- The USPSTF says pregnant people should be offered interventions to support healthy weight gain.
- It found interventions like fitness and nutrition programs may reduce negative birth outcomes.
- Some women’s health experts worry the recommendations could deepen fatphobia in medicine.
- Visit Insider’s homepage for more stories.
Pregnant people should be offered interventions like exercise programs and nutrition counseling in order to support healthy weight gain throughout their pregnancy, the US Preventive Services Task Force (USPSTF) said Tuesday.
The task force, an independent panel of experts that issues health guidance like on when and how often to screen for various cancers, said a range of behavioral counseling interventions can help prevent excess weight gain in pregnancy, which is linked to an increased risk of negative health outcomes like c-section and preterm birth.
This is the first time the USPSTF has taken up the issue of weight gain in pregnancy.
But a women’s health expert told Insider the guidelines are likely to do more harm than good by further stigmatizing fat patients, leading to serious mental health complications and even excess weight gain.
Pregnant people should gain 11 to 18kg
The Centers for Disease Control and Prevention recommends pregnant women gain between 11 and 18kg during pregnancy, depending on their weight before getting pregnant. Generally, people with a “normal” BMI should gain about a pound a week, while people with obesity should gain about a half a pound a week. Most weight gain happens in the second and third trimesters.
Weight gain reflects a healthy, growing fetus, as well as the development of the placenta, the growth of breast tissue and fat stores, and even an increase in blood volume and other fluids.
But the task force said almost half of pregnant people are already overweight or obese, and gaining too much can be harmful to mom and baby. Rates of overweight and obesity in pregnancy are higher in Native American, Black, and Hispanic women than white women.
To see if interventions work to reduce negative birth outcomes, the USPSTF reviewed 68 studies that evaluated various diet, exercise, and behavioral counseling programs in pregnancy. Some included regular group fitness, for example, along with counseling sessions to focus on issues like goal-setting and building social support.
The studies included over 25,000 participants ages 18 to 33 who were coached by a range of professionals including clinicians, registered dietitians, fitness professionals, physiotherapists, and health coaches.
The report found interventions were linked to a lower risk of certain negative outcomes
The USPSFT found that, on the whole, interventions were linked to a lower risk of certain negative outcomes like gestational diabetes, emergency c-sections, and large for gestational age babies. Moms in the programs were also less likely to gain “excess weight,” per the National Academy of Medicine’s recommendations.
While the task force found the overall benefit of the interventions to be no better than “moderate,” it still said the benefits outweighed the risks, which it said were small since few studies reported any harms.
“The USPSTF concludes with moderate certainty that effective behavioral counseling interventions aimed at promoting healthy weight gain and preventing excess gestational weight gain in pregnancy have a moderate net benefit for pregnant persons,” the recommendations say.
More work needs to be done to determine if the interventions pay off longer-term, and whether any particular length or type of intervention works better than others. The panel also doesn’t know if the studies’ results apply to teens under 18 or pregnant people over 33.
Dr. Jessica Shepherd, an OB-GYN who serves as the chief medical officer of VeryWell Health and was not a part of the panel, told Insider the panel’s focus on behavioral modifications rather than just diet and exercise is encouraging because it can lead to longer-term benefits.
“This a good step into us looking at the alternatives to how we as clinicians could counsel patients, but also for patients to consider as a way that they can actually address their weight issues,” pregnant or not, she said.
The recommendations could perpetuate weight stigma and worsen moms’ mental health
Haley Neidich, a therapist with special training in maternal health issues who was not involved in the task force, told Insider the recommendations will only hurt pregnant women – especially those in marginalized communities.
“I am very concerned that this report from the new task force will do nothing but lead to an increase in fatphobia and weight stigma by practitioners,” she said. “While non-weight focused, inclusive, and evidence-based healthy education may be beneficial to pregnant women, a focus on their weight as the metric of success will do nothing but lead to shame, worsening mental health outcomes and even weight gain.”
Neidich said the healthcare system is already too focused on weight as an indicator of health, something that worked against her when she was pregnant.
“As a healthy fat person who experienced discrimination by multiple medical professionals during my pregnancies, I can tell you that a program like this would have done nothing but further alienate me,” she said. “It took a lot of searching and funds that most people don’t have to find weight-inclusive practitioners who would support my goal of health rather than an arbitrary goal to only gain a certain amount of pounds.”
Neidich said more effort should be put into supporting moms’ mental health, as suicide is a leading cause of maternal death within the first year of birth.
“Instead of focusing on women’s weight, which we know doesn’t actually help to decrease their size, let’s properly screen them for the presence of mental health conditions,” she said.