**5. Conclusions**

Achieving appropriate pregnancy weight gain is necessary to optimize maternal, infant, and population health but it is not easily done. Promoting healthy weight gain during pregnancy is an investment in both the mother's longevity and the next generation. As health workers, we see the individual and societal outcomes when women gain too much or too little in pregnancy. Women who gain too much suffer the health consequences from obesity and its associated morbidities. Women who gain suboptimally have infants with more susceptibility to disease and death. The platform of excessive pregnancy weight gain is that up to 50% of women in certain countries start pregnancy overweight or obese. Though the first wave of obesity seen in developed countries is slowing, the developing countries have now taken the globesity baton as they transition to Western eating and more sedentary lifestyles. Women who are young, in their first pregnancy, and who start pregnancy with a high body mass index are much more likely to gain excessively and their more complicated pregnancies come at a cost to their health in the short term and long term. Women who do not have proper access to food and start pregnancy undernourished may ultimately not be able to supply the necessary nutrients for optimal growth and development of their infant.

During pregnancy, it is customary for women to solicit and process advice. Pregnancy weight gain is a topic in which women must receive advice that is based on evidence. As health workers we are the source of this evidence, whether from a local ministry of health or from a weight gain guideline that is recognized as applicable to women of your area. Basic pregnancy weight gain guidelines are as follows: women who are underweight or normal weight need to gain more pregnancy weight than do overweight and obese women. Overweight and obese women do not need additional fat stores as do women in lower BMI categories. Most of the weight gained in pregnancy should be from mid-pregnancy to term as this is the period of fetal growth. In early pregnancy, some women may not gain any weight or may even lose some weight. This is acceptable as long as there are no signs of dehydration or disease. All women need a balance of energy and protein in the second and third trimesters for the rapidly developing fetus. Avoiding excessive gain will dramatically lessen the chance of retaining weight during postpartum and ending up in a high BMI category by the next pregnancy. Exclusive breastfeeding for at least 6 months benefits the infant, increases maternal metabolism and has protective effects for cardiovascular disease in middle age. Pregnancy weight gain is important in the short term and in the long term.
