75 g/kg/day plus 10 g/day 2
Initiate folic acid 400 µg/day at the first prenatal visit 2
Weigh patients at every visit and plot on an individualized growth chart 4
If first-trimester gain exceeds 2.3 kg in normal-weight women, provide immediate intensive counseling 4
If weekly gain exceeds 0.9 kg after the first trimester in normal-weight women, intervene with dietary and activity counseling 4

Recommending weight reduction during pregnancy in obese women is contraindicated as it reduces neonatal weight, according to the European Society of Cardiology 3
Restricting salt intake may induce low intravascular volume near delivery, according to the European Society of Cardiology 3