Prenatal Weight Gain Chart

N.C. Department of Health and Human Services
Women’s and Children’s Health Section
PRENATAL WEIGHT GAIN CHART
Pre-Pregnancy Normal Weight
BMI 18.5–24.9
Weight Gain Recommendations (singleton):
♦ 2.2–6.6 lb. gain 1
st
trimester
♦ 1 lb. gain per week 2
nd
and 3
rd
trimesters
♦ 25–35 lb. total weight gain
-5
5
10
15
20
25
30
35
40
45
0 4 8 12 16 20 24 28 32 36 40
Weeks of Gestation
Weight Gain (Pounds)
baseline
EDC ______________________________
Ht. (without shoes) __________________
Pre-Pregnancy Wt. ___________________
Pre-Pregnancy BMI __________________
Date
Weeks
Gestation Weight Notes
1. Last Name First Name MI
2. Patient Number
3. Date of Birth
(MM/DD/YYYY)
Month Day Year
4. Race □ American Indian or Alaska Native □ Asian
□ Black/African American □ Native Hawaiian/Other Pacic 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
DHHS 2388B (Revised 06/10)
Women’s and Children’s 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.
Page 1/1
Free Download
Prenatal Weight Gain Chart PDF
Favor this template? Just fancy it by voting!
(0 Votes)
0.0
Related Forms