Research and Professional Literature to Inform Practice, July/August 2025

Sufficient weight gain during pregnancy has been studied extensively and is associated with many perinatal health outcomes, including cesarean birth, hypertensive disorders of pregnancy, and fetal growth.1, 2 However, the current weight guidelines from the National Academy of Medicine (NAM)3 provide guidance only for the second and third trimesters and do not include specific recommendations for each week of pregnancy, which makes them harder to actualize. Weight loss early in pregnancy, for example, could occur as a result of nausea and vomiting, dietary changes, or an underlying health condition. However, little research has explored the impact of first trimester weight changes and how these changes are seen across the trajectory of an entire pregnancy. Therefore, researchers undertook a careful analysis of weight gain during pregnancy to identify the optimal weight changes per week that are associated with a decreased risk of adverse outcomes, including hypertensive disorders of pregnancy (HDPs), preterm birth, small for gestational age (SGA) birth, and stillbirth according to trimesters and body mass index (BMI) groups. Using prospective data collected as part of the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be, researchers analyzed data from 10,038 participants from 8 different clinical sites representing 7 states across the country. The study excluded multiparous pregnancies and multiple gestations, and for this analysis, those with a diagnosed fetal anomaly were excluded due to the association with adverse pregnancy and neonatal outcomes. Individuals were recruited between 6- and 13-weeks’ gestation, at which point prepregnancy weight was reported, and current weight was measured (visit 1). Subsequent weights were collected at 16- to 21-weeks’ gestation (visit 2), 22- to 29-weeks’ gestation (visit 3), and at birth (visit 4). Primary outcomes included HDPs, preterm birth, SGA, and stillbirth, whereas secondary outcomes included gestational diabetes, cesarean birth, and neonatal complications. Optimal gestational weight change was identified through regression modeling, defined as the level of weight change that corresponded with the lowest adjusted risk ratio (aRR). Those with no gestational weight change were used as a reference group. Individuals were grouped using their BMI category, similar to the NAM's guidelines. In total, 8121 patients representing diverse racial, ethnic, and education backgrounds were included in the analysis, including 4373 (53.8%) with a normal or underweight BMI, 2002 (24.7%) with an overweight BMI, and 1746 (21.5%) with an obese BMI. In this analysis, researchers identified a different ideal weight gain than current NAM standards. They found that the ideal weight change rate in early pregnancy was 0.7 kg or 1.5 lb per week for individuals with a normal, underweight, and an overweight BMI. The ideal rate was 0.6 kg or 1.3 lb per week for individuals with obesity. In the second trimester, they identified a weight change of 0.7 kg or 1.5 lb per week for individuals with a normal or underweight BMI and 0.5 kg or 1.1 lb per week for individuals with an overweight and obese BMI. In the third trimester, they identified a weight change of 0.5 kg or 1.1 lb per week for individuals with a normal or underweight BMI and 0.4 kg or 0.9 lb per week for individuals with an overweight and obese BMI. This is much more lenient than the NAM guidelines, which recommend that during the second and third trimester, appropriate weight gain is 0.5 kg or 1.1 lb per week for individuals who are normal or underweight, 0.3 kg or 0.7 lb per week for individuals who are overweight, and 0.2 km or 0.4 lb per week for individuals with obesity. Further, researchers identified various risks of insufficient or excessive weight gain across all 3 trimesters. Insufficient weight gain in the first trimester was associated with a fetus that was SGA, with an increased risk of SGA, preterm birth, and neonatal complication when weight gain was insufficient in the second and third trimester. Excessive weight gain across all 3 trimesters mirrors prior research but is notable for happening at a higher weight the prior recommendations. The finding of increased risk for SGA is notable because individuals following the NAM guidelines in the second trimester are increasing their risk for SGA. However, researchers did find that the NAM recommendations, unlike their own recommendations, were associated with a decreased risk of cesarean birth. This paradox shows the challenge of balancing the needs of the birthing person and the fetus. Perhaps a more individualized target for weight gain during pregnancy may be warranted for some based on their specific risk factors and health history. Although these results are from a single study and not yet sufficient to inform broad changes to clinical recommendations, the results shine a light on the further research needed in this area to ensure optimal perinatal health outcomes. It is also important to understand the limits of patient education because many aspects of weight and nutrition are systemic problems that cannot be solved by individual actions. Individualized, person-centered approaches to help individuals navigate weight changes throughout the entire pregnancy and postpartum are a critical component of perinatal health care and deserve sufficient evidence to guide clinicians and patients alike. Approximately 17% of individuals living in the United States had a substance use disorder (SUD) within the past year,1 and many of these individuals will become pregnant or give birth while using substances. There are, however, numerous structural and social barriers to receiving perinatal health care. Prior literature has shown how individuals with SUD may avoid care due to fears about punitive policies and concerns about the potential for the involvement of child welfare services