Weight gain during pregnancy is often talked about as a number to manage. But a new systematic review suggests a more useful way to think about it: healthy pregnancy weight gain is shaped by support, food access, nutrition counseling, supplements, physical activity and prenatal care.
The review, published in BMJ Global Health, looked at antenatal interventions in low- and middle-income countries and found that programs delivered early in pregnancy may help women achieve healthier gestational weight gain. The interventions included nutrition supplementation, healthy eating promotion, education and counseling, physical activity and combined diet-and-exercise programs.
Both too little and too much weight gain during pregnancy can raise health risks for mothers and babies. Inadequate weight gain is linked with concerns such as preterm birth and low birth weight, while excessive weight gain is associated with risks including preeclampsia and unplanned cesarean delivery.
The review focused on low- and middle-income countries, where pregnancy nutrition can be shaped by barriers that go far beyond personal choice. Food insecurity, limited access to health care, poor diet quality and inadequate micronutrient supplementation can all make healthy weight gain harder to achieve.
“Interventions delivered during pregnancy, especially when started early and tailored to local contexts, can reduce both inadequate and excessive gestational weight gain. The most effective approach depends on the type of intervention and the woman’s nutritional or weight status, which highlights the need for personalized interventions,” said Priscilla Aba Aggrey, a PhD in public health student in George Mason University’s Department of Global and Community Health.
The review found that different interventions appeared to help in different ways. Physical activity programs during pregnancy were more effective at reducing excessive weight gain. Multiple micronutrient supplements were linked with a greater likelihood of optimal pregnancy weight gain compared with iron-folic acid supplementation alone. Education and counseling also helped pregnant women maintain healthier weight gain, especially when counseling was culturally tailored and focused on nutrition.
Combined diet-and-physical-activity programs, including personalized dietary guidance, supervised exercise and healthy-eating reminders, were also effective in reducing excessive gestational weight gain.
The findings do not point to one universal pregnancy program. Instead, they suggest that prenatal support works best when it is started early and adapted to the person, community and setting.
That distinction matters. Pregnancy weight gain is not just about eating more or eating less. A woman who enters pregnancy undernourished may need different support than someone at risk of excessive weight gain. A woman who cannot reliably access nutritious foods may need different resources than someone who mainly needs counseling, movement guidance or supplement support.
The review also has important limits. It summarizes existing studies, so its conclusions depend on the quality, design and consistency of the research included. It also focused on low- and middle-income countries, meaning the findings should not be treated as direct advice for every health care setting.
Still, the larger message is relevant beyond any one country: prenatal care can support healthier pregnancy outcomes when it addresses real-life barriers, not just individual behavior.
“Policymakers and health care providers in low- and middle-income countries can adopt these interventions and incorporate them into routine prenatal care to help pregnant women achieve healthy weight gain outcomes and reduce preventable complications for both mothers and babies,” Aggrey said.
The authors reported that contributions from PAA, AA-K and CHN were supported by graduate research assistantships from George Mason University.