Best Practices

Weight Gain During Pregnancy

Not gaining enough weight during pregnancy is the largest contributor to the number of low weight births in Colorado, and in 2011 one in five pregnant women (20.6 percent) did not gain enough weight.  Colorado women also experience a significant rate of excessive weight gain.  With nearly a third of women (31.8 percent) beginning pregnancy in the overweight or obese category in 2011 and close to half of all women (48.6 percent) gaining above recommended levels, it is important to address weight gain on both ends of the spectrum.  Women should only gain the amount of weight necessary for a healthy pregnancy.  (Data source:  PRAMS, 2011) 

In 2009, the National Academy of Sciences in conjunction with the Institute of Medicine produced a report titled Weight Gain During Pregnancy:  Reexamining the Guidelines outlining revised recommendations for weight gain in pregnancy.

  • Weight gain recommendations are based on a calculation involving a woman's weight and height prior to pregnancy, called body mass index (BMI).
  • There are four BMI categories with corresponding weight gain recommendations.
  • Rate of weight gain is as important as total weight gain. Strive for consistent gains each month.

Weight Category

Body Mass Index*


Recommended Total Weight Gain

Recommended Rates of Weight Gain** in the 2nd and 3rd Trimesters
(Mean Range)


Less than 18.5 

28 -- 40 lb 

1 (1 -- 1.3) lb/wk

Normal Weight

18.5 -- 24.9

25 -- 35 lb

1 (0.8 -- 1) lb/wk


25 -- 29.9

15 -- 25 lb

0.6 (0.5 -- 0.7) lb/wk

(all classes)

30 and greater

11 -- 20 lb

0.5 (0.4 -- 0.6) lb/wk

 * Body mass index is calculated as weight in kilograms divided by height in meters squared or as weight in pounds multiplied by 703 divided by height in inches

**Calculations assume a 1.1 -- 1.4 lb weight gain in the first trimester.

Modified from Institute of Medicine (US). Weight gain during pregnancy:  reexamining the guidelines.  Washington, DC. National Academies Press; 2009. 2009 National Academy of Sciences

Background Documents

Recommended Strategies

Assess Weight Status and Appropriate Weight Gain:

  • Determine a client's body mass index and track weight gain on a prenatal weight gain grid
  • Discuss recommendation for total weight gain and rate of weight gain
  • Monitor weight gain trends at each appointment and advise accordingly

Counseling Guidelines:


  • Nausea or vomiting
  • Typical food choices
  • Access to food
  • Changes in activity level
  • Changes in appetite
  • Stress levels
  • Body image concerns
  • Smoking status

If gaining too much weight:

  • Limit juice, soft drinks or other sweetened beverages. Instead drink 8 glasses of water daily
  • Increase fruit and vegetable consumption
  • Choose low-fat dairy products
  • Choose whole grains
  • Limit foods high in fat and sugar (desserts, fried foods, cheese)
  • Increase activity, if medically appropriate

If not gaining enough weight:

  • Add healthy snacks in between meals (yogurt, trail mix, hummus/pita, fruit smoothie)
  • Choose higher calorie, high quality foods (nuts, cheese, avocado, dried fruits, whole grain bread and pastas, etc.)
  • Choose a variety of fruits and vegetables, then add cheese, yogurt, hummus or peanut butter to increase calories
  • Avoid filling up on liquids before a meal
  • Monitor excercise and decrease activity, if needed
  • Quit smoking, if applicable
  • Seek food assistance, if needed

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