Monday, 17 November 2008
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The Skinny on Obesity and Pregnancy
by Nurse Jenna 
It is one of the classic portrayals of pregnancy—the weird food craving of pickles and ice cream. Unfortunately many pregnant women do not just indulge in occasional odd flavor combinations, they gain weight far beyond what is recommended, or are already carrying an unhealthy number of pounds prior to their pregnancy.
Obesity has become an epidemic that has led to a plethora of health problems that carry over to complications during pregnancy. This in turn often leads to many delivery interventions and complications for both mothers and babies that would otherwise be unnecessary in a normal, healthy pregnancy.
A woman who has an appropriate BMI (body mass index—determined by dividing weight in kilograms by height in meters with 19.6-26 being normal) prior to her pregnancy would be expected to gain 25-30 pounds during the course of the pregnancy. Often women use pregnancy as an excuse to eat whatever they want and rationalize it because they are “eating for two.”
The reality is that during pregnancy, a woman only needs an additional 500 calories per day for a healthy weight gain if she is of normal weight. If a woman is already overweight going into the pregnancy, which half of the woman of childbearing age are, she should only gain 15-25 pounds. Those who are considered “obese”, with a BMI greater than 30, should gain no more than 15 pounds.
A woman’s weight gain not only affects her, but continues to affect her baby throughout its life. It has been shown that women that gain more than 40 pounds are twice as likely to have children who struggle with weight problems their entire life. Women who gain more than the amount suggested by their providers are more likely to give birth to babies greater than 9 pounds, which then have a greater risk of longer deliveries and a higher rate of Cesarean sections. They are also at greater risk for pre-eclampsia, gestational diabetes, preterm delivery and babies with congenital birth defects.
So why is it that over 70-90% of women are gaining “excessive” amounts of weight with pregnancy (more than that recommended)? This is one component of a pregnancy and the resulting lowered risk of deliver complications that women can control. With the push for “decreased medical intervention” in what should be a normal birthing process why aren’t women taking charge of something they can by maintaining proper eating and exercising habits before and during the pregnancy?
How much weight did you gain during pregnancy? Had your provider discussed appropriate weight gain with you during your prenatal visitis?
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Comments (56)
I gained 50 with my first and she's skinny like a twig and I dropped every ounce of it.
The doc did mention it but never made a big deal about it.
I'm only 8 weeks pregnant so I don't know how much I will gain but so far I've lost about 10 lbs. I don't suspect I will gain much excess because I plan on eating healthfully and keeping the "junk food" to occasional. I also plan to start some sort of pregnancy yoga or other light exercise along with walking.
I gained 50 with my son - yikes!
With my daughter I gained 35.
im 18 and just had my son in may. i only weighed 105 when i got pregnat then i gained like almost 80 pounds then i have dropped like 20 something of it i still fell huge but i was under weight for my age to begin with
30 with my first
25 with my second
and am working hard to keeping it at 20 for my third. i'm 20 weeks pregnant now and have gained 6lb so far.
I think you have to first consider the fact that obese people are not that way by choice.
I mean honestly, don't you think that every woman wants to experience the baby bump as early as possible? To have a nice little baby belly? Instead of worrying about whether or not they are ever even going to look pregnant??
I am overweight, I am also pregnant with my first, 10 weeks along. Thus far, I have lost 12 pounds. I have talked to many who say that my weight is not an issue. If healthy babies only came from skinny women, there would be alot of unhealthy babies. Likewise, skinny women have babies with health issues too.
I have known both overweight women who delivered healthy babies and thin women who delivered babies who weren't so healthy... some with lasting health concerns. I personally think it puts unnecessary pressure on a woman to make her worry about her weight right off the bat. Please don't misunderstand, we should be aware of our weight gain during pregnancy.
There's no evidence that supports that by being overweight prior to pregnancy, but otherwise healthy will cause any additional complications with reasonable weight gain during pregnancy than that of a woman who wasn't over weight prior to pregnancy, and otherwise healthy who gains a reasonable amount of weight. Personal, physical, strength cannot always be determined by weight.
