Assistant Professor of Public Health Nutrition
Dr. Andrea Deierlein is a nutritional and reproductive epidemiologist who studies dietary and environmental determinant of obesity and metabolic health-related outcomes. Her previous work focused on predictors and outcomes of gestational weight gain including maternal obesity, postpartum weight retention, and gestational diabetes.
With the support of the National Institute of Environmental Health Sciences, she is expanding her research to investigate associations of prenatal and postnatal nutritional and environmental chemical exposures with disease outcomes.
Dr. Deierlein teaches Epidemiology for Global Health and Nutrition and Metabolism.
BS, Animal Science, Cornell University, Ithaca, NYMS, Health Nutrition, Columbia University, New York, NYMPH, Epidemiology, Columbia University, New York, NYPhD, Nutrition Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
Travel Scholarship, Be Our Voice Childhood Obesity Prevention Advocacy Training, Robert Wood Johnson Foundation (2013)New York Academy of Sciences Education Fellowship (2012)Postdoctoral Fellowship in Pediatric Environmental Health, Icahn School of Medicine at Mount Sinai (2010)Travel Scholarship, Researching Women’s Environmental Health: Food, Nutrition, and Obesity, University of Rochester Medical Center (2010)Travel Scholarship, Childhood Obesity Symposium, University of Southern California (2010)
Environmental Public Health ServicesEpidemiologyMaternal and Child HealthNutritionWomen's Health
Is meeting the recommended dietary allowance (RDA) for protein related to body composition among older adults?: Results from the cardiovascular health of seniors and built environment studyBeasley, J. M., Deierlein, A., Morland, K. B., Granieri, E. C., & Spark, A.
Journal titleJournal of Nutrition, Health and Aging
Page(s)1-7Objective: Studies suggest protein intake may be associated with lower body weight, but protein has also been associated with preservation of lean body mass. Understanding the role of protein in maintaining health for older adults is important for disease prevention among this population. Design: Cross-sectional study of the relationship of dietary protein on body composition. Setting: New York City community centers. Participants: 1,011 Black, White, and Latino urban men and women 60-99 years of age. Measurements: Protein intake was assessed using two interviewer-administered 24-hour recalls, and body composition was assessed using bioelectrical impedance analysis (BIA) of fat mass (kg) (FM), fat free mass (kg) (FFM), and impedance resistance (Ohms). Statistical Analysis: Indices of FM and FFM were calculated by dividing BIA measurements by height squared (m2), and percent FFM was calculated by dividing FFM by the sum of FM and FFM. Log linear models adjusting for age (continuous), race/ethnicity, education, physical activity (dichotomized at the median), hypertension, diabetes, and total calories (continuous). Results: Just 33% of women and 50% of men reported meeting the RDA for protein. Both fat free mass index (FFMI) and fat mass index (FMI) were negatively associated with meeting the RDA for protein (Women: FFMI -1.78 95%CI [-2.24, -1.33], FMI -4.12 95% CI [-4.82, -3.42]; Men: FFMI -1.62 95% CI [-2.32, -0.93] FMI -1.80 95% CI [-2.70, -0.89]). After accounting for confounders, women and men consuming at least 0.8 g/kg/day had a 6.2% (95% CI: 5.0%, 7.4%) and a 3.2% (95% CI 1.1%, 5.3%) higher percent fat free mass, respectively. Conclusions: FFM, FFMI, FM, and FMI were inversely related to meeting the RDA for protein. Meeting the RDA for protein of at least 0.8g/kg/day was associated with a higher percentage of fat free mass among older adults. These results suggest meeting the protein recommendations of at least 0.8 g/kg/day may help to promote lower overall body mass, primarily through loss of fat mass rather than lean mass.
Longitudinal associations of phthalate exposures during childhood and body size measurements in young girlsDeierlein, A., Wolff, M. S., Pajak, A., Pinney, S. M., Windham, G. C., Galvez, M. P., Silva, M. J., Calafat, A. M., Kushi, L. H., Biro, F. M., & Teitelbaum, S. L.
