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"Eating for two"? Think again.

How much weight should a woman gain during pregnancy?

For many women (including myself when I was first expecting 17 years ago), pregnancy becomes an excuse to pig out -- or at least to indulge cravings and soothe mood swings with treats. Lots of women gain more weight than they should and find it difficult to shed later on.

As Frances Largeman-Roth, whose book, Feed the Belly, is the subject of this week's "Eat, Drink and Be Healthy" column, explains, current recommendations call for women to consume just 300 extra calories per day. And that should be done only during the second and third trimesters of pregnancy. During the first trimester, you can't really get away with adding any extra calories to your diet.

For the first time since 1990, the Institute of Medicine last May issued updated guidelines for weight gain during pregnