Body mass index (prior to pregnancy or at the first antenatal visit) and weight gain during pregnancy are among the important determinants of the health of both mother and baby.
19.1.1 Calculating and interpreting BMI
Body mass index (BMI) is commonly used to classify adults as being underweight, of healthy weight, overweight or obese. It is calculated by dividing weight by the square of height: weight (kg)/height (m)2. The WHO classification of BMI classification is given in Table D1.
19.1.2 Weight classification during pregnancy in Australia
Among women who gave birth in Australia in 2018:
- 3.8% were underweight, 49.5% were in the healthy weight range, 26.0% were overweight but not obese and 21.0% were obese at the first antenatal visit
- Aboriginal and Torres Strait Islander women were more likely than non-Indigenous women to be either obese (31.0% vs 21.0%) or underweight (6.8% vs 3.8%) and less likely to be in the healthy weight range (38% vs 49.5%), with a similar likelihood of being overweight but not obese (24%)
- compared to women in the highest socioeconomic status quintile, those in the most disadvantaged quintile were more likely to be obese (26.7 vs 12.4%), less likely to be in the healthy weight range (42.0 vs 60.3%) and had a similar likelihood of being overweight (27.1 vs 23.1%) or underweight (both 4.2%)
- obesity was most common in very remote areas (27.1 vs 18.7% in major cities), prevalence of overweight was similar across geographical regions, prevalence of healthy weight decreased with increasing remoteness (51.7% in major cities to 39.2% in very remote areas) and underweight was more common in very remote areas (7.1 vs 3.8% in major cities).
19.1.3 Weight stigma
Determinants of heath, including weight status, involve complex interactions between multi-level factors including policy, community, socio-demographic, psychosocial, family and genetic influences. Awareness of weight stigma can help health professionals to provide care that recognises the complexity of these interacting factors and removes inadvertent blame from the individual for less desirable health outcomes. Among the general population, weight stigma is a recognised risk factor for adverse psychological and physical health issues, which can exacerbate unhealthy eating behaviours (such as binge eating) and weight gain.
There is evidence of perceived weight stigma felt by women receiving pregnancy care (regardless of their size); . This can be tied to the fact that high weight status has been linked to adverse pregnancy outcomes. High gestational weight gain has also been linked to increased vulnerability to weight stigmatisation . Evidence from non-pregnant populations highlight the potential for stigma to reinforce an unhealthy weight gain cycle .
Adopting a respectful, positive and supportive approach and providing information about healthy eating and physical activity in an appropriate format may assist discussion of weight. This should be informed by appropriate education for health professionals.
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19.2 Assessing BMI
19.2.1 Measuring height and weight and calculating BMI
Routine measurement of women’s weight and height and calculation of BMI at the first antenatal contact allows identification of women who require additional care during pregnancy. When there is an accurate record of a woman’s pre-pregnancy BMI, this may be used to estimate gestational weight gain (see Section 19.3). Note that the BMI can be less accurate for assessing healthy weight in certain groups due to variations in muscle mass and fat mass (eg cut-offs lower than the WHO classifications may be appropriate for women from Asian backgrounds and higher cut-offs for women from the Pacific Islands).
19.2.2 Risks associated with a low or high BMI
Low pre-pregnancy BMI
Systematic reviews are consistent in finding that low pre-pregnancy BMI is associated with an increased risk of:
- preterm birth ;
- small for gestational age ; ; ;
- low birthweight ; ; ; .
Systematic reviews have also found a possible increase in risk of miscarriageand placental abruption (Adane et al 2019) and a decreased risk of gestational diabetes . There was no clear effect on risk of congenital heart defects .
High pre-pregnancy BMI
Systematic reviews are consistent in finding that pre-pregnancy overweight and obesity is associated with:
- large for gestational age ; ;
- macrosomia ; ;
- childhood overweight/obesity ; .
Systematic reviews have also found associations between high pre-pregnancy BMI and:
- increased risk of gestational diabetes , preterm birth, neonatal asphyxia , admission to neonatal intensive care, stillbirth and congenital heart defects ;
- reduced risk of small for gestational age and placental abruption .
Systematic reviews found a decreased likelihood of initiating breastfeeding among women who were obese; .
19.2.3 Discussing BMI with women
Women who have a BMI that is below or above the healthy range are likely to require additional care and support during pregnancy. For women with an elevated BMI, there may be additional implications for care during pregnancy (eg the potential for difficulties with palpation and poor ultrasound visualisation) and the birth (eg need for the birth to take place in a larger centre, difficulties with fetal assessment and monitoring). Relevant risks associated with a woman’s BMI should be explained and the woman given the opportunity to discuss these and how they might be minimised.
Assessment of fetal growth is discussed in Section 22.1 and assessment for risk of preterm birth in Chapter 23.
19.3 Monitoring weight gain
While BMI prior to or early in pregnancy is independently associated with pregnancy outcomes, the amount of weight gained during pregnancy is also a contributing factor. The US Institute of Medicine (IOM) provides guidance on weight gain in pregnancy based on pre-pregnancy BMI. The IOM recommendations are consensus-based and were written in 2009 but have since been assessed using data from 1.3 million women .
|Pre-pregnancy BMI (kg/m2)||Recommended weight gain (kg)||Rates of weight gain 2nd and 3rd trimester (kg/wk)|
|18.5 to 24.9||11.5–16.0||0.42 (0.35–0.50)|
|25.0 to 29.9||7.0–11.5||0.28 (0.23–0.33)|
A number of studies have suggested that the IOM guidelines may not be applicable to all women.
- A systematic review of the utility of IOM-2009 guidelines among Indian and other Asian pregnant women in terms of maternal and fetal outcomes (n=13 studies) highlighted the need for gestational weight gain recommendations across the different body mass index levels specifically for Indian women and other Asian populations.
- A retrospective cohort study in China (n=8,209) IOM weight gain ranges are too high for Chinese women. found that the lowest accumulated risk of low birthweight and macrosomia was not always achieved among women who gained weight within recommendations and suggested that the
- A cohort study in the United States (n=181,948) IOM guidelines for weight gain during pregnancy reduced risk for various adverse maternal outcomes in all ethnic groups studied. However, the guidelines were better at predicting small and large for gestational age than other infant outcomes. found that adherence to the 2009
Pre-pregnancy BMI (kg/m2)
Recommended weight gain (kg)
Rates of weight gain* 2nd and 3rd trimester (kg/wk)
- Sources: IOM 2009) and matched with Asian BMI cut-offs . based on (
With women’s consent, measure their weight and height at the first antenatal visit, calculate their pre-pregnancy body mass index (BMI) and give them advice about the benefits of meeting the recommended healthy weight gain for their pre-pregnancy BMI.
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19.3.1 Determinants of gestational weight gain
Weight gain below guidelines
A systematic review found that women with lower educational attainment had an increased risk of inadequate weight gain (OR 1.3; 95% CI 1.0 to 1.6, p=0.017) .
An analysis of observational data from a longitudinal cohort study of Aboriginal women during pregnancy (n=110)found that 32% of women had inadequate weight gain.
Cohort studies in the United States; ; have found that African American women, Hispanic women and women in socially disadvantaged areas are more likely to experience inadequate weight gain.
Weight gain exceeding guidelines
Systematic reviews have found associations between weight gain exceeding recommendations and:
- lower educational attainment
- body image dissatisfaction ;
- lack of social support
- concern about weight gain, negative attitude towards weight gain, inaccurate perceptions regarding weight, higher than recommended target weight gain, less knowledge about weight gain, higher levels of cognitive dietary restraint, and perceived barriers to healthy eating .