Page(s)492-499Background: Phthalates are environmental chemicals that may play a role in the development of obesity. Few studies have investigated longitudinal associations between postnatal phthalate exposures and subsequent anthropometric measurements in children. Methods: We collected data as part of The Breast Cancer and Environment Research Program at three US sites. A total of 1,239 girls, aged 6-8 years, were enrolled in 2004-2007. We categorized baseline phthalate exposures, assessed from creatinine-corrected urinary concentrations of low-molecular weight phthalate metabolites, as low, 2 (95% CI: 0.28, 2.1) and from 1.5 (95% CI: -0.38, 3.3) to 3.9 cm (95% CI: 1.3, 6.5), respectively. High-molecular weight phthalates were negatively associated with height but only among girls who were normal weight at baseline (BMI ≤ 85th percentile). Conclusion: Phthalates, specifically low-molecular weight phthalates, have small but detectable associations with girls' anthropometric outcomes. Low-molecular weight phthalates showed stronger associations than other types of phthalates.
Comparison of the nutrient content of children's menu items at US restaurant chains, 2010-2014Deierlein, A., Peat, K., & Claudio, L.
Journal titleNutrition Journal
Issue1Objective: To determine changes in the nutritional content of children's menu items at U.S. restaurant chains between 2010 and 2014. Methods: The sample consisted of 13 sit down and 16 fast-food restaurant chains ranked within the top 50 US chains in 2009. Nutritional information was accessed in June-July 2010 and 2014. Descriptive statistics were calculated for nutrient content of main dishes and side dishes, as well as for those items that were added, removed, or unchanged during the study period. Results: Nutrient content of main dishes did not change significantly between 2010 and 2014. Approximately one-third of main dishes at fast-food restaurant chains and half of main dishes at sit down restaurant chains exceeded the 2010 Dietary Guidelines for Americans recommended levels for sodium, fat, and saturated fat in 2014. Improvements in nutrient content were observed for side dishes. At sit down restaurant chains, added side dishes contained over 50 % less calories, fat, saturated fat, and sodium, and were more likely to contain fruits/vegetables compared to removed sides (p∈
Analysis of the Caloric and Macronutrient Content of Meal Options Offered to Children at Popular Restaurant ChainsDeierlein, A., Coffman, K., & Claudio, L.
Journal titleInternational Journal of Child Health and Nutrition
Diet Quality of Urban Older Adults Age 60 to 99 Years: The Cardiovascular Health of Seniors and Built Environment StudyDeierlein, A., Morland, K. B., Scanlin, K., Wong, S., & Spark, A.
Journal titleJournal of the Academy of Nutrition and Dietetics
Page(s)279-187There are few studies that evaluate dietary intakes and predictors of diet quality in older adults. The objectives of this study were to describe nutrient intakes and examine associations between demographic, economic, behavioral, social environment, and health status factors and diet quality. Cross-sectional data were from black, white, and Hispanic adults, age 60 to 99 years, living independently in New York City and participating in the Cardiovascular Health of Seniors and the Built Environment Study, 2009-2011 (n=1,306). Multivariable log-linear regression estimated associations between selected factors and good diet quality, defined as a Healthy Eating Index score more than 80 (based on the 2005 Dietary Guidelines for Americans [HEI-2005]). Dietary intakes were similar for men and women; intakes of energy, fiber, and the majority of micronutrients were less than recommendations, whereas intakes of fats, added sugar, and sodium were within the upper range or exceeded recommendations. Hispanic ethnicity (relative risk [RR]=1.37; 95% CI 1.07 to 1.75), energy intake
Local food environments are associated with girls' energy, sugar-sweetened beverage and snack-food intakesDeierlein, A., Galvez, M. P., Yen, I. H., Pinney, S. M., Biro, F. M., Kushi, L. H., Teitelbaum, S., & Wolff, M. S.
Journal titlePublic Health Nutrition
Page(s)2194-2200Objective: To describe availability and frequency of use of local snack-food outlets and determine whether reported use of these outlets was associated with dietary intakes. Design: Data were cross-sectional. Availability and frequency of use of three types of local snack-food outlets were reported. Daily dietary intakes were based on the average of up to four 24 h dietary recalls. Multivariable linear regression models estimated average daily intakes of energy, sugar-sweetened beverages (SSB) and snack foods/sweets associated with use of outlets. Setting: Multi-site, observational cohort study in the USA, 2004-2006. Subjects: Girls aged 6-8 years (n 1010). Results: Weekly frequency of use of local snack-food outlets increased with number of available types of outlets. Girls with access to only one type of outlet reported consuming food/beverage items less frequently than girls with access to two or three types of outlets (P <0·001). Girls' daily energy, SSB and snack foods/sweets intakes increased with greater use of outlets. Girls who reported using outlets > 1 to 3 times/week consumed 0·27 (95 % CI 0·13, 0·40) servings of SSB more daily than girls who reported no use. Girls who reported using outlets > 3 times/week consumed 449·61 (95 % CI 134·93, 764·29) kJ, 0·43 (95 % CI 0·29, 0·58) servings of SSB and 0·38 (95 % CI 0·12, 0·65) servings of snack foods/sweets more daily than those who reported no use. Conclusions: Girls' frequency of use of local snack-food outlets increases with the number of available types of outlets and is associated with greater daily intakes of energy and servings of SSB and snack foods/sweets.
An anthropometric model to estimate neonatal fat mass using air displacement plethysmographyDeierlein, A., Thornton, J., Hull, H., Paley, C., & Gallagher, D.
Journal titleNutrition and Metabolism
Volume9Background: Current validated neonatal body composition methods are limited/impractical for use outside of a clinical setting because they are labor intensive, time consuming, and require expensive equipment. The purpose of this study was to develop an anthropometric model to estimate neonatal fat mass (kg) using an air displacement plethysmography (PEA POD Infant Body Composition System) as the criterion. Methods. A total of 128 healthy term infants, 60 females and 68 males, from a multiethnic cohort were included in the analyses. Gender, race/ethnicity, gestational age, age (in days), anthropometric measurements of weight, length, abdominal circumference, skin-fold thicknesses (triceps, biceps, sub scapular, and thigh), and body composition by PEA POD were collected within 1-3 days of birth. Backward stepwise linear regression was used to determine the model that best predicted neonatal fat mass. Results: The statistical model that best predicted neonatal fat mass (kg) was: -0.012 -0.064*gender + 0.024*day of measurement post-delivery -0.150*weight (kg) + 0.055*weight (kg) 2 + 0.046*ethnicity + 0.020*sum of three skin-fold thicknesses (triceps, sub scapular, and thigh); R 2 = 0.81, MSE = 0.08 kg. Conclusions: Our anthropometric model explained 81% of the variance in neonatal fat mass. Future studies with a greater variety of neonatal anthropometric measurements may provide equations that explain more of the variance.
Gestational weight gain and predicted changes in offspring anthropometrics between early infancy and 3 yearsDeierlein, A., Siega-Riz, A. M., Herring, A. H., Adair, L. S., & Daniels, J. L.
Journal titlePediatric obesity
Page(s)134-142Objective: To determine how gestational weight gain (GWG), categorized using the 2009 Institute of Medicine recommendations, relates to changes in offspring weight-for-age (WAZ), length-for-age (LAZ) and weight-for-length z-scores (WLZ) between early infancy and 3 years. Methods: Women with singleton infants were recruited from the third cohort of the Pregnancy, Infection, and Nutrition Study (2001-2005). Term infants with at least one weight or length measurement during the study period were included (n = 476). Multivariable linear mixed effects regression models estimated longitudinal changes in WAZ, LAZ and WLZ associated with GWG. Results: In early infancy, compared with infants of women with adequate weight gain, those of women with excessive weight gains had higher WAZ, LAZ and WLZ. Excessive GWG ≥ 200% of the recommended amount was associated with faster rates of change in WAZ and LAZ and noticeably higher predicted mean WAZ and WLZ that persisted across the study period. Conclusions: GWG is associated with significant differences in offspring anthropometrics in early infancy that persisted to 3 years of age. More longitudinal studies that utilize maternal and paediatric body composition measures are necessary to understand the nature of this association.
How can we assist women in managing gestational weight gain?Deierlein, A., & Siega-Riz, A. M.
Journal titleWomen's Health
Long–term consequences of obesity in pregnancy for the motherDeierlein, A., & Siega-Riz, A. M.
Page(s)81-86Current knowledge argues that pregnancy serves as a preview of a woman’s long-term health. The numerous physiological changes during pregnancy, which stress the metabolic system , can reveal subclinical disease states as well as identify new ones [2,3]. Evidence for this assertion exists in studies that have examined the association between gestational diabetes mellitus (GDM) and subsequent type 2 diabetes mellitus (T2DM) , as well as hypertensive disorders during pregnancy and subsequent cardiovascular disease risk factors . Whether pregnancy is on the causal pathway or simply a time period that allows these chronic diseases to be unmasked remains yet to be determined. Obese women are more likely to be at higher risk of developing complications such as GDM, hypertensive disorders, and pre-eclampsia during pregnancy [6–9]. In this chapter we will focus on the evidence for the association between gestational weight gain and postpartum weight retention among obese women, as well as the association between obesity and lack of breastfeeding, and how these associations are potentially interrelated to cause further disease in obese women. Postpartum weight retention. Pregnancy and its associated weight gain may be potential “triggers” for the development of obesity in women [10,11]. Pooled estimates of average absolute postpartum weight retention in units of body mass index (BMI) (kg/m2) are 2.42 (95% CI: 2.32–2.52) at six weeks, 1.14 (95% CI: 1.04–1.25) at six months, and 0.46 (95% CI: 0.38–0.54) at twelve months postpartum . These estimates suggest that most women will lose the majority of weight that is associated with pregnancy within one year postpartum. However, many studies have observed a wide range of variation in postpartum weight retention [13,14], with as many as 20% of women having substantial postpartum weight retention ranging over 5kg (11lbs) .
Physical activity during pregnancy and risk of hyperglycemiaDeierlein, A., Siega-Riz, A. M., & Evenson, K. R.
Journal titleJournal of Women's Health
Page(s)769-775Objective: To determine the association between moderate and vigorous physical activities (MVPA) during midpregnancy and the risk of hyperglycemia. Methods: Data were from 1437 pregnant women. Frequency, duration, and intensity of MVPA during the previous 7 days were collected via questionnaire at 17-22 weeks' gestation. Modes of MVPA included work, recreation, transportation, caregiving, and indoor and outdoor household activities. Hyperglycemia was defined as a glucose concentration ≥130 mg/dL on a 1-hour, 50-g glucose challenge test or gestational diabetes mellitus (GDM) assessed at ∼27 weeks' gestation. Multivariable Poisson regression estimated risks of hyperglycemia associated with total and mode-specific MVPA. Results: There were 269 women (18.7%) with hyperglycemia. Any metabolic equivalent (MET) hours/week of recreational MVPA was associated with a 27% lower risk of hyperglycemia (adjusted relative risk, [aRR] 0.73, 95% confidence interval [95%CI] 0.54-0.99). Multiplicative interaction terms were significant for prepregnancy body mass index (BMI) and recreational MVPA (p=0.01). Among women with prepregnancy BMI 2, recreational MVPA was associated with a 48% lower risk of hyperglycemia (aRR 0.52, 95%CI 0.33-0.83) compared to women who reported none. There was no association of hyperglycemia and recreational MVPA among women with prepregnancy BMI 2. Conclusions: Recreational MVPA during pregnancy is associated with a lower risk of hyperglycemia, specifically among women with prepregnancy BMI 2. Further research is warranted to determine recommended amounts and intensities of physical activity and to discern whether there are differences in the effects of physical activity between specific modes of physical activity or among subgroups of women in relation to hyperglycemia.
Postpartum Weight Retention, Chronic Disease, and Optimal Inter-Pregnancy IntervalGillman, M. W., Poston, L., & Deierlein, A.
Childhood Hair Product Use and Earlier Age at Menarche in a Racially Diverse Study Population: A Pilot StudyJames-Todd, T., Terry, M. B., Rich-Edwards, J., Deierlein, A., & Senie, R.
Journal titleAnnals of Epidemiology
Page(s)461-465Purpose: Previous studies suggest that hair products containing endocrine disrupting chemicals could alter puberty. We evaluated the association between childhood hair product use and age at menarche in a racially diverse study population. Methods: We recruited 300 African-American, African-Caribbean, Hispanic, and white women from the New York City metropolitan area who were between 18-77 years of age. Data were collected retrospectively on hair oil, lotion, leave-in conditioner, perm, and other types of hair products used before age 13. Recalled age at menarche ranged from 8 to 19 years. We used multivariable binomial regression to evaluate the association between hair product use and age at menarche (
Effects of pre-pregnancy body mass index and gestational weight gain on infant anthropometric outcomesDeierlein, A., Siega-Riz, A. M., Adair, L. S., & Herring, A. H.