I agree with the post for the most part. I do think that obesity can and does cause problems with labour and delivery - leading to higher interventions and cesareans. BUT, I do have aproblem with the BMI. I do not think the BMI takes into consideration bone mass/density, where the weight is carried or genetics etc. I'm of average height and not perfect by any means in my size. I think I'm overweight - I know I have pounds to lose. But at 170 lbs, I'm considered obese! I think that's ridiculous! Is part of that because the BMI has set that "perfect standard" that doesn't include NORMAL anymore? I think more needs to be taken into consideration other than just weight and weight gain in pregnancy. A client of mine, with her first baby, gained 80 lbs! She's a slender woman, and her baby was of average size. Her doc at the time didn't harp on it - because she was eating well and looked healthy and had that glow. She lost it all quickly and looked great. Pregnant again - this time she choose to go midwifery route, and that midwife could not see past the 80 pound number. She refused to take into consideration her health, eating habits et.
As with all things - there are always exceptions to the normal - and that's why I don't like the BMI. It lumps EVERYBODY into one box without taking into consideration much else.
That said - with each of my four pregnancies, I gained anywhere from 30- 50 lbs. I was "overweight" with 3 out of the 4. I went on to have normal labours and births, and had babies that weighed 8 lbs 1 oz, 9 lbs, 8 lbs 3 oz and 8 lbs 13 oz. All of my children now (ages 4-12) show no signs of obesity or have health difficulties. I think how we teach our children to live - ie diet and exercise makes more of a difference in the long run than what we gained while pregnant with them.
@OurPlaceOnTheWeb@xanga - There is indeed a lot of evidence that being overweight prior to pregnancy can cause problems with the pregnancy that are much less likely to occur to if one is of normal weight--as mentioned gestational diabetes and pre-eclampsia, among others. If someone thinks they have an endocrine issue that is complicating weight loss, they should certainly see a specialist to rule that out. Otherwise, despite what fad diets would like people to believe, weight loss really is about having the amount of calories expended be greater than the amount consumed.
@nicolevw@xanga - While the BMI system may not be perfect it is much better than the height and weight charts of the past and if anything allows people a greater range of "normal" than what might otherwise be considered healthy if body fat percentages were being calculated for the majority of people.
I gained 60 pounds with DD. I went from 143 to 203 and then back to 140 in about 6 months. I went to work after my maternity leave and a few of the guys who had only known me as 8 months pregnant (on bed rest at 8 months) told me to stop trying to disappear since I was so skinny. This time I am going to do what ever I can to only gain 20 pounds. I am already overweight for my height (5'3" / 160) so I want to be able to lose as much while breastfeeding as possible so I can get back to a healthier weight.
@NurseJenna -My point with the remark about no evidence is that just because you are overweight does not mean you have a 100% chance of any or all said complications. Or, that if you are not over weight that you have a 0% chance of any or all said complications. As I previously stated, I have known women who were thin have all of the listed complications that are more common in overweight women.... I have also known overweight women who had none of those complications.
I am fully aware of how to lose weight, endocrine issues, etc. Please do not insult my intelligence with regard to how to lose weight, issues that weight can cause, etc. Talk to anyone who is overweight, we are all painfully aware of fad diets vs. proper diet & exercise. We are also aware of the testing to check our endocrine system. Again, don't you think, if it were that easy, we would all be thin?
If everyone in the world were meant to be thin, we would all be thin, just the same as hair color, eye color, sexual orientation, etc. You can do things to alter them, certainly, but you can't change what you are underneath it all.
I gained 30 with my first and 28 with my second. My doctor did discuss weight gain with me - but mostly on my insistence. I am pretty health conscious, and I didn't want to gain too much. My doctor thought that since I hadn't had weight issues in the past that I would be fine throughout my pregnancy. And she was right! I lost all the weight with 6 weeks with both my kids. That's probably just due to good genes (and breastfeeding), though!
With my first, I gained 50lbs, I ended up having high blood pressure (maybe weight gain related?) and I was miserable becuase I was so puffed up...She was a normal weight of 7lbs 14oz when she was born. Now she is 2 1/2 and is tiny...Healthy, but skinny. Sometimes I think she should be a roly poly with how much she can eat in a day...Pediatrician believes that she is so skinny becuase she was crawling and walking very early, and the fact that she NEVER stops. She's very very active. Plus we a good diet...
With my second I gained a nice 30lbs, and I felt great throughout that pregnancy. He was 9lbs when he was born! Now he is 14 months and at a pretty "normal" weight. He's obviously bigger than his sister was at his age, but I think that it was becuase he had time to fatten up before crawling and walking.
Very interesting post!
@nicolevw@xanga - I appreciate your post. I must say, already being sensitive about weight in early pregnancy, the post made me feel as if I am harming my child by being overweight (even prior to pregnancy).