There were no clear associations between weight gain exceeding recommendations and:
- anxiety ; , stress ; , self-efficacy , self-esteem or social support
- parity (r 0.04, 95%CI 0.10 to 0.16, p=0.61; 17 studies), including after adjusting for pre-pregnancy BMI (r 0.08, 95%CI 0.19 to 0.03, p=0.16; 16 studies)
The evidence of an association between weight gain exceeding recommendations and depression was inconsistent; .
Protective factors included a perception of control over weight gain, lower than recommended target weight gain and higher self-efficacy for healthy eating.
Cohort studies have found associations between weight gain exceeding guidelines and:
- pre-pregnancy BMI (≥25 vs <25) (OR 3.35; 95%CI 2.44 to 4.64; p<0.0001)
- stopping smoking compared to women who never smoked (weekly weight gain in second and third trimesters MD 0.09 kg; 95%CI 0.03 to 0.15)
There was no clear association in cohort studies between weight gain exceeding guidelines and:
- experiencing hardship in childhood (OR 1.45, 95%CI 0.99 to 2.14), in adulthood (OR 0.72; 95%CI 0.41 to 1.26) or in pregnancy (OR 1.09; 95%CI 0.43 to 2.76)
- maternal age (<30 vs ≥30) (OR 1.02; 95%CI 0.98 to 1.02; p=0.89)
- household income (<CAN$60,000 vs ≥CAN$60,000) (OR 1.06; 95%CI 0.71 to 1.26; p=0.71)
- education level (<university vs ≥university degree) (OR 1.26; 95%CI 0.93 to 1.70; p=0.14)
- country of birth (other countries vs Canada) (OR 1.05; 95%CI 0.78 to 1.41; p=0.73). .
An analysis of observational data collected from a longitudinal cohort study of Aboriginal women during pregnancy (n=110)found that 54% of women had weight gain exceeding recommendations.
19.3.2 Risks associated with low or high gestational weight gain
A meta-analysis of individual participant data (n=265,270) BMI classifications.found that low or high gestational weight gain was associated with pregnancy complications across all
Weight gain among women of any BMI
Weight gain lower than recommendations
In a systematic review of cohort studies of pregnant women of any BMI (23 studies; 1,309,136 women) , weight gain lower than recommendations was associated with an increased risk of:
- preterm birth (OR 1.70; 95%CI 1.32 to 2.20)
- small for gestational age babies (OR 1.53; 95% CI 1.44 to 1.64).
There was an association between weight gain lower than recommendations and a lower likelihood of:
- large-for-gestational-age babies (OR 0.59; 95%CI 0.55 to 0.64)
- macrosomia (OR 0.60; 95%CI 0.52 to 0.68).
There was an association between weight gain lower than recommendations and a possible lower likelihood of caesarean section (OR 0.98; 95%CI 0.96 to 1.02).
In an analysis of individual participant data from the control arms of 36 RCTs (n=4,429) aOR 1.94; 95%CI 1.31 to 2.28) and small-for-gestational-age babies (aOR 1.52; 95%CI 1.18 to 1.96) were increased with gestational weight gain lower than recommendations. Findings on caesarean section and large-for-gestational-age babies were inconclusive.the odds of preterm birth (
Weight gain higher than recommendations
The systematic review of cohort studiesfound that weight gain higher than recommendations was associated with an increased risk of:
- large-for-gestational age babies (OR 1.85; 95%CI 1.76 to 1.95)
- macrosomia (OR 1.95; 95%CI 1.79 to 2.11)
- caesarean section (OR 1.30; 95%CI 1.25 to 1.35).
There was an association between weight gain higher than recommendations and lower likelihood of small-for-gestational-age babies (OR 0.66; 95%CI 0.63 to 0.69) and preterm birth (OR 0.77; 95%CI 0.69 to 0.86).