Journal titleThe Journal of Pediatrics
Page(s)221-226Objective: To determine whether pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) influence infant postnatal growth. Study design: Participants were from the Pregnancy, Infection, and Nutrition study, a prospective pregnancy cohort. Term infants with weight or length measurements at approximately 6 months were included (n = 363). Multivariable regression estimated associations for weight-for-age (WAZ), length-for-age (LAZ), and weight-for-length z-scores (WLZ) and rapid infant weight gain with categorical maternal exposures defined with the 2009 Institute of Medicine recommendations. Results: Pre-pregnancy overweight and obesity were associated with higher WAZ (linear regression coefficient [β], 0.32; 95% CI, 0.04-0.61) and WLZ (β, 0.39; 95% CI, 0.02-0.76), respectively. Pre-pregnancy BMI was not associated with LAZ. Excessive GWG was associated with higher WAZ (β, 0.39; 95% CI, 0.15-0.62) and LAZ (β, 0.34; 95% CI, 0.12-0.56). Excessive GWG ≥200% of recommended amount was associated with higher WAZ (β, 0.68; 95% CI, 0.28-1.07), LAZ (β, 0.45; 95% CI, 0.06-0.83), and WLZ (β, 0.43; 95% CI, 0.04-0.82). Risk of rapid weight gain increased across maternal exposure categories; however, none of the estimates were significant. Conclusions: Pre-pregnancy BMI and GWG are modifiable intrauterine exposures that influence infant postnatal anthropometric outcomes. Further investigation with infant body composition measurements is warranted.
The association between maternal glucose concentration and child BMI at age 3 yearsDeierlein, A., Siega-Riz, A. M., Chantala, K., & Herring, A. H.
Journal titleDiabetes Care
Page(s)480-484OBJECTIVE - The objective of the study was to determine the association between child BMI at age 3 years and maternal glucose concentration among women without pre-existing diabetes or a gestational diabetes mellitus (GDM) diagnosis. RESEARCH DESIGN AND METHODS - Data are from the Pregnancy Infection and Nutrition and Postpartum studies and include 263 mother-child pairs. Measured weights and heights at 3 years were used to calculate age- and sex-specific BMI z scores and percentiles. Multivariable linear regression models were used to examine associations of continuous BMI z scores with maternal glucose concentration. Modified Poisson regression estimated risk ratios of child overweight/obesity (BMI ≥85th percentile). RESULTS - The mean (SD) maternal glucose concentration and prepregnancy BMI were 103.8 (23.7) mg/dL and 24.3 (5.9) kg/m 2, respectively. At 3 years, the mean (SD) child BMI z score was 0.29 (0.99), 20.9% were overweight/obese and 5.3% were obese. In the adjusted model, when compared with glucose concentration
Implementation of the new institute of medicine gestational weight gain guidelinesSiega-Riz, A. M., Deierlein, A., & Stuebe, A.
Journal titleJournal of Midwifery and Women's Health
Page(s)512-519In May 2009, the Institute of Medicine (IOM) introduced revised gestational weight gain guidelines that were based on balancing the benefits and risks of weight gain for both the mother and child's health. This article provides an overview of these new recommendations, explaining the key changes made from the previous 1990 IOM recommendations. The important role of health care providers of pregnant women in the implementation of the new recommendations is detailed, and specific guidance for troubleshooting issues that may be encountered when helping women achieve appropriate gestational weight gains is provided.
Sociodemographic, perinatal, behavioral, and psychosocial predictors of weight retention at 3 and 12 months postpartumSiega-Riz, A. M., Herring, A. H., Carrier, K., Evenson, K. R., Dole, N., & Deierlein, A.
Page(s)1996-2003Postpartum weight retention plays an important role in the pathway leading to obesity among women of childbearing age. The objective of this study was to examine predictors of moderate (1-10 pounds) and high (>10 pounds) postpartum weight retention using data from a prospective pregnancy cohort that followed women into the postpartum period; n = 688 and 550 women at 3 and 12 months, respectively. Analysis included descriptive statistics and predictive modeling using log-binomial techniques. The average weight retained at 3 and 12 months postpartum in this population was 9.4lb (s.d. = 11.4) and 5.7lb (s.d. = 13.2), respectively. At 3 months postpartum, prepregnancy weight, gestational weight gain, and hours slept during the night were associated with moderate or high weight retention, whereas having an infant hospitalized after going home and scoring in the upper 75th percentile of the Eating Attitudes Test (EAT) were associated only with high weight retention. At 12 months postpartum, prepregnancy weight, gestational weight gain, and maternal education were associated with moderate weight retention; and gestational weight gain, maternal age, race, employment status, and having an infant hospitalized at birth were associated with high weight retention. The results of this study illustrate the importance of prepregnancy weight and gestational weight gain in predicting postpartum weight retention. Furthermore, given the lack of successful intervention studies that exist to date to help women lose weight in the postpartum period, the results of this study may help to inform future interventions that focus on such aspects as hours of sleep, dealing with stress associated with a hospitalized infant, and nonclinical eating disorder symptomatology.
