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The Institute of Medicine (IOM) recommends pregnancy weight gain ranges based on pre-pregnancy BMI. Underweight women (BMI <18.5) should gain 28-40 lbs, while obese women (BMI 30+) should gain 11-20 lbs. Gain is typically 1-4 lbs in the first trimester, then 0.8-1 lb/week in the second and third trimesters.