Sara Edwards is a third-year doctoral student at Emory University and has 20 years of clinical expertise as a nurse-midwife. She has taught undergraduate and graduate nursing at Emory for over ten years, primarily in maternal-child health. Her research interests include biobehavioral influences (especially the Brain-Gut Axis) on gestational weight gain and the impact these factors have on racial health disparities in maternal and neonatal outcomes and chronic diseases.


Nearly two-thirds of US women of childbearing age are overweight or obese and nearly half, once pregnant, gain excess gestational weight. In 2009, the Institute of Medicine (IOM) published new recommendations for pre-pregnancy body mass index (BMI) and gestational weight gain (GWG). The most restrictive weight gain recommendation category is for pre-pregnant obese women to gain between 11-20 pounds. This restrictive recommendation presents a particular challenge for African-American (AA) women, who are more likely than women of other races to enter pregnancy overweight or obese. The age-adjusted prevalence is 75% of AA women of childbearing age entering pregnancy overweight or obese, the highest of all races. Given that the strongest predictor of excessive GWG is prepregnant BMI and 68% of AA women gain excessively, research is beginning to focus upon racial differences in pre-pregnant weight and GWG. Women who start their pregnancies overweight are six times more likely than those of healthy weight to gain more than recommended. As BMI increases, folate levels decrease, directly contributing to an increased incidence of birth defects. Excessive GWG and postpartum weight retention are important predictors of lifelong obesity and are associated with multiple obstetric complications. With the exception of gestational diabetes, all the most serious complications are more common among AA women, contributing to AAs having the highest national rates of maternal, fetal and neonatal morbidity and mortality. Scientific scrutiny of the underlying mechanisms that contribute to excessive GWG in this population is needed and the current state of the science will be presented.