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)
@der_lila_Stern@xanga - Ditto. Parenthood is probably about two years off or so for us, too, and I want to get into much better shape before we conceive. I only gained weight when I got really sick a few years ago--my thyroid shut down for a while--and I gained 55 pounds in three months (and I don't give a damn what anyone says, there are just not enough Pop-Tarts in the world to make someone gain that amount of weight that quickly!). I've already lost 20 pounds, though, and I'd actually like to lose about 40 more.
Anyway, good luck to you as you pursue your body and baby goals!
With our son, I had a midwife who is very strong-minded about healthy eating during pregnancy...I can't speak for people who seem to gain weight easily, and I'm sure not every overweight woman has a difficult pregnancy/birth. But speaking from my own experience, I was often glad that my health care provider encouraged a good diet. She usually wasn't as concerned about the weight in itself as where it the weight's coming from...like, is it a lot of fluid, and 'all baby' or is most of the weight on YOU?
I ate a high protein diet; and that seemed to work well for me. I gained a total of about 24 lb; and by 3-4 weeks postpartum, I was back down to 140, my average pre-preg weight. I am muscled and large boned, and 5' 6", so I guess that's average.
My labor was short and without problems- 10 hours; no pain meds, interventions, etc. I can't give a healthy diet all the credit for everything, but I do think it made the difference in post-partum health. I felt totally pre-preg. two weeks after giving birth, and by then had resumed all light housework, shopping, social activities, etc. It would only make sense that a well-nourished body would recover from birth more quickly.
My sympathies lie with women who have difficulty keeping weight down no matter what they do...but I've also seen some who seemingly do not care. Every woman is different, but we can all at least try to make good choices...
I was told I should gain no more than 15 pounds. Tricky tricky doctor didn't say that since I LOST 13 pounds the first 16 weeks, that the 15 started from there. But I've only gained 5 so far...so I'm still under my starting weight by 8 pounds, and he told me he wants me to gain only 5 more. I'm a week away from the third trimester and he said the baby is a little on the bigger side (but nothing to be worried about), so I think that's not bad.
i'm 33 weeks and have gained approx 20lbs (although last i was weighed was 2 weeks ago.)
and the whole "eating for two" excuse is ridiculous! the fact that you are eating for two means that you need to consider eating healthier. it's no longer just for you... it's for the health of your precious baby!
I gained about 20 pounds with my son - think I may gain a little more with this pregnancy. Over here in Northern Ireland we are not weighed during pregnancy except for the first visit and we don't do the glucose test - at least not routinely. I seem to add baby weight but I think running after a toddler helps me burn off excess!!!!
I'm 5'4" & weighed 117 when I got pregnant, I gained a total of 25lbs. I was not over weight before, nor did I gain too much according to the above info. However my doctor told me at one point I was gaining too much, not to go on a diet, but that I should eat a lot of salads.
Sounded like a Diet to ME!!! I Ignored his advice!!! 
my mom told me when she was pregnant her doc kept a close look on how much weight she gained. i was told that a normal women should not gain more than 10-15 kg (which would be something like 20-30 pounds i guess). i cant see how some women eat anything they want during pregnancy, but then again, i havent been pregnant yet.
while i agree that the BMI isnt perfect to show one's healthy weight, its pretty close. with a BMI of 26, id be huge, even though thats still in the healthy range. so if i had a bmi of 30, i wouldnt be telling myself im just a little too heavy or that i have strong bones. id be running to the gym to lose weight.
i think doctors should be way more clear with their patients about what obesity causes. and especially with pregnant women, because it hurts their kids.
@Beautiful_Disaster_74@xanga - Thanks! Good luck to you as well. And congrats on the 20 pounds already gone!
I gained 30 pounds with my daughter, and had lost it all within 3 weeks. Then gained some of it back while transitioning to SAHM life. My doctor and I discussed healthy weight gain, and I fell right into the right amount for me. I was/am 172 lbs. at 6'. A little more than I'd prefer, but healthy. My mom usually only gained 10 lbs. or so for each of us 5 kids, but she had really bad heartburn the whole time and couldn't eat. She gained all of her weight afterward when she could really eat again.
well i gained 35 with my daughter. i dropped 20 of that right away and still am holding onto that extra LOL
my doc never even mentioned my weight, maybe just once when i went up 5lbs in a week towards the end im pretty sure he was just concerned with how much water i started to retain, i swelled up like crazy! that was the last two weeks though.
my daughter was 9lbs and they were sure i had gestational diabetes that they didnt catch, but her sugar was fine and so was mine.
idk how much really counts. you never know.
i'd like to lose about 10-15 more but no more then that im almost 5'8" and at 170.