or criminal penalties for themselves or other family members.2 Further, individuals with SUD experience bias, stigma, and judgment when they seek care from providers that can perpetuate the inaccessibility and unacceptability of perinatal care.3, 4 The attitudes of providers can even lead to substandard care and negative outcomes for the pregnant person and their fetus.5 Because of the unique ramifications of pregnancy and parenting, perinatal care in particular is an important touchpoint of care for individuals with SUD. To ensure that the voices of individuals who are pregnant and parenting with SUD are included in efforts to create standards of care, researchers conducted in-depth interviews with pregnant individuals currently receiving treatment for SUD. Using an adapted phenomenological approach, which focuses on the lived experiences of individuals within dynamics of unequal power relations, researchers recruited individuals with SUD who were either pregnant or within one year postpartum, regardless of whether or not they had custody of their child. Participants were recruited by flyers posted in 3 SUD treatment centers in Colorado, one inpatient center and 2 outpatient centers. In total, 22 participants were interviewed, the majority of whom were currently in an inpatient residential treatment center (65%), postpartum at the time of the interview (65%), and multiparous (77%). Five major themes were identified by the researchers. The first theme, perceptions of barriers to accessing care and sharing SUD, highlighted the pervasive difficulty in accessing care for those with SUD. Participants experienced internal shame about substance use, feared judgment by their providers, and also feared that disclosure would trigger the involvement of law enforcement. Many participants had prior negative experiences with health care providers that informed these views and felt distrustful toward all subsequent health care providers. Some suggested that transparency from their health care providers helped make them feel more comfortable. The second theme centered on reasons why participants ultimately shared their substance use history. Despite the barriers to disclosure, ultimately all participants in this study shared their substance use with the perinatal health care provider. Some shared out of a desire to receive the appropriate health care services that they needed, and others wanted to ensure they could collaborate with their health care providers throughout their course of care. Many shared that disclosure of their substance use led to appropriate care, more transparent interactions, and a more open relationship. Participants also shared information about their health care experience after sharing about the SUD, as described in the third theme. Among those who had positive experiences, they reported feeling supported, encouraged, and not judged by health care providers who normalized the prevalence of SUD. Additionally, individuals who had positive experiences felt that their internal stigma and shame were eased by the dignified care they received from health care providers. The fourth theme shared the impact of these disclosures to health care providers. Those with positive interactions subsequentially felt empowered and self-sufficient and reported being more likely to feel confident advocating for their and their infant's needs. Trust was enhanced between patients and health care providers in these situations. However, those who had negative experiences disclosing described their distrust of health care providers as growing. They also discussed feelings of shame and reported that they often avoided subsequent care after these negative experiences. In the fifth theme, participants described their interactions with support systems. Many participants said it was helpful for them to receive coordinated care, including services, resources, and education during the perinatal period. Connection with community support for substance use treatment in particular was valued and incredibly helpful as they navigated pregnancy and or postpartum while newly sober. However, a few participants discussed receiving insufficient information from their care team, particularly in the domains of housing and substance use treatment. Some reported testing positive for substances during their prenatal visits but never received information and education about treatment or any resources for community support networks. They felt this would have made a difference in dealing with what one participant described as a “hopeless situation.” Participants also shared their recommendations based on their lived experiences. In particular, they focused on treatment from health care providers. They encouraged providers to show empathy, kindness, and support for individuals with a history of or current SUD. Some described a need for a safe space without health settings where they could be free of criticism. Others felt that providers needed to make an effort to connect with them and get to know them because so often those with SUD are quickly and harshly stereotyped. Participants also wanted providers to realize that SUD does not indicate a flaw in their character but rather reflects a difficulty or adversity they had faced during their life. In getting to know them on a more human level, participants felt that their providers might see that they were, in fact, good parents and working hard to get on stable footing. This study highlights the critical role of perinatal health care providers in supporting or further stigmatizing individuals with SUD during pregnancy and postpartum. Although this study captures the experiences of only individuals who are seeking treatment for SUD, the ramifications for the need to provide compassionate care extend to both those with a history of SUD and those who are actively using substances during pregnancy. Individuals dealing with SUD have numerous barriers to health care before they make it to