1.

Last Name 2. Patient Number 3. Date of Birth (MM/DD/YYYY)

First Name

MI

N.C. Department of Health and Human Services Womens and Childrens Health Section

Month Day Year 4. Race American Indian or Alaska Native Asian Black/African American Native Hawaiian/Other Pacific Islander Unknown White 5. Ethnic Origin Hispanic Cuban Hispanic Mexican American Hispanic Other Hispanic Puerto Rican Not Hispanic/Latino Unreported 6. Gender Female Male 7. County of Residence
45

PRENATAL WEIGHT GAIN CHART

Pre-Pregnancy Underweight BMI <18.5
Weight Gain Recommendations (singleton): 2.26.6 lb. gain 1st trimester 1 lb. gain per week 2nd and 3rd trimesters 2840 lb. total weight gain

EDC _______________________________ Ht. (without shoes) _ __________________ Pre-Pregnancy Wt.____________________ Pre-Pregnancy BMI ___________________
Date Weeks Gestation Weight Notes

40

35

30

25

Weight Gain (Pounds)

20

15

10

baseline

-5

Weeks of Gestation DHHS 2388 (Revised 06/10) Womens and Childrens Health Section (Review 06/13) Source: Institute of Medicine, 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC. National Academies Press; Committee to Reexamine IOM Pregnancy Guidelines.

12

16

20

24

28

32

36

40

1. Last Name 2. Patient Number 3. Date of Birth (MM/DD/YYYY)

First Name

MI

N.C. Department of Health and Human Services Womens and Childrens Health Section

Month Day Year 4. Race American Indian or Alaska Native Asian Black/African American Native Hawaiian/Other Pacific Islander Unknown White 5. Ethnic Origin Hispanic Cuban Hispanic Mexican American Hispanic Other Hispanic Puerto Rican Not Hispanic/Latino Unreported 6. Gender Female Male 7. County of Residence
45

PRENATAL WEIGHT GAIN CHART

Pre-Pregnancy Normal Weight BMI 18.524.9
Weight Gain Recommendations (singleton): 2.26.6 lb. gain 1st trimester 1 lb. gain per week 2nd and 3rd trimesters 2535 lb. total weight gain

EDC _______________________________ Ht. (without shoes) _ __________________ Pre-Pregnancy Wt.____________________ Pre-Pregnancy BMI ___________________
Date Weeks Gestation Weight Notes

40

35

30

25 Weight Gain (Pounds)

20

15

10

baseline

-5

Weeks of Gestation DHHS 2388 (Revised 06/10) Womens and Childrens Health Section (Review 06/13) Source: Institute of Medicine, 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC. National Academies Press; Committee to Reexamine IOM Pregnancy Guidelines.

12

16

20

24

28

32

36

40

1. Last Name 2. Patient Number 3. Date of Birth (MM/DD/YYYY)

First Name

MI

N.C. Department of Health and Human Services Womens and Childrens Health Section

Month Day Year 4. Race American Indian or Alaska Native Asian Black/African American Native Hawaiian/Other Pacific Islander Unknown White 5. Ethnic Origin Hispanic Cuban Hispanic Mexican American Hispanic Other Hispanic Puerto Rican Not Hispanic/Latino Unreported 6. Gender Female Male 7. County of Residence
45

PRENATAL WEIGHT GAIN CHART

Pre-Pregnancy Overweight BMI 25.029.9
Weight Gain Recommendations (singleton): 2.26.6 lb. gain 1st trimester 0.6 lb. gain per week 2nd and 3rd trimesters 1525 lb. total weight gain

40

EDC _______________________________ Ht. (without shoes) _ __________________ Pre-Pregnancy Wt.____________________ Pre-Pregnancy BMI ___________________
Date Weeks Gestation Weight Notes

35

30

25

Weight Gain (Pounds)

20

15

10

baseline

-5

DHHS 2388 (Revised 06/10) Weeks of Gestation Womens and Childrens Health Section (Review 06/13) Source: Institute of Medicine, 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC. National Academies Press; Committee to Reexamine IOM Pregnancy Guidelines.

12

16

20

24

28

32

36

40

1. Last Name 2. Patient Number 3. Date of Birth (MM/DD/YYYY)

First Name

MI

N.C. Department of Health and Human Services Womens and Childrens Health Section

Month Day Year 4. Race American Indian or Alaska Native Asian Black/African American Native Hawaiian/Other Pacific Islander Unknown White 5. Ethnic Origin Hispanic Cuban Hispanic Mexican American Hispanic Other Hispanic Puerto Rican Not Hispanic/Latino Unreported 6. Gender Female Male 7. County of Residence
45

PRENATAL WEIGHT GAIN CHART

Pre-Pregnancy Obese BMI 30.0
Weight Gain Recommendations (singleton): 1.14.4 lb. gain 1st trimester 0.5 lb. gain per week 2nd and 3rd trimesters 1120 lb. total weight gain

40

EDC _______________________________ Ht. (without shoes) _ __________________ Pre-Pregnancy Wt.____________________ Pre-Pregnancy BMI ___________________
Date Weeks Gestation Weight Notes

35

30

25

Weight Gain (Pounds)

20

15

10

baseline

-5

12

16

20

24

28

32

36

40

DHHS 2388 (Revised 06/10) Weeks of Gestation Womens and Childrens Health Section (Review 06/13) Source: Institute of Medicine, 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC. National Academies Press; Committee to Reexamine IOM Pregnancy Guidelines.