Government figures show that more than half of today’s women are overweight or obese before they get pregnant. Some doctors are re-thinking weight gain during pregnancy.
Thirty-one-year-old Lisa Bitos is expecting to welcome her first baby, a girl, in about two weeks. She’s never weighed more than 100 pounds but she gained 40 during her pregnancy.
At Saint Louis University, her doctor, Raul Artal, says the 40-pound gain is all right for someone as small as Lisa, but he says most women gain too much during pregnancy.
Dr. Artal says, "For too many years we have told pregnant women, uh, don’t move, be confined, and eat for two.”
Current guidelines recommend women of normal weight gain 25-35 pounds, underweight women up to 40 pounds and overweight women between 15-25 pounds.
Dr. Artal says, "The emphasis, in my opinion, should be on individualizing."
As long as tests show the fetus is growing as expected, women don't have to worry about eating for two.
"I think it's entirely reasonable that mothers that are either overweight, obese or certainly morbidly obese do not gain too much weight or not at all in pregnancy," the doctor says.
Adding weight to Dr. Artal’s argument is a recent study that found the guidelines might also feed childhood obesity. Even normal weight women who followed them were at risk of having overweight children by age three.
Lisa has other plans.
She says, "I have this goal that I will lose it within a month.”
She stopped strenuous workouts at seven months, but says once the baby is born, she'll be back at the gym.
Excess weight during a pregnancy increases the risk of gestational diabetes and high blood pressure which can complicate deliveries. It can also lead to more Caesarian sections because babies are bigger.
Fast Facts:Most women gain about 25 to 35 pounds during their pregnancy.
Some of the weight gain is lost immediately after birth. However, it can take weeks to months for women to get back to their pre-pregnancy weight. Some women never lose all the extra weight.
Gaining too much weight during pregnancy can increase the risk of complications for mom and the fetus.
The institute of medicine has issued some general guidelines for weight gain based on a woman’s body mass index. However, some experts say those guidelines may be too liberal and doctors should take a more individualized approach when monitoring weight gain for pregnant women.
Pregnancy and Weight
In 2003, there were more than 4 million live births in the U.S., roughly a two percent increase over 2002. Most women gain about 25 to 35 pounds during their pregnancy (median weight gain is 30.5 pounds).
The average baby weighs about 7 to 8 pounds at birth. So, where does the rest of the weight come from? During pregnancy, a woman’s body takes on extra fat stores, accounting for 6 to 8 of those pounds. There is an increase in blood volume (an extra 3 to 4 pounds) and fluid volume (2 to 3 pounds). The breasts increase in size (1 to 3 pounds), as does the uterus (about 2 pounds). The rest of the weight comes from the placenta (1 to 2 pounds) and amniotic fluid (2 pounds).
Once the baby is born, women tend to lose a significant amount of the weight gained during pregnancy. However, it can take some time for women to get back to their weight before pregnancy. Some women never lose the excess weight.
Weight Gain Recommendations
Proper weight gain is important during pregnancy. If a woman doesn’t gain enough weight, she runs the risk of having a low-birth weight or premature baby. Gaining too much weight isn’t healthy either. Overweight women are at higher risk of developing pregnancy complications (like gestational diabetes and high blood pressure), having a very large baby, needing a cesarean delivery, and longer labor. In addition, women who gain too much weight during pregnancy have a harder time losing the excess weight after delivery.
Currently, the Institute of Medicine recommends that doctors take into account a woman’s pre-pregnancy weight before making recommendations for appropriate weight gain during pregnancy. According to Institute guidelines, a woman who is underweight before becoming pregnant (as determined by body mass index) should gain between 28 and 40 pounds. A normal-weight woman should gain 25 to 35 pounds. A woman who is overweight before pregnancy should gain 15 to 25 pounds. Obese women should gain 15 pounds. Pregnant women who are carrying more than one baby will need to gain more weight.
Reconsidering Weight Gain Guidelines
Raul Artal, M.D., a Maternal Fetal Medicine Specialist at St. Louis University, says pregnancy weight gain guidelines were developed more than 20 years ago. Since then, doctors have learned more about the need to maintain better health during pregnancy. In the past, women were often advised to take it easy and to eat enough to feed “two.” However, many women want to remain active during pregnancy and don’t want to worry about having to lose a lot of weight after the baby is born.
Artal says, instead of following broad guidelines, doctors should take a more individualized approach to weight gain recommendations. Ultrasound measurements can be used to monitor the growth of the fetus. As long as the baby is growing as expected, women shouldn’t have to worry about eating enough food for “two.” Women should concentrate on staying active (unless there are health concerns for her or the fetus) and eating a healthy diet.
Artal’s advice is very timely. A recent study from the Harvard Medical School found women who follow the traditional pregnancy weight gain recommendations may be setting the groundwork for obesity in their children. Using the Institute of Medicine guidelines for pregnancy weight gain recommendations, the researchers found women who gained too much weight and those who gained an acceptable weight had children who were overweight by age three.
On The Web:March of Dimes
For general information about pregnancy: