Pregnant, Nourished, And Future-Ready: Why Gestational Weight Gain (GWG) Must Be A Public-Health Priority

In a small Rajasthan village, Jyoti Kumari, though unable to read or write, made a profound choice. She defied her family's long-held superstitions about pregnancy diets to embrace scientific nutritional advice from active frontline workers in her area. The Anganwadi didi worked to build trust, patiently counselled the family, and empowered Jyoti to make informed choices for her baby's well-being. By achieving a healthy weight gain of 8.2 kg, Jyoti did more than just meet a health target; she broke a cycle of intergenerational malnutrition. Her decision not only ensured she delivered a healthy baby against the odds but also illuminated a scalable path forward for maternal health across India. Jyoti’s story is not an isolated tale of determination; it is a powerful illustration of a critical public health challenge and its solution.

One in two Indian children can be referred to as small vulnerable newborn (SVN), placing them at increased risk of neonatal deaths,developmental delays and long-term health problems. Much of that damage begins before birth. Pregnancy is a critical window for shaping a child’s future health, and one of the clearest markers of maternal nutrition during this period is gestational weight gain (GWG)-how much weight a woman gains in pregnancy. Too little weight gain raises risks of preterm birth and small-for-gestational-age babies and low birth weight babies; too much gain raises risks of gestational diabetes, hypertension and caesarean deliveries. In India, a significant proportion of women enter pregnancy underweight. Many women also gain insufficient weight during pregnancy, while a smaller proportion gain too much. Optimal GWG means gaining the right amount, supported by diverse diets, adequate micronutrients, and healthy behaviours. On the other hand, lifestyle studies show that counselling on diet diversity and physical activity reduces excessive GWG. By the first antenatal visit, much of GWG potential is already set. The Mother and Infant (MAI) cohort study from Pune showed that maternal nutrition status before and in early pregnancy strongly predicts birth size, with mid-pregnancy around 28 weeks being a critical window for action. That is why preconception and antenatal care must be mainstreamed.

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Some states are experimenting. Uttar Pradesh’s Suhaag Kit and Bihar’s Nai Pehal Kit provide newlyweds with nutrition products and counselling to delay their first pregnancy. Maharashtra’s Vatsalya program centres on pre-pregnancy to the first 1000 days with an intention to reduce the preventable morbidity and mortalities among mothers and children by preparing for conception and growth monitoring. Rajasthan’s RajPusht takes a “cash plus” approach, combining transfers, counselling and digital weighing to improve maternal diets and weight monitoring. Community-based events (CBEs) under POSHAN Abhiyaan and Village Health Sanitation and Nutrition Days (VHSNDs) can integrate preconception counselling, involve men, and engage families. These low-cost initiatives ensure women enter pregnancy with healthier baselines, making GWG easier to achieve and safer to manage.

Diet is not only an individual choice — it is shaped by policy. India’s PDS, ICDS, POSHAN Abhiyaan and fortification programmes determine what women eat. If these channels prioritise pulses, dairy, eggs and millets, healthy GWG becomes more achievable. Evidence from studies such as the REVAMP study in Pune (Research Exploring Various Aspects and Mechanisms in Preeclampsia) and the GARBHINI cohort study in Haryana highlights that global standards often fail to align with Indian realities. Women here need locally tailored guidance supported by nutrition-sensitive food systems. If cheap, ultra-processed foods continue to dominate markets, poor-quality or excessive weight gain becomes the norm.

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The ICMR-INDIAB study warns that metabolic disease is now common across all classes. Even normal-weight women are at high risk of diabetes and hypertension. The WINGS trial (Women and Infants Integrated Interventions for Growth Study) in Delhi tested a combined package of health, nutrition, Water, Hygiene and sanitation and psychosocial interventions from preconception through early childhood, showing that while effects on gestational weight gain were limited, integrated interventions led to significantly better maternal and neonatal outcomes. This demonstrates that multi-pronged strategies, rather than single solutions, are necessary for improving outcomes in high-risk pregnancies. This proves that in high-risk pregnancies, single fixes don’t work — multi-pronged approaches are essential.

Adolescent pregnancy adds another layer of risk. Young mothers, often undernourished, gain less weight and deliver smaller babies, perpetuating intergenerational undernutrition. Delaying marriage, ensuring adolescent-friendly services, and providing tailored nutrition packages where pregnancies occur are critical steps.

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Nutrition is smart economics. Global analyses show up to 18-fold returns in productivity, healthcare savings and human capital. The Global Burden of Disease data 1990-2017 highlight that malnutrition continues to be the leading risk factor for disease burden in India. Yet FAO/UNICEF surveys show over 70% of households cannot afford a healthy diet. Without subsidies, vouchers and improved market access, maternal diets and GWG will remain compromised.

An integrated vision for a nourished India can be framed around the call to action represented by M-O-T-H-E-R-S: mainstream preconception care, observe and monitor maternal weight, tailor the soon-to-be-released WHO global GWG standards to be India-specific, promote healthy food environments, eliminate the double burden of malnutrition and metabolic risk, reach adolescents, and strengthen integrated packages of support.

A moral and pragmatic imperative

Poor maternal nutrition is a policy-responsive challenge, with immediate payoffs at delivery, medium-term benefits for child growth and education, and long-term returns for the economy. By placing optimal GWG and preconception care at the centre of maternal health and nutrition, India can deliver healthier babies, stronger mothers and a more productive future. This is not just about weighing women — it is about breaking the cycle of poor health and building a healthier nation. That is an investment India cannot afford to delay. This will also be a step towards releasing Kuposhan Mukt Bharat by our leadership with an inherent message of “Poshit Mahilayein, Poshit Samaaj."

Written By: Shweta Khandelwal and Reema Mukherjee

Affiliation: IPE Global and ICMR, respectively