Prenatal Weight Gain Grid Template Page 3
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3Prenatal Weight Gain Grid
Multifetal Pregnancy
Obese
Body Mass Index (BMI) Table for Determining
Name:______________________________________
Weight Classification for Women (1)
(weight in pounds)
❏
❏
❏
❏
A
B
C
D
ID#: _______________ Date of Birth: _____________
Height
Normal Weight Underweight
Overweight
Obese
BMI
BMI
BMI
BMI
(in inches
18.5 - 24.9
< 18.5
25.0 - 29.9
> 30.0
no shoes)
Weight Gain Recommendations
58
089 – 118
< 89
119 – 142
> 142
D - Obese: 25 to 42 lb total
59
092 – 123
< 92
124 – 147
> 147
1
st
trimester: 3.2 to 5.4 lb gain
60
95 – 127
< 95
128 – 152
> 152
2
nd
& 3
rd
trimesters: 0.8 to 1.4 lb/week
61
98 – 131
< 98
132 – 157
> 157
Check if applicable:
❏
D
62
101 – 135
< 101
136 – 163
> 163
55
63
105 – 140
< 105
141 – 168
> 168
64
108 – 144
< 108
145 – 173
> 173
65
111 – 149
< 111
150 – 179
> 179
50
66
115 – 154
< 115
155 – 185
> 185
67
118 – 158
< 118
159 – 190
> 190
68
122 – 163
< 122
164 – 196
> 196
69
125 – 168
< 125
169 – 202
> 202
45
70
129 – 173
< 129
174 – 208
> 208
71
133 – 178
< 133
179 – 214
> 214
72
137 – 183
< 137
184 – 220
> 220
40
(1) Adapted from the Clinical Guidelines on the Identification, Evaluation and Treatment of
Overweight and Obesity in Adults. National Heart, Lung and Blood Institute (NHLBI), National
Institutes of Health (NIH). NIH Publication No. 98-4083.
35
# Wks.
Total
Date
Weight
D
Preg.
Wt. Gain
30
25
20
15
10
EDD: _________________________
5
Height (no shoes): ______________
Prepregnancy Weight: ___________
0
If prepregnancy weight is unknown, use
professional judgement to select A, B, C, or D range.
Next, plot the midpoint of the selected range for the
-5
number of weeks pregnant to obtain the Expected
Weight Gain. Then use this equation:
Expected
Estimated
Current
–
Weight
=
Prepregnancy
-10
Weight
Gain
Weight
0
5
10
15
20
25
30
35
40
Number of Weeks Pregnant
See top of page 2 for instructions.
1st trimester
2nd trimester
2nd trimester
3rd trimester
Page 3
Source: Florida Dept. of Health
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