The analysis of individual participant data from the control arms of RCTs aOR 1.50; 95%CI 1.25 to 1.80), large-for-gestational-age babies (aOR 2.00; 95%CI 1.58 to 2.54), and reduced odds of small-for-gestational-age babies (aOR 0.66; 0.50 to 0.87). No significant effect on preterm birth was detected.found that weight gain higher than recommendations was associated with increased odds of caesarean section (
A meta-analysis of individual participant data (37 studies, 162,129 mothers and children) BMI category (p-values for interactions of maternal BMI with gestational weight gain: p=0.038, p<0.001, and p=0.637 in early, mid, and late childhood, respectively).found that, relative to the effect of maternal pre-pregnancy BMI, excessive gestational weight gain only slightly increased the risk of childhood overweight/obesity within each clinical
Systematic reviews of cohort studies have found that:
- the risk of urinary incontinence increased with each 10 kg of weight gain (RR 1.34; 95%CI 1.11 to 1.62)
- weight gain exceeding recommendations may increase the risk of autism spectrum disorder (OR 1.23; 95%CI 1.09 to 1.38; p=0.0008) but more studies are needed to confirm this result .
High weight gain in early pregnancy
A secondary analysis of an RCT (n=7,895) found that among women who gained weight exceeding the IOM guidelines by week 15-18, 93% exceeded the recommended total gestational weight gain. In contrast, 55% of women with early gestational weight gain within recommendations had total gestational weight gain higher than recommendations (p<0.001). Women with excessive early gestational weight gain had higher rates of gestational diabetes (OR 1.4; 95%CI 1.1 to 1.9), large-for-gestational-age babies (OR 1.4; 95%CI 1.2 to 1.6), and macrosomia >4,000 g (OR 1.5; 95%CI 1.3 to 1.8).
Outcomes among women from US/Europe and Asia
Weight gain lower than recommended was associated with preterm birth among women from the USA/Europe (OR 1.35; 95%CI 1.17 to 1.56) but not women from Asia (OR 1.06; 95%CI 0.78 to 1.44) . It was associated with an increase in risk of small-for-gestational-age babies among women from both groups.
Weight gain higher than recommended was associated with large-for-gestational age babies, macrosomia and caesarean section among women from both groups.
Gestational weight gain among underweight women
A meta-analysis of individual participant data (n=265,270)found that among underweight women:
- low weight gain was associated with an increased risk of preterm birth and small for gestational age (both p<0.001) and a reduced risk of gestational hypertension (p<0.05) and large for gestational age (p<0.001)
- high weight gain was associated with a reduced risk of small for gestational age (p<0.05).
Gestational weight gain among women with healthy pre-pregnancy weight
In the meta-analysis of individual participant data (n=265,270) BMI in the healthy range:, among women with pre-pregnancy
- low weight gain was associated with an increased risk of preterm birth and small for gestational age and a reduced risk of large for gestational age (all p<0.001)
- high weight gain was associated with an increased risk of gestational diabetes, gestational hypertension, pre-eclampsia, preterm birth and large for gestational age and a reduced risk of small-for-gestational age (all p<0.001).
Gestational weight gain among pregnant women who are overweight
In the meta-analysis of individual participant data (n=265,270), among women who were overweight:
- low weight gain was associated gestational diabetes, gestational hypertension, pre-eclampsia, small for gestational age (all p<0.001) and preterm birth (p<0.05)
- high weight gain was associated with gestational diabetes, gestational hypertension, pre-eclampsia, preterm birth and large for gestational age (all p<0.001).
Gestational weight gain among pregnant women with obesity
In the meta-analysis of individual participant data (n=265,270), among women with obesity both low and high weight gain were associated with increased risk of gestational diabetes, gestational hypertension, pre-eclampsia, preterm birth and large for gestational age (all p<0.001).
Weight gain lower than recommendations
A retrospective cohort study in the United States (n=~12,000,000 birth records) IOM guidelines among women with obesity reduced the risk of gestational hypertension, eclampsia, induction of labour and Caesarean section but was also associated with increased risks for multiple adverse neonatal outcomes with macrosomia the exception.found that weight gain lower than the
A systematic review of cohort studies of pregnant women with obesity (18 cohort studies; 99,723 women)found that weight gain lower than recommendations was associated with an increase in risk of:
- preterm birth (aOR 1.46; 95%CI 1.07 to 2.00)
- small-for-gestational-age babies (OR 1.24; 95%CI 1.13 to 1.36).
Weight gain lower than recommendations was associated with a lower likelihood of:
- large-for-gestational-age babies (aOR 0.77; 95%CI 0.73 to 0.81)
- macrosomia (aOR 0.64; 95%CI 0.54 to 0.77)
- gestational hypertension (aOR, 0.70; 95%CI 0.53 to 0.93)
- pre-eclampsia (aOR 0.90; 95%CI 0.82 to 0.99).
- caesarean section (aOR 0.87; 95%CI 0.82 to 0.92).
There was no difference in risk of gestational diabetes (aOR 1.15; 95%CI 0.91 to 1.45), low birthweight (aOR1.08; 95%CI 0.76 to 1.54), Apgar score <7 at 5 minutes (aOR 0.92; 95%CI 0.67 to 1.27) or postpartum weight retention (MD -5.3 kg; 95%CI -9.0 to 1.17).
A systematic review of cohort studies (n=60,913)found that, among women who were obese, gestational weight loss compared to weight gain within the guidelines:
- increased the risk of small-for-gestational-age babies (aOR 1.76; 95%CI 1.45 to 2.14; 2 studies) and low birthweight (aOR 1.68; 95%CI 1.10 to 2.57; 1 study)
- was associated with a lower likelihood of large for gestational age (aOR 0.57; 95%CI 0.52 to 0.62; 2 studies), macrosomia (aOR 0.58; 95%CI 0.38 to 0.89; 1 study) and caesarean section (aOR 0.73; 95%CI 0.67 to 0.80; 2 studies).
There was a possible reduction in risk of pre-eclampsia (aOR 0.82; 95%CI 0.66 to 1.02; 1 study) and no clear difference in risk of gestational diabetes (aOR 0.88; 95%CI 0.62 to 1.25; 1 study) or Apgar score <7 at 5 minutes (aOR 1.08; 95%CI 0.81 to 1.44; 2 studies). No studies reported on preterm birth.
At every antenatal visit, offer women the opportunity to be weighed so that low or high gestational weight gain is identified and risk of associated adverse outcomes monitored.
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19.3.3 Women’s views on advice on weight gain during pregnancy
A systematic review of qualitative studiesfound that women are highly motivated to change their behaviour to improve fetal health but may not recognise the link between excess gestational weight gain and negative fetal health outcomes. Regular, clear, sensitive counselling geared to individual circumstances was frequently mentioned as a strong facilitator of healthy weight gain in pregnancy.
An Australian cross-sectional study (n=536) IOM recommendations on gestational weight gain.found that only half of pregnant women were aware of
Cross-sectional studies from overseas have found that:
- more than half (57%) of women reported that their healthcare provider talked to them about personal weight gain limits during pregnancy and a third of these women were counselled regularly; among those not counselled, over half (56%) reported that healthcare provider guidance would have been helpful to achieve their target weight
- two-thirds (67%) of women received advice on gestational weight gain as part of antenatal care and women who reported following this advice had lower odds of weight gain exceeding recommendations (OR 0.18; 95%CI 0.03 to 0.91) (n=91)
- experiences of regular weighing were positive and participants believed it should be part of standard antenatal care, that there was a lack of information provided on gestational weight gain and healthy lifestyle in pregnancy, and that healthcare professionals are ideally placed to provide this advice (n=10) . An Australian focus group that examined barriers and enablers to the regular weighing of women throughout pregnancy (n=44) (Hasted et al 2016) found that, while most health professionals supported regular weighing, various concerns were raised. These included access to resources and staff, the ability to provide appropriate counselling and evidence-based interventions, and the impact of weighing on women and the therapeutic relationship.
19.3.4 Health professional’s views on weight monitoring as part of pregnancy care
In an Australian study following introduction of a pregnancy weight gain chart (n=42), 63% of health professionals surveyed used the chart, 76% reported that they needed more training in counselling pregnant women about weight gain, and insufficient time was the main barrier to weighing and discussing weight gain with women.
An Australian cohort study found that recording of weight is improved by providing scales to clinics and staff training (18.9%) and medical record prompts (61.8%) (n=~13,000 per cohort).
A cohort study in the United States (n=733)found that introduction of a "best practice alert" into an electronic medical record system improved the rate of gestational weight counselling (p<0.001), documented weight gain (p<0.001) and weight gain consistent with guidelines (p=0.003).
19.3.5 Recent evidence on regular weighing
A systematic literature review found no clear difference in weekly weight gain (MD -0.00 kg; 95%CI -0.03 to 0.02) or weight gain exceeding the IOM guidelines for women who were underweight (OR 1.50; 95%CI 0.14 to 16.54), in the healthy weight range (OR 0.72; 95%CI 0.48 to 1.09), overweight (OR 0.85; 95%CI 0.45 to 1.62) or obese (OR 1.60; 95%CI 0.72 to 3.54) . The interventions assessed in the two included studies (n=977) differed in that one involved regular weighing by a health professional and the other involved self-weighing .
The systematic literature review conducted to inform these Guidelinesfocused on weighing by a health professional and included three studies.
An Australian RCT (n=782) ; addressed regular weighing at antenatal care visits plus advice on weight gain versus usual care. The study found no difference in weight gain, proportion of women gaining more weight than IOM recommended range or secondary outcomes . Among a subset of women who provided feedback (n=586), 73% were comfortable with being weighed routinely .
A pilot study in the United Kingdom (n=76) IOM guidelines, depression or anxiety.combined regular weighing by midwives and advice on weight gain with self-weighing between antenatal visits. Compared to usual care, there was no difference in the percentage of women gaining excessive weight during pregnancy or in mean depression and anxiety scores. Feedback in a subset of participants showed support for routine weighing among participants (9/12) and midwives (7/7). The same group then conducted a larger study of the intervention (n=656) , which also found no clear difference in weight gain exceeding
When these three trials were pooled, there was no difference in weight gain exceeding guidelines (RR 1.01 95% CI 0.92 to 1.12; 3 RCTs; n=1,327; very low certainty) or mean weekly weight gain (MD 0.01 kg per week 95%CI –0.03 to 0.05; 2 RCTs; n=711; very low certainty). When the two United Kingdom studies were pooled, there was a small reduction in the risk of depression (MD -0.77; 95%CI -1.44 to -0.09; low certainty) and anxiety (MD -0.77; 95%CI -1.48 to ‑0.06; low certainty). There was no indication in the three trials that either excessive gestational weight gain or mean gestational weight gain differed in women in the healthy weight range at the beginning of pregnancy compared with women who were overweight or obese.
19.3.6 Other considerations include
- The potential for sub-optimal visualisation on ultrasound for women with elevated BMI (delaying the ultrasound until 20 to 22 weeks pregnancy for women with BMI ≥30 may provide better results but needs to be balanced against the possibility of a delayed diagnosis of structural anomalies) (SOGC 2010).
- Antenatal consultation with an obstetric anaesthetist to identify any potential difficulties with venous access, regional or general anaesthesia for women with a BMI ≥40.
- For women with a high BMI, ongoing nutritional advice following childbirth from an appropriate health professional, with a view to weight reduction and maintenance.
19.4 Practice summary: weight and BMI
At all antenatal visits.
Midwife; GP; obstetrician; Aboriginal and Torres Strait Islander Health Practitioner, Aboriginal and Torres Strait Islander Health Worker; multicultural health worker
- Explain the purpose of assessing weight and weight gain during pregnancyDiscuss the benefits of having weight within the healthy range before, during and in between pregnancies. For women with a BMI outside the healthy range, explain that assessing weight gain during pregnancy is helpful in identifying women whose weight gain is below or above recommendations.
- Engage women in discussions about weight gainOffer women the opportunity to be weighed and to discuss their weight gain since the last antenatal visit. Use the IOM recommendations to give women advice about the risks of inadequate or excessive weight gain. Provide advice on nutrition and exercise based on the Australian dietary and physical activity guidelines (see Chapter 11).
- Consider referralWomen with a BMI above or below the healthy range or who are gaining weight at a rate below or above recommendations may benefit from referral for nutrition advice from an accredited practising dietitian.
- Take a holistic approach
Provide women with culturally appropriate advice on the benefits of a healthy diet and regular physical activity. When making referrals, consider access to and costs of care and develop alternative care pathways for women who experience health inequalities as a result of social and cultural barriers.
19.5.1 Health professionals
- CMACE & RCOG (2010) CMACE & RCOG Joint Guideline. Management of Women with Obesity in Pregnancy. London: Centre for Maternal and Child Enquiries & Royal College of Obstetricians and Gynaecologists.
- IOM (2009) Weight Gain During Pregnancy. Re-examining the Guidelines. Institute of Medicine and National Research Council. Washington DC: National Academies Press.
- NHMRC (2013) Australian Dietary Guidelines: Providing the Scientific Evidence for Healthier Australian Diets. Canberra: Commonwealth of Australia.
- NHMRC (2005) Nutrient Reference Values for Australia and New Zealand. Canberra: National Health and Medical Research Council.
- NICE (2010) Dietary Interventions and Physical Activity Interventions for Weight Management Before, During and After Pregnancy. NICE public health guidance 27. London: National Institute for Health and Clinical Excellence.
- SOGC (2010) Obesity in pregnancy. J Obstet Gynaecol Can 32(2): 165–73.
19.5.2 Women and families
- DoH (2014) Australia’s Physical Activity & Sedentary Behaviour Guidelines for Adults (18-64 years). Accessed 25 August 2016.
- NHMRC/DoH (2015) Australian Guide to Healthy Eating. Accessed 25 August 2016.
- NHMRC/DoH (2015) Healthy Eating When You’re Pregnant or Breastfeeding. Accessed 25 August 2016.
- Adane AA, Shepherd CCJ, Lim FJ et al (2019) The impact of pre-pregnancy body mass index and gestational weight gain on placental abruption risk: a systematic review and meta-analysis. Arch Gynecol Obstet 300(5): 1201-10.
- AIHW (2020) Australia’s mothers and babies 2018: in brief. Canberra: Australian Institute of Health and Welfare.
- Allen-Walker V, Mullaney L, Turner MJ et al (2017) How do women feel about being weighed during pregnancy? A qualitative exploration of the opinions and experiences of postnatal women. Midwifery 49: 95-101.
- Arora P & Tamber Aeri B (2019) Gestational weight gain among healthy pregnant women from Asia in Comparison with Institute of Medicine (IOM) Guidelines-2009: A systematic review. J Pregnancy 2019: 3849596.
- Aune D, Mahamat-Saleh Y, Norat T et al (2019) Body mass index, abdominal fatness, weight gain and the risk of urinary incontinence: a systematic review and dose-response meta-analysis of prospective studies. BJOG 126(12): 1424-33.
- Balsells M, Garcia-Patterson A, Corcoy R (2016) Systematic review and meta-analysis on the association of prepregnancy underweight and miscarriage. Eur J Obstet Gynecol Reprod Biol 207: 73-79.