I know the risks, but I don't think that is a 100% of the time kind of thing... it's a "Risk". I have been walking, eating well, etc. I have always been physically strong, just struggle with my weight. I have lost 12 pounds in 9 weeks of pregnancy. Unintentional, just due to feeling sick, etc. Fun stuff.
I would have loved to be thin before getting pregnant... unfortunately, that just isn't the way I am built.
I also agree with the BMI being a bit ridiculous. At my smallest, diet and exercise (1200 calories a day, 2 hours of exercise a day) I weighed 165 at 5'7". I was skinny beyond what looked healthy for me.... and I know my suggested weight is even below that.
I think if there were less shame attached to weight it would be easier, if nothing else, to move through life and like who you are.
With my first I gained 30 pounds, the second almost 60 and she was over 10 pounds at birth. I delivered her naturally with no meds. She is a skinny little thing now, so I have no fear of a weight issue for her. With three through five I gained approximately 25-30 pounds. My smallest child was 7 lbs. 1 oz. and she was almost a month early.
I understand the concern, but with everything, there are exceptions to every rule. I did my best to watch what I was eating while pregnant with all my children and did not have a weight issue prior to being pregnant. For my family, traditionally we have larger babies.
@nicolevw@xanga - I definitely agree with you on the BMI thing. My optimal weight is 180 lbs. I'm 5'9" and big-boned (yes, there is such a thing- it's not just an excuse). Plus, muscle weighs more than fat and I don't mean to brag when I say that I am strong for a woman. Throwing a 50 lb. feed sack over my shoulder and wlking away with was a daily occurence at my old job. My husband weighs a grand total of 155 lbs., dripping wet, and I used to (aka before I got huge pregnant!) pick him up and give him piggy back rides... yeah, mostly just to bug him. ;) But he is the definition of the word 'wiry' and maybe even 'scrawny'. He's about 5'10" and mostly bare muscle. It's just the difference in our builds. All of his brothers (he has 7) but one are wiry and scrawny. His parents are not big people either. Pretty much the total opposite from my family where 6' is the shortest of all my uncles (my own brothers haven't hit there growth spurt yet). And they're bruces- big, not fat, but just big. So I am not ashamed when I am at my optimal weight of 180. I feel great there. I have tried losing and going lower but that seems to be my stopping point, no matter what I do. Of course, being 9 1/2 mo. pregnant (yes, I am overdue) does not have me anywhere near there! I would have to say I have gained about 50-60 lbs. since I got pregnant (on top of the "newlywed 15"). Yeah, not good. But I seem to be more worried about then my midwife does and my glucose levels turned out to be on the lower side, so if she's not worried about it, I guess I'll just worry about getting it off once Baby Dear decides to come. I'm sure I have not eaten perfectly during my pregnancy, but I have really, really cut back on my sugar intake, even down to beverages with sugar in them. I drink a lot of water and raw milk and when I need something sweet I usually find a piece of fresh fruit to chew on. Not to say I've done this perfectly- the ice cream still calls my name from the freezer and I indulge every 2 weeks or so, but it's better than nuthin'. ;)
Sorry, didn't mean for this to get so long, but this is just me and how I don't fit into 'average', if there is such a thing! lol Even though I've gained a lot, I'm still strong and able and do way too many things that make others lift eyebrows, "Should you be doing that?"
"I don't know, but nothing hurts, so I am!"
