 1. The association between Institute of Medicine, IOM, Guidelines and Pregnancy Outcomes across ethnicities is uncertain. 2. We evaluated the associations of gestational weight gain, GWG, outside 2009 IOM Guidelines, with maternal and infant outcomes across the USA, Western Europe and East Asia, with subgroup analyses in Asia. 3. The aimless to explore ethnic differences in maternal pre-pregnancy body mass in index, BMI, GWG and health outcomes across these regions. 4. Methods, we used a systematic review, meta-analysis and meta-aggression of observational studies for the study. Medline This article was authored by Rebecca F. Goldstein, Sally K. Abel, Sanjiva Rana Sr., and others. We are article.tv, links in the description below.