The Skinny On Weight Gain In Pregnancy

How much weight should you gain in pregnancy? Well, that is a very good question that does not have a simple answer.

And why does it matter at all anyway? Why shouldn’t you be able to eat what you want (or not)? My word, you are pregnant for goodness sake. So much of what is happening to you is out of your control – sometimes it seems like food is your only solace against the swelling, stretch marks, and sleepless nights. On the other hand, what if you are constantly nauseated and everything you smell makes your stomach churn and you just…Don’t. Want. To. Eat. ANYTHING!

As it turns out, if you gain too much, you are at risk for a much bigger baby than your body was meant to have, as well as not being able to shed the pounds after delivery. Also, your risk of gestational diabetes is much higher with excessive weight gain which, in turn, increases your risk of a larger baby, shoulder dystocia at delivery, cesarean section, and problems with your baby’s blood sugar after delivery. Gain too little weight and your baby may end up small for gestational age or growth restricted, which may require frequent ultrasounds for fetal growth, non-stress tests and early delivery. Either of these scenarios could cause problems with your baby both in the nursery and beyond.

By the end of a normal pregnancy with a healthy, normal weight gain, you can expect to carry an extra 25-35 pounds; but where does it all go? Although it may seem so, not all of the gained weight is fat. The breakdown of where weight goes with a normal weight gain (25-35 pounds) is shown below. Of course, these extra pounds can vary from woman to woman and pregnancy to pregnancy. If you stay within the recommended weight gain, the more likely you are to shed those extra pounds after delivery. For those women who gain more than what is recommended, getting back to your pre-pregnancy weight is less likely, especially after having more than one child.

There are many reasons why you might gain too much during pregnancy. One common misconception in many cultures is the “Eating for Two” myth. Many women feel pressure from well-meaning family members and friends to eat more and gain more weight “for the baby”, and subsequently gain more weight than is needed. In addition, the normal increases in certain hormones related to pregnancy (leptin and gherlin) lead to increased hunger or, on the other hand, the oftentimes debilitating symptoms nausea and vomiting of pregnancy. Women who suffer from significant nausea and vomiting of pregnancy often lose weight in the early part of pregnancy, but end up rebounding once they feel better and gain too much weight by the end of pregnancy.

Another factor to consider are the changes in exercise levels during pregnancy for those who had an exercise routine prior to becoming pregnant. The first trimester of pregnancy is usually associated with extreme fatigue. Patients complain of feeling dog tired and can’t summon the energy to do much of anything, let alone exercise. For many women, the extreme changes that accompany the first trimester are quite a surprise, and it is especially hard for those who are normally go-getters with lots of energy and who always found the time to do some sort of exercise prior to becoming pregnant. Women who usually need only six hours of sleep at night often find they need nearly double that during these first weeks of pregnancy. For others, daytime exhaustion is coupled with difficulty sleeping deeply or for more than a few hours at night. Even in pregnancy your weight is a matter of calories in minus your calories out. When your exercise level decreases, your weight will inevitably increase. For those who do not have an exercise routine, these pregnancy changes can bring on a sudden increase in weight gain that starts earlier in pregnancy.

Over the years, I have had many normal pre-pregnancy weight patients who become frustrated by their excessive weight gain during pregnancy. They express to me that they can’t understand why or how this is happening. Quite often these patients had convinced themselves that they were eating very healthy, yet they were gaining an average of 2 pounds per week or more. As a result, I started having these patients keep food and exercise journals or bring me activity logs if they had monitors on their phones or monitors they wore on their bodies. After reviewing these journals, I began to see a pattern emerge.

I found that these patients were eating what we would consider to be healthy foods, just too much of them. They had increased their calories much more than they had realized. Studies have shown that Americans are terrible about estimating the amount of calories that are in foods, and even in foods they consider to be healthy. For example, most of my patients had cut caffeinated beverages out of their pregnancy diet, but were replacing these drinks with high calorie drinks like lemonade and fruit juices; both packed with sugar. High sugar beverages taste great, but often contain 100-200 calories per cup. Other patients had switched from white to wheat bread thinking it was healthier. In truth, you can add wheat to literally any carbohydrate and label it as a wheat product. Just because something is labeled as “wheat” doesn’t mean it is healthier. Dried fruit is another problem. Sure, it’s got fiber, but it also has tons of added sugar and sulfur to keep it preserved longer. Since the fruit is dried, it has at least 3 times more calories per volume than its fresh counterpart. Fresh is ALWAYS best with fruit! It will keep you feeling full longer, and you get all the nutrients that you miss out from the drying process. Finally, many patients also assume that all yogurts are created equal. This is not true! Most flavored yogurts pack 15 grams of sugar per 6 oz., and yes, even if they’re flavored with fruit they’re not necessarily healthy. If you crave yogurt, I recommend plain Greek yogurt with fresh cut fruit.

The guidelines for weight gain in pregnancy are aimed at optimizing good outcomes for both you and your baby. How much (or how little) you should gain is determined by your pre-pregnancy body mass index (BMI). Your BMI is a function of your height and weight. If you don’t know what yours is, click on this link to an online calculator: http://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm. Once you know your BMI, see where you fall in the table below. Your pre-pregnancy body weight and BMI are extremely important when having a goal in mind of how much weight to gain during pregnancy. Bear in mind that many things can influence your BMI. A woman with a larger muscle mass (Cross-Fit anyone?) may have a higher BMI because muscle weighs more than fat and her actual lean body mass would put her into the normal BMI category for weight gain. If you are thinking about getting pregnant, it is a good idea to have a “pre-pregnancy” visit with your doctor to discuss your weight, activity level and any potential health risks that you might be facing during a future pregnancy. If you are not where you want to be, using this time to get closer to a normal BMI before pregnancy will help place you in a better position.

The use of an online application for keeping track of caloric intake seems to help most patients manage weight issues in pregnancy. I have used and recommended the www.loseit.com, as well as www.myfitnesspal.com applications. The Lose It! App allows you to scan the barcodes of almost any item and automatically pull caloric and nutritional info from a huge online database, which really helps when you’re grabbing a pre-packed lunch on the go and still want to stay within your daily budgets. With MyFitnessPal you can access calorie counts and nutritional information from local restaurants, taking the guesswork out of eating out. You can also access your current calorie count online from any computer and get some extra encouragement by sharing your progress with friends.

In summary, reaching a healthy weight before pregnancy is alway your best option. If you find yourself pregnant and not at your ideal BMI make an appointment with your provider as soon as possible to develop a plan for you to optimize your pregnancy goals and limit risks to yourself and your baby throughout the pregnancy.