- Bombak AE, McPhail D, Ward P (2016) Reproducing stigma: Interpreting "overweight" and "obese" women's experiences of weight-based discrimination in reproductive healthcare. Soc Sci Med 166: 94-101.
- Brownfoot FC, Davey MA, Kornman L (2016a) Routine weighing to reduce excessive antenatal weight gain: a randomised controlled trial. BJOG 123(2): 254–61.
- Brownfoot FC, Davey MA, Kornman L (2016) Women’s opinions on being weighed at routine antenatal visits. BJOG 123(2): 263-70.
- Cai GJ, Sun XX, Zhang L et al (2014) Association between maternal body mass index and congenital heart defects in offspring: a systematic review. Am J Obstet Gynecol 211(2): 91-117.
- Carreno CA, Clifton RG, Hauth JC et al (2012) Excessive early gestational weight gain and risk of gestational diabetes mellitus in nulliparous women. Obstet Gynecol 119(6): 1227-33.
- Daley A, Jolly K, Jebb SA et al (2019) Effectiveness of a behavioural intervention involving regular weighing and feedback by community midwives within routine antenatal care to prevent excessive gestational weight gain: POPS2 randomised controlled trial. BMJ Open 9(9): e030174.
- Daley AJ, Jolly K, Jebb SA et al (2015) Feasibility and acceptability of regular weighing, setting weight gain limits and providing feedback by community midwives to prevent excess weight gain during pregnancy: randomised controlled trial and qualitative study. BMC Obes 2: 35.
- de Jersey, Guthrie T, Tyler J et al (2019) A mixed method study evaluating the integration of pregnancy weight gain charts into antenatal care. Matern Child Nutr 15(3): e12750.
- Fealy SM, Taylor RM, Foureur M et al (2017) Weighing as a stand-alone intervention does not reduce excessive gestational weight gain compared to routine antenatal care: a systematic review and meta-analysis of randomised controlled trials. BMC Pregnancy Childbirth 17(1): 36.
- Garcia AH, Voortman T, Baena CP et al (2016) Maternal weight status, diet, and supplement use as determinants of breastfeeding and complementary feeding: a systematic review and meta-analysis. Nutr Rev 74(8): 490-516.
- Goldstein RF, Abell SK, Ranasinha S et al (2017) Association of gestational weight gain with maternal and infant outcomes: A systematic review and meta-analysis. JAMA 317(21): 2207-25.
- Goldstein RF, Abell SK, Ranasinha S et al (2017b) Association of gestational weight gain with maternal and infant outcomes: a systematic review and meta-analysis. JAMA 317(21): 2207-25.
- Goldstein RF, Abell SK, Ranasinha S et al (2018) Gestational weight gain across continents and ethnicity: systematic review and meta-analysis of maternal and infant outcomes in more than one million women. BMC Med 16(1): 153.
- Goto E (2017) Dose-response association between maternal body mass index and small for gestational age: a meta-analysis. J Matern Fetal Neonatal Med 30(2): 213-18.
- Han Z, Mulla S, Beyene J et al (2011) Maternal underweight and the risk of preterm birth and low birth weight: a systematic review and meta-analyses. Int J Epidemiol 40(1): 65-101.
- Hartley E, McPhie S, Skouteris H et al (2015) Psychosocial risk factors for excessive gestational weight gain: A systematic review. Women Birth 28(4): e99-e109.
- Hasted T, Stapleton H, Beckmann MM et al (2016) Clinician's attitudes to the introduction of routine weighing in pregnancy. J Pregnancy 2016: 2049673.
- Headen I, Mujahid MS, Cohen AK et al (2015) Racial/ethnic disparities in inadequate gestational weight gain differ by pre-pregnancy weight. Matern Child Health J 19(8): 1672-86.
- Hill B, Bergmeier H, McPhie S et al (2017) Is parity a risk factor for excessive weight gain during pregnancy and postpartum weight retention? A systematic review and meta-analysis. Obes Rev 18(7): 755-64.
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