Condition
Weight Gain in Pregnancy
Editors: Elliot M. Levine MD, FACOG; Esther Jolanda van Zuuren MD; Katharine DeGeorge MD, MS
References
General References Used
The references listed below are used in this DynaMed topic primarily to support background information and for guidance where evidence summaries are not felt to be necessary. Most references are incorporated within the text along with the evidence summaries.
- Committee to Reexamine IOM Pregnancy Weight Guidelines, Food and Nutrition Board and Board on Children, Youth, and Families. Weight gain During Pregnancy: Reexamining the Guidelines. Washington, D.C.: Institute of Medicine and National Research Council of the National Academies, 2009.
- Kaiser L, Campbell CG, Academy of Nutrition and Dietetics (AND). Practice paper of the Academy of Nutrition and Dietetics: nutrition and lifestyle for a healthy pregnancy outcome. AND 2014 Jul PDF.
Recommendation Grading Systems Used
- United States Preventive Services Task Force (USPSTF) grades of recommendation (after July 2012)
- Grade A - USPSTF recommends the service with high certainty of substantial net benefit
- Grade B - USPSTF recommends the service with high certainty of moderate net benefit or moderate certainty of moderate-to-substantial net benefit
- Grade C - USPSTF recommends selectively offering or providing this service to individual patients based on professional judgment and patient preferences with at least moderate certainty that net benefit is small
- Grade D - USPSTF recommends against providing the service with moderate-to-high certainty of no net benefit or harms outweighing benefits
- Grade I - insufficient evidence to assess balance of benefits and harms; evidence is lacking, of poor quality, or conflicting
- References
- PubMed34032846JAMAJAMA20210525325202053-20552053USPSTF recommendation statement on behavioral counseling interventions for healthy weight and weight gain in pregnancy (JAMA 2021 May 25;325(20):2087), editorial can be found in JAMA 2021 May 25;325(20):2053, also published at USPSTF 2021 May
- USPSTF Grade Definitions
- American College of Obstetricians and Gynecologists (ACOG) levels of recommendations
- Level A - based on good and consistent scientific evidence
- Level B - based on limited and inconsistent scientific evidence
- Level C - based primarily on consensus and expert opinion
- Reference - ACOG Practice Bulletin 230 on obesity in pregnancy (Obstet Gynecol 2021 Jun 1;137(6):e128), commentary can be found in Obstet Gynecol 2021 Sep 1;138(3):489
Synthesized Recommendation Grading System for DynaMed Content
- The DynaMed Team systematically monitors clinical evidence to continuously provide a synthesis of the most valid relevant evidence to support clinical decision-making (see 7-Step Evidence-Based Methodology).
- Guideline recommendations summarized in the body of a DynaMed topic are provided with the recommendation grading system used in the original guideline(s) and allow users to quickly see where guidelines agree and where guidelines differ from each other and from the current evidence.
- In DynaMed content, we synthesize the current evidence, current guidelines from leading authorities, and clinical expertise to provide recommendations to support clinical decision-making in the Overview & Recommendations section.
- We use the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to classify synthesized recommendations as Strong or Conditional.
- Strong recommendations may be used when, based on the available evidence, clinicians (without conflicts of interest) consistently have a high degree of confidence that the desirable consequences (health benefits, decreased costs and burdens) outweigh the undesirable consequences (harms, costs, burdens).
- Conditional recommendations may be used when, based on the available evidence, clinicians believe that desirable and undesirable consequences are finely balanced, or appreciable uncertainty exists about the magnitude of expected consequences (benefits and harms).
- Conditional recommendations may be used when clinicians disagree in judgments of the relative benefit and harm or have limited confidence in their judgments.
- Conditional recommendations may also be used when the range of patient values and preferences suggests that informed patients are likely to make different choices.
- DynaMed synthesized recommendations (in the Overview & Recommendations section) are determined with a systematic methodology.
- Recommendations are explicitly labeled as Strong recommendations or Conditional recommendations when a qualified organization has explicitly deliberated on making such a recommendation.
- Recommendations are phrased to match the strength of recommendation.
- Strong recommendations use "should do" phrasing, or phrasing implying an expectation to perform the recommended action for most patients.
- Conditional recommendations use "consider" or "suggested" phrasing.
- Recommendations are verified by ≥ 1 editor with methodological expertise, not involved in recommendation drafting or development, with explicit confirmation that Strong recommendations are adequately supported.
- Recommendations are published only after consensus is established with agreement in phrasing and strength of recommendation by all editors.
- If recommendations are questioned during peer review or post publication by a qualified individual, or reevaluation is warranted based on new information detected through systematic literature surveillance, the recommendation is subject to additional internal review.
DynaMed Editorial Process
- DynaMed topics are created and maintained by the DynaMed Editorial Team and adhere to evidence-based methodology and inclusive language standards.
- All editorial team members and reviewers have declared that they have no financial or other competing interests related to this topic, unless otherwise indicated.
- DynaMed content includes Practice-Changing Updates, with support from our partner, McMaster University.
Special Acknowledgements
- DynaMed topics are written and edited through the collaborative efforts of the above individuals. Deputy Editors, Section Editors, and Topic Editors are active in clinical or academic medical practice. Recommendations Editors are actively involved in development and/or evaluation of guidelines.
- Editorial Team role definitions
Topic Editors define the scope and focus of each topic by formulating a set of clinical questions and suggesting important guidelines, clinical trials, and other data to be addressed within each topic. Topic Editors also serve as consultants for the internal DynaMed Editorial Team during the writing and editing process, and review the final topic drafts prior to publication. Section Editors have similar responsibilities to Topic Editors but have a broader role that includes the review of multiple topics, oversight of Topic Editors, and systematic surveillance of the medical literature. Recommendations Editors provide explicit review of Overview and Recommendations sections to ensure that all recommendations are sound, supported, and evidence-based. This process is described in "Synthesized Recommendation Grading." Deputy Editors oversee DynaMed internal publishing groups. Each is responsible for all content published within that group, including supervising topic development at all stages of the writing and editing process, final review of all topics prior to publication, and direction of an internal team.
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DynaMed Levels of Evidence
Quickly find and determine the quality of the evidence.
DynaMed provides easy-to-interpret Level of Evidence labels so users can quickly find and determine the quality of the best available evidence. Evidence may be labeled in one of three levels:
1Level 1 (likely reliable) Evidence
2Level 2 (mid-level) Evidence
3Level 3 (lacking direct) Evidence
Grades of Recommendation
Guideline producers are now frequently using classification approaches for their evidence and recommendations, and these classifications are recognized and requested by guideline users. When summarizing guideline recommendations for DynaMed users, the DynaMed Editors are using the guideline-specific classifications and providing guideline classification approach when this is done.
Download the full version of Levels of Evidence