a provider, and this study highlights the tremendous role that the kindness and respect, or lack thereof, have on individual stigma, shame, and future care-seeking behavior for both participants and their families. Since the Dobbs v. Jackson Women's Health Organization US Supreme Court decision in 2022, state-level abortion restrictions have been enacted across the United States. As a result, half of all reproductive-age women live in states that either entirely ban or severely restrict abortion.1 Less is known, however, on how the Dobbs decision has altered the landscape for adolescents, an age group that has long faced additional hurdles to abortion care. Two recently published studies explore the impact of abortion restrictions on adolescents from 2 different angles: one documents how many adolescents are living in a state with some form of policy restriction on abortion, and the second explores how adolescents in one state navigate the parental consent law. The second of these 2 studies, Lindberg et al,2 seeks to better understand the scope of abortion policy changes that specifically impact adolescents using census data and publicly available data on current state-level abortion bans, gestational limits, and parental notification requirements. Parental consent laws vary by state but generally require notification, consent, or both notification and consent or at least one parent or guardian 24 to 48 hours before an abortion.3 In total, there are over 10 million young women aged 13 to 17 in the United States. Roughly half of these females live in states with either an abortion ban (24%) or a restrictive gestational limit (24%). Additionally, just under half of adolescents live in a state with parental involvement laws. Taken together, 66% of young women aged 13 to 17, over 7 million adolescents, live in a state with an abortion ban, a gestational age limit, or parental involvement requirements. Analysis of the race and ethnicity identified 2 races disproportionately impacted: 78% of Black adolescents and 72% of non-Hispanic White adolescents live in states impacted by these policies. To understand how adolescents navigate parental disclosure and parental consent laws in one state, Coleman-Minahan et al4 interviewed 33 adolescents in the state of Colorado as part of a multistate project on young people's access to and experiences with abortion care. Parental notification is required in Colorado and involves the notification of a parent or adult relative with whom they reside in writing 48 hours before receiving abortion care. Those who cannot safely or reasonably notify a parent or guardian can obtain a judicial bypass, which is a process in which the court will grant permission for a minor to obtain an abortion. Prior literature has highlighted how burdensome and traumatic judicial bypass can be for adolescents and how this process further delays abortion care.5, 6 Of the 33 participants representing 34 pregnancies, 17 pregnancies occurred among adolescents aged 15 to 17, 13 of which ended in abortion and 17 pregnancies occurred among young adults, 15 of which ended in abortion. The sample was racial and ethnically diverse, and a third of the participants were immigrants themselves or had immigrant parents. When asked about the process of disclosing a pregnancy to a parent or guardian, many participants described disapproval from parents regarding abortion, pregnancy, and sex as reasons to not disclose. In particular, those who feared a parent may oppose an abortion were unwilling to disclose a pregnancy. Those who could not disclose a pregnancy desired the support of their parents and were disappointed that they could not involve their parents in this part of their life. Generally, participants who did disclose their pregnancy described parents responding to the news in roughly the way they expected, including parents who were supportive of their child's decision-making or those who were upset. In one instance, a woman's partner disclosed the pregnancy to her parents against her wishes when she wanted an abortion. She ended up continuing the pregnancy after her parents threatened to cut her and her existing child off financially. Four adolescents obtained a judicial bypass to receive an abortion, whereas other adolescents who sought abortion care disclosed to their parents. Notification is actualized by written notification sent to the parent or guardian's house at least 48 hours before the abortion is scheduled to occur. However, dealing with the parental notification letters was a source of confusion and stress for those who sought this route to care. Additionally, 3 of the participants who used parental notification, instead of judicial bypass, would not have told their parent or guardian unless this law was in place because they feared these individuals would not support their decision. Even 3 of the 4 individuals who used judicial bypass experienced an unwanted disclosure to a parent or guardian. Among those who used judicial bypass, all found the process emotionally challenging, stressful, and embarrassing. This was especially true for adolescents of color, who felt further stigmatized by the process. Further, the process of obtaining judicial bypass delayed access to care. Some considered self-managed abortion using unsafe over-the-counter medications, whereas others were forced to travel out of state because the abortion pushed participants past the clinic's gestational age limit. The stories shared by adolescents in Colorado highlight the complexity of adolescent pregnancy and abortion care and the burdensome laws on all young individuals in the state. Although parental notification was less legally burdensome, many participants found this process stressful and introduced the possibility of harm and limits on their reproductive autonomy. For those who used judicial bypass, the process was even more harmful and stressful. 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