I gained 40 in my pregnancy now granted I lost 10 in my first trimester. So overall I gained only 30. Now technically, according to the old height/weight chart and the BMI I was considered overweight by almost 30 pounds. But ask anyone...I certainly didnt look it. And thats b/c I was mostly muscle I am short and very stout for my height. No one ever believed me when I told them my weight (before pregnancy) Not even my doctor...he told me there was no way I could weigh 150. And to his surprise I did...I am currently 170...I still have at least 20 pounds to lose to get back to "normal" weight and its been over 3 months. But on average it takes a woman 6 months to a year to lose all the baby weight. I do agree that being "over weight" can cause health issues...but how your pregnancy goes also reflects how healthy you've been all your life not just a few months to a year leading up to getting pregnant. My good friend in college, we got pregnant at the same time...not trying to, we had joked about it, but never planned it, our due dates were 1 day apart...she was extremely healthy and in shape. But she ended up with diabetes, excessive weight gain cuz of it, high blood pressure, preclamsia, and many other issues...they ended up taking her baby 10 weeks early, cuz they were on the edge of losing her and they didnt want to lose the baby too. She had to do a natural birth cuz a c section she would have lost to much blood, and she was kept in quarantine for a week, ICU for another 2 weeks, and then in the hospital for another week after that. When she finally came too a couple days after giving birth she had no idea she had given birth...theres more but I wont go on...no the only reason my baby was taken by c section 4 weeks early was b/c I had a previa and I kept going into labor even on meds. I was also on bed rest in the hospital for a month b4 I was far enough along to where it was safe to deliver my daughter. I considered both of us of good weight and healthy...she was more then I, but we both ended up having a lot issues anyways...I think it just goes to prove that in the end we are not in control. We can do all we can and still drop dead at the age of 40 from a heart attack. Be healthy and be happy. Eat the right amount of protein and greens, along with a good exercise program, and what happens happens. We all have our doctors and they will help us along the way. We dont need to obsess about our weight. Thats the biggest problem with the world today...everyone has decided that there is the "prefect form" and not everyone was created to be that perfect form. Each person is beautiful on the inside and is beautiful on the outside to someone. Not every guy finds me attractive but my husband does, cuz I was created for him. So like I said be healthy be happy...cuz stress also causing weight gain and if your gonna stress about your weight during pregnancy that can be just as harmful as gaining "too much weight"
And also...my mom has thyroid problems that make it very hard to lose weight...so she never really lost the weight from each of us kids...(there are 3 of us) and ya know what, she never had any health issues as far as being over weight. Now of course she did eat healthy and exercised regularly...but just because your over weight doesn't doom you to have health issues. It just raises your chances. But that is why we have doctors to help us
Weight is definitely something I have thought about related to pregnancy. I have also heard that it is often more difficult for overweight women to conceive.
I plan on having kids in about 2 years. Until then, I am trying to do everything to prepare my body - including weight control.
I was overweight when I became pregnant and in my first trimester I lost about 10lbs. I am now 10 days from due date and have gained about 20lbs. or so. I really was hoping only to gain 15, but I will confess I was not a healthy eater before becoming pregnant and my eating habits really didn't improve when I became pregnant, I ate pretty much the way I always did. I have had a very good pregnancy with little to no complications. I have had slightly high blood pressure in my last trimester, but that is about it. I don't know how my being overweightthis will effect my baby, but I have always struggled with my weight and I hope my child will not struggle as I have.
I gained 66 pounds during my pregnancy. I've lost all but 10-15 pounds of it. I am not exactly trying to get to my pre-pregnancy weight though, I was a little underweight. My doctor did mention the amount of weight I was gaining, but he didn't make a big deal out of it. My doctor gave excellent pre-natal care and advice. In fact, I am planning my next pregnancy so I can have it at the same hospital instead of in another city in case I relocate after my degree.
I gained about 35 lbs and lost it by my baby's first birthday. That seemed about right. I wish I could have lost the weight sooner, but it just wouldn't come off while I was breastfeeding exclusively. I guess I was the exception to the rule on that one.
In birthing practice I've observed morbidly obese (250+ or so) to have more difficulty delivering vaginally because of a narrowed birth canal and difficulty moving around while in labor. Being obese doesn't cause problems for everyone, but being a healthy weight certainly increases your chances of a natural delivery without complications.
At 5'7" and 140 lbs. before finding out we were pregant, I fell into the 'normal' range on my BMI...a bit high-end of 'normal', but I was in the process of trying to develope an exercise plan when, "Hey...I'm a week past the brown pills [vs the three weeks of pink pills] and no period...uhm...what??" happened. I've gained 28 pounds at 40 weeks. The weight conversations with my OB tended to go, "You need to gain more weight! Buy carb-protein bars! GO! Eat them! NOW!"
With my first child I gained 38lbs. I was underweight prior to being pregnant and my doctor wanted me to gain between 30 and 40 lbs. With my second child I gained 22lbs. I was a normal weight prior to pregnancy and my doctor wanted me to gain between 25 and 30lbs. I tried to reach that but I was pretty active during my pregnancy and burned through most of what I ate. I was concerned because there was a 10 year gap between my two that it would be hard to lose the weight after this one but by the time I was 3 weeks post partum I had lost the weight that I gained.
My mama was overweight (yet still smaller than I am now
) when she had all three of us, natural birth and we all came out healthy. I want to be at a nice weight before I get pregnant but it's for shallow reasons, not because I think it will hurt my baby. I just want a nice pregnancy belly, where it's all baby, not 75% me, 25% baby! LOL