Pregnancy Question: “How is my weight?”

“Dr. Petersen, how is my weight?”

Frequent, I get asked “How is my weight?” at prenatal
visits.

I, in turn, respond with a question of my own:   “How do YOU feel about your weight”?

I ask this because weight gain, in a lot of ways is up to the individual patient.  Why?  Because, in truth, the weight that you gain is the weight you will have to lose after the pregnancy.   It is recommended that we gain SOME weight in pregnancy.  How much or how little is necessary, however, is still unclear.  Most obstetricians and experts in the field agree that 20-30 pounds is an acceptable weight gain during pregnancy.

When I had my first child, I was in college.  I wasn’t a doctor, I was barely even pre-med.  I didn’t know ANYTHING about OB/GYN!

I thought that I could eat whatever I wanted because the baby would use up all the calories.  My friends and family pushed food at me all the time!  My grandmother told me that the fat would just “melt” away after the baby was born.  The sad truth is that when my first child was born I went home 40 pounds heavier than I had ever been in my life.  Trying to lose that much weight with a newborn to care for was awful. Boy, did I feel lied to when that baby was born.  Now I had all the stress of being a new parent, along with having nothing that I could wear but maternity clothes.  I was devastated.
Back in the day…

Centuries ago when food was scarce, the practice of encouraging women to “eat for two” made sense.  Most women began pregnancy underweight and they worked and cared for children during pregnancy the same as they would before pregnancy in order to survive.  Consuming extra calories was difficult in these times.

Unfortunately, centuries later, friends and relatives still push this out-dated advice.  Pregnant women are encouraged to eat “for the baby” at parties and family gatherings.  People seem to think that they are helping by constantly offering “the baby” food.  Nobody tells you that most American women are already eating enough calories to support a growing fetus before they are even pregnant.

They also don’t tell you that every pound that you gain in pregnancy is not devoted towards the baby. In general only a total of 10 pounds can be attributed to the weight of the baby, the amniotic fluid, and the extra blood volume of pregnancy.  Early in the pregnancy this number may only
be 5 pounds.  Some patients do gain a fair amount of weight from fluid (swelling), but this is not usually until later in the pregnancy and therefore not a likely reason for being overweight before the last months.

We really only need 200-400 more calories a day for the baby’s nutrition over a baseline healthy diet.  That’s only 1 blueberry muffin, a small cheeseburger, or 2-3 Coca Cola’s.  Without consuming many more calories than many of us already are, you can still have a healthy pregnancy.  If you look at how many calories Americans are already eating, many women really don’t need to increase their calories at all. We recommend a minimum of 1500 calories a day in pregnancy.  Most women are eating well over that when they are not pregnant. So, the problem is not trying to gain weight for mostwomen anymore.  The problem is trying not too gain too much.

It is extremely easy to gain weight when you arepregnant.  A few of us will have enough nausea in the first trimester to lose a little weight, or maintain our pre-pregnancy weight in the first few weeks, but that is the exception rather than the rule.    Lost weight is almost always well replaced by the second trimester. This is because in pregnancy one of the goals of the metabolism is to elevate blood sugar and fats in the circulation for the baby to take out of the bloodstream through the placenta.  This high blood sugar and nutrient rich blood is great for the baby, but the hormones associated with this change are what you could call “storage hormones.”   They promote storage of calories as fat.  This may be an evolutionary necessity, or it may just be a side effect that plagues women with unnecessary
weight gain during pregnancy.

But Baby needs to eat!  Right?

One of the reasons that we gain so much weight is because we tend to think that if we eat a lot in pregnancy, it will all get used by the baby to grow.  The opposite is actually true- what the baby doesn’t take your body avidly stores.  The baby needs good, consistent nutrition, but he or she does not consume a large amount of calories.  Cortisol, insulin, and growth hormone allserve to try and store nutrients rather than increase metabolism or “burn calories”.  So, you can gain weight faster when you are pregnant even if you eat the same number of calories as a non-pregnant woman!

Merry go Round Metabolism

Unfortunately, for a number of women, obesity often begins in their first pregnancy.   After the baby is born, many women will fail to lose that last 10 pounds of baby weight before they get pregnant again.  If they keep 10 pounds after each pregnancy, that’s 20 pounds after 2 and 30 after 3
pregnancies. This is not to mention any weight gained between pregnancies.  Given that our metabolism slows down as we get older we already have to work hard to stay in our appropriate weight range.  Without serious effort , that 10-20 pounds stays for a lifetime.  If you think about most of us that are not pregnant right now, most of us are already struggling to maintain our weight.  It is not easier after pregnancy.   Friends and relatives always made it seem to me like the fat just melts off of you after the baby is born because you have some epic increase in metabolism.  Yes, there are women that seem to drop it like nothing after they have the baby, but the majority of us are stuck with it without some serious work.  Whether we breastfeed or not, it’s hard to do that kind of work when you have a newborn.  Seems like all you can do is sit around and eat!   Lack of sleep also is shown to decrease your metabolism and we all know that you don’t get any sleep when you have a newborn!

Another way that we get sabotaged with excessive pregnancy weight gain is with lack of activity.  People encourage pregnant women to rest, sit, and sleep.   Our friends and relatives discourage activity in pregnancy.  On top of that we are tired, our feet hurt after working all day and we don’t feel very cute in workout clothes.

Getting active

The truth is, however, unlike friends and relatives, doctors now encourage pregnant women to exercise.

You should try to maintain an active lifestyle when you are pregnant.  Women that are used to exercising can continue their level of activity unless they feel pain or contractions.  There is no maximum heart rate that pregnant women should avoid during exercise (another myth) and there is no reason to discourage pregnant women from exercising because they might “get too hot”.  Pregnant women SHOULD
avoid activities that they could fall during, however, even if they are used to doing them.  Rollerblading, snow skiing, and bike riding are not good activities because we tend to be more “clumsy” when we are pregnant and a fall can be devastating to a pregnant woman and her
baby.  While some women can maintain high impact activities like running all the way to delivery, some choose to decrease to a lower impact activity due to fatigue or discomfort.  Regardless, maintaining aerobic exercise of some type is not only OK, it is RECOMMENDED.  I recommend 20 or more minutes a day at least 3 days a week.  Ideally, however, pregnant women should get some type of aerobic exercise EVERY day.

In order for us to maintain that activity, however, there has to be a dedication to it from the beginning.  It is very hard to get motivated to exercise when you are pregnant as you are already tired a lot of the time.  You are more likely to do well with this if you are committed to it from the beginning of the pregnancy.  As you get further along you get more fatigue and aches and pains.  The third trimester is NO TIME to try to start an exercise regimen!

Dr. P’s Blog Pregnancy Weight Points:

  • 20-30 pounds is an appropriate weight gain for
    most patients.  (Obese patients are
    encouraged not to gain more than 15 pounds.)
  • Pregnancy
    weight gain should be viewed as maternal weight
    gain.  The baby only requires a 2-400
    kcal/day increase in women that are not already overeating.
  • Metabolism in pregnancy is not faster, in
    contrast, gaining weight occurs faster in pregnancy than in the non-pregnant
    state.
  • Be more active.
    A sedentary lifestyle is not recommended for pregnant patients, and
    contrary to popular belief fat does not “melt off” of the majority of women in
    the post-partum period, even if they breastfeed.
  • Having a healthy weight gain in pregnancy is
    also very important for avoiding obesity later in life.

If I had had this information when I was pregnant with my first child it would have saved me a lot of heartache and stretch marks.  That is why I pass it along to you!

I’m interested in your comments!

Dr. P

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