I was about 25 pounds overweight when I got pregant with DS. I didn't know what to do for exercise and I had always dieted, but didn't know what to do, so I gained 20 pounds in my first trimester. Let me also add that I got pregnant right around Thanksgiving, so we had ALL of those get togethers with food. Not that it's an excuse, but it gives you some perspective. My doctor really didn't say anything until I mentioned it. I ended up with gestational diabetes but I controlled it with diet and exercise. I only ended up gaining 40 total, and that was after he was 2 and 1/2 weeks late. I really feel like the diabetic diet kept my weight from getting way out of control. The first 25 pounds came off within 2 weeks and the rest...well...I'm still working on it and DH is 14 months. If I would have been more mindful of my weight gain at the beginning, I would have only gained 25 at the most.
We got pregnant again when DH was 8 months old and I was nursing and really trying hard to lose the weight. I was only 3 pounds away from my pre-baby weight. I didn't realize I was pregnant for 6 weeks. Everything was fine, with the exception of my endocrinologist, who monitored my GD with my first pregnancy, wanting me to check sugars and do the diet, even though I didn't test positive for GD yet (I was like 12 weeks along...really early). Anyway, we lost the baby at 14 weeks and the weight that I had gained, although it wasn't much, did not come off at all. Nothing like having to deliver a stillborn child and then have to lose the weight, too.
I'm doing WW now and hoping to get pregnant soon, but I also want to be healthy.
I only gained 25 lbs with my baby. I've already lost it. Unfortunately, i had a few extra pounds to get rid of before i was pregant. Not many, though. =) Since i've already lost the 25, i'm sure it'll be no problem losing the rest!
And women gain so much weight during pregnancy because they think they can eat whatever they want. Those women have a misconception about "eating for 2".
The first thing I learned when I was pregnant is that you are NOT actually eating for 2. Just eat the way you normally ate. If you crave something, figure out what it is you need from it. If you crave nachos? Maybe you just need cheese. If you want a milkshake..maybe you just need milk.
@OurPlaceOnTheWeb@xanga - Very nicely put! I am 11 weeks and was overweight when I started. I lost weight, too, I'm still about 3 lbs behind my pre-pregnancy weight. My doctor and I did discuss my weight gain parameters, but she didn't put a huge emphasis on it.
@furyyes@xanga - I even just read an article about the lack of evidence that all pregnancies of overweight women will result in complications. I can't remember the site, though if I find it again I will certainly post it.
I had to go to a Reproductive Endocrinologist (RE) because of my relationship status (not because of weight issues or really even infertility) and they deal with high risk patients all the time. My doctor told me that she was not concerned about my weight, that women who are over weight not only get pregnant all the time, but have healthy babies without any complications. With that coming from a specialist, I'll take it as the gospel!!
I hit 10 weeks today! So excited. My weight loss is at 12 pounds, but I know that will only last for so long. I am eating well and just listening to my body.
Congratulations to you! Thanks for your response and good luck!! Maybe we will keep in touch a bit since we are very close in our journies.
Well I gained 40 lbs during pregnancy. When I got pregnant I was 120 lbs and I'm 5'8". That was seriuosly underweight ( I had lost about 15 lbs in the 6 months prior to becoming pregnant due to pure starvation, seriuosly). I had very bad morning sickness in addition to my lack of food at the time, so it was hard for me to put on weight. My doctor advised me to eat a lot of ice cream for the calories since I was not gaining enough weight. She was born healthy at 6 lbs 9 oz. I lost the usual 10 lbs immediately after birth and because I breastfed I quickly lost 15 lbs in the following 3 months. So by the time my daughter was 4 months old I looked like my old self (prestarvation), and stayed that way for almost two years. Unfortunately my weight gain can't be blamed on pregnancy. I blame it mostly on myself with the help of depressive eating and depo provera(which I'm no longer on and don't recommend to anyone). Now, 3 years later, I weigh 170 lbs., 10 lbs more than at my highest during pregnancy! Life is funny that way. ^_^
I only gained 28 lbs during my pregnancy. I was very happy with my weight gain, and was determined to keep the weight gain in the normal range. And yes, by Dr. always reminded me of proper nutrition and weight gain. But I learned about that more from my doula. The nice thing about not gaining too much weight was that it was easier to lose it post-delivery! I'm now at my pre-pregnancy weight and maintaining well!
What is the strangest food craving you ever heard a pregnant woman having?
I gained about 10 to 15lbs. My health care providers didn't say anything about it til I took my glucola test (glucose intolerant) so they said to cut back on the sugar and also to cut back on bread. Now I am back to if not a little less than pre-baby weight. I feel like I eat more now than when I was pregnant but don't seem to be gaining and I attribute that to breastfeeding and what I eat, mostly veggies, meat and occasional splurge of sweet things.
wow, I only gained 17 pounds throughout my pregnancy. I never used being pregnant as an excuse to eat whatever I want, but I did use it as an excuse to NOT eat whatever I want... and eat healthier for the baby. As a result... I didn't gain as much as my doctor wanted me to and was told to GAIN more... in fact my doctor told me it was healthier for me to gain 2 much than to gain 2 little. (my baby was at a healthy weight when born,6pounds 5ounces which is good for my size) im glad I kept eating healthy instead of trying to gain weight eating unhealthy like the doctor stupidly recommended.
I gained forty pounds with my son.
I was also 100 pounds and 5'2" pre-preg. He came out comletely healthy and is a happy silly little boy. He was 7 pounds, 8 ounces. My doctor didn't worry about my weight gain, since I was so small (he just worried about me going early, but I was four days late! Haha). I do think that what you eat WHILE you're pregnant effects weight gain and the health of the baby and mother. Being pregnant isn't an excuse to eat only junk food. I refused to eat anything unhealthy except for special occasions, and I drank no caffine at all.
From the friends I've seen and reading all these comments, it does seem that heavier women generally do have harder times in labor/birth, but how you treat yourself when you're pregnant that has the biggest impact.
@janusfiles@xanga - my sister loved cottage cheese :p I loved pizza lunchables, but instead of putting the sauce with the pepperoni and the fudge with the M&Ms, I put the fudge with the peperoni and the sauce with the M&Ms!
I was (am) overweight when I had my daughter and I only gained 15 lbs exactly throughout my whole pregnancy... I gained the last 10 lbs of it at the last 2 weeks! I lost about 20 lbs in the beginning of my pregnancy so before and after my pregnancy I am down 40-50 lbs!!! I never gained it back... Thank you GOD!! (And I mean it!) The bad or sad part of it was that I still ended up having a c-section, but well my labor was induced my choice. I was one day away from my due date and all the walking, she wasn't coming! She would drop and toward the last few days she dropped a lot, so my sister told me to call my doc and since she was on call ask if I could come in and she said Yes, so we went and she popped my bag! My baby came out 9lbs 4.5 oz. She gained 2 lbs in the last two weeks right with me! She was supposed to be 7lbs! But well now she is a healthy little girl weighing 19lbs at 10 months! She is a tall, slim little girl... gets it from her daddy... lucky girl!
This is my 4th pregancy and i have been watchful of what i eat. my first pregnancy i gained 30 lbs. 2nd pregnancy I gained 25. 3rd pregnancy i agained 20lbs. Being over weight with this 4th pregnancy, I have watched my caloric intake (max extra 400 calories a day or less) i have so far gained only 8lbs and I am 34 weeks along now. My doc would like for me to gain about 2lbs per week til delivery so to make sure the baby doesn't deplete me of my energy/vitamins, etc. It is very important to be mindful of your weight gain b/c it's very true that you can have complications, big baby. I also have gestational diabetes too so I am also being careful about my sugar intake. First 2 babies were 8 lbs. 3rd baby was 6 lbs delivered at 36 weeks. So there's a potential chance that I may deliver another 8 lb baby as well....
I was overweight when I got pregnant. I didn't plan my pregnancy, I was planning to get healthy so that someday I would be able to conceive. Doctor told me to gain no more than 15 pounds. I actually lost nearly 15 and gained about 5 or 6 back, so when I gave birth I was below my pre-pregnancy weight. I had a nearly perfect pregnancy with no complications at all until I delivered a stillborn at 41 weeks. I guess shit happens regardless of how careful you try to be.
I only gained 25 lbs when I was pregnant for Nick, unfortunately I developed some sort of freakish hypothyroidism as a result of being pregnant and after he was born, I packed on another 50lbs on top of that!!! It has been a struggle of several years to get it off and it ain't over yet, LOL.