الفهرس 
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Abstract
This systematic review of adverse outcomes of gestational weight gain, often referred to as maternal weight gain, is motivated by several trends in perinatal health that are of great public health concern. Gestational weight gain is natural and it is well accepted by pregnant women. But, high weight gain is sometimes seen as appropriate and wealthy by pregnant women and her family. There is a report that high weight gain is common in developed countries. In Egypt, A common saying that ’a woman is eating for two while pregnant’ implies that a mother should consume twice as much during pregnancy. However, in reality this is not true. Although maternal consumption will directly affect both herself and the growing fetus, over eating excessively will compromise the baby’s health as the infant will have to work extra hard to become healthy in the future. Therefore, excessive calories, rather than going to the infant, often get stored as fat in the mother.
Women are increasingly gaining weight during pregnancy beyond the thresholds set by the Institute of Medicine (IOM); obesity levels among women of childbearing ages are rising dramatically; and pregnancy complications associated with excess gestational weight gain such as macrosomic babies and cesarean delivery have increased in prevalence. These trends point to the need for assessment of the guidelines to address optimal weight gain for all women during pregnancy.
This prospective randomized study was conducted on 150 pregnant woman admitted for labour , divided into 3 groups according to their gestational weight gain
group A: Pregnant women with low gestational weight gain
group B: Pregnant women with normal gestational weight gain
group C: Pregnant women with high gestational weight gain
Table 5 :Recommendation from the institute of medicine for total weight gain during pregnancy classified by pre-pregnancy body mass index.
Recommended total weight gain range (kg) Pre-pregnancy BMI (kg/m2)
12.5 - 18.0 Underweight (<18.5)
11.5 - 16.0 Normal weight (18.5 - 24.9)
7.0 - 11.5 Overweight (25.0 - 29.9)
5.0 - 9.0 Obese (≥30.0)
The influence of gestational weight gain on maternal and neonatal outcomes was compared between the 3 groups regarding gestational hypertension, gestational DM , antepartum & postpartum hemorrhage, PROM, chorioamnionitis , pastdate ,vertex presentation, cesarean section , APGAR score at 1 minute after delivery , incidence of macrosomia and neonatal length.
All patients in the study were subjected to:
1. Full history.
2. General examination.
3. Pelvic examination
4. Ultrasound.
The principal aim of this study was to examine pregnancy outcomes (both maternal & fetal) of excess weight gain during pregnancy.
In this study, many adverse pregnancy outcomes; both maternal and fetal; have been observed associated with high gestational weight gain .
In pregnancy maternal metabolic manifestations of the metabolic syndrome, such as gestational hypertensive disorders and diabetes, become clinically recognized. At parturition the high gestational weight gain group of patients were at an increased risk of cesarean delivery and associated complications of anesthesia, cephalo-pelvic disproportion and fetal distress . For the fetus there are short-term risks of fetal distress, fetal macrosomia, more specifically obesity.
The results of this study concurred with [Thorsdottir et al.,2002, Chen et al.,2010] who confirmed the link between gestational hypertension and excessive gestational weight gain. It also goes with the results of [Sebire NJ et al, 2001] who stated that risk of macrosomia depends not only on the weight before pregnancy but also on weight gain during pregnancy. Supported by several other studies [Kabali and M. M. Werler,2007, Chen et al.,2010]. During labor, an influence of weight gain on the birth process was found with a significant rate of cesarean section. This goes along with [Deruelle,2011,Thorsdottir et al.,2002], who found that an excessive weight gain during pregnancy increases the risk of cesarean section. Our study goes hand in hand with ( Stotland et al.,2006) as we found excess gestational weight gain increases the risk of developing fetal distress.
This study, like any other observational study of its kind suffers from several limitations. Firstly, Weight and height were measured at time of delivery; pre-pregnancy measurements were not available. However the ideal time to record the baseline height and weight of a pregnant woman is before she has started gaining weight due to gestation taking into consideration that pre-pregnancy weight was known from the patients’ own words and history taking. Secondly, our study used data collected over 11months; a short duration which should be extended in later studies and researches to show the longstanding impact of excess gestational weight gain on both the patient &her baby .Finally, the small sample size that needs to be larger in further studies and researches.
The primary objective in the management of excessive weight gain during pregnancy is prevention. Pregnant women should receive counseling about recommended weight gain, nutrition, and food choices during pregnancy. Having obese women lose weight with lifestyle changes and achieve a normal BMI before conception is also recommended.