A systematic review of outcomes of maternal weight gain according to the Institute of Medicine recommendations: birthweight, fetal growth, and postpartum weight retentionSiega-Riz, A. M., Viswanathan, M., Moos, M. K., Deierlein, A., Mumford, S., Knaack, J., Thieda, P., Lux, L. J., & Lohr, K. N.
Journal titleAmerican Journal of Obstetrics and Gynecology
Issue4This systematic review focuses on outcomes of gestational weight gain, specifically birthweight, fetal growth, and postpartum weight retention, for singleton pregnancies with respect to the 1990 Institute of Medicine weight gain recommendations. A total of 35 studies met the inclusion criteria and were reviewed. There was strong evidence to support associations between excessive gestational weight gain and increased birthweight and fetal growth (large for gestational age) as well as inadequate gestational weight gain and decreased birthweight and fetal growth (small for gestational age). There was moderate evidence to support the association between excessive gestational weight gain and postpartum weight retention. Clear clinical recommendations based on this review are challenging because of several limitations in the literature. Improvements in future research include the use of consistent definitions of gestational weight gain and outcomes of interest, assessment of confounders, and better collection of weight and weight gain data.
Dietary energy density but not glycemic load is associated with gestational weight gainDeierlein, A., Siega-Riz, A. M., & Herring, A.
Journal titleAmerican Journal of Clinical Nutrition
Page(s)693-699Background: Most pregnant women gain more weight than the ranges recommended. Excessive weight gain is linked to pregnancy complications and to long-term maternal and child health outcomes. Objective: The objective was to examine the impact of dietary glycemic load and energy density on total gestational weight gain and the weight gain ratio (observed weight gain/expected weight gain). Design: Data are from 1231 women with singleton pregnancies who participated in the Pregnancy, Infection, and Nutrition Cohort Study. Dietary information was collected at 26-29 wk of gestation with the use of a semiquantified food-frequency questionnaire. Linear regression models were used to estimate the associations between quartiles of glycemic load and energy density with total gestational weight gain and weight gain ratio. Results: Dietary patterns of pregnant women significantly differed across many sociodemographic and behavioral characteristics, with the greatest contrasts seen for glycemic load. After adjustment for covariates, compared with women in the first quartile consuming a mean dietary energy density of 0.71 kcal/g (reference), women in the third quartile consuming a mean energy density of 0.98 kcal/g gained an excess of 1.13 kg (95% CI: 0.24, 2.01), and women in the fourth quartile consuming a mean energy density of 1.21 kcal/g gained an excess of 1.08 kg (95% CI: 0.20, 1.97) and had an increase of 0.13 (95% CI: 0.006, 0.24) units in the weight gain ratio. All other comparisons of energy intakes were not statistically significant. Glycemic load was not associated with total gestational weight gain or weight gain ratio. Conclusion: Dietary energy density is a modifiable factor that may assist pregnant women in managing gestational weight gains.
Outcomes of maternal weight gain.Viswanathan, M., Siega-Riz, A. M., Moos, M. K., Deierlein, A., Mumford, S., Knaack, J., Thieda, P., Lux, L. J., & Lohr, K. N.
Journal titleEvidence report/technology assessment
Page(s)1-223OBJECTIVES: The RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center (RTI-UNC EPC) systematically reviewed evidence on outcomes of gestational weight gain and their confounders and effect modifiers, outcomes of weight gain within or outside the 1990 Institute of Medicine (IOM) guidelines, risks and benefits of weight gain recommendations, and anthropometric measures of weight gain. DATA SOURCES: We searched MEDLINE Cochrane Collaboration resources, Cumulative Index to Nursing & Allied Health Literature, and Embase. REVIEW METHODS: We included studies published in English from 1990 through October 2007. We excluded studies with low sample size (based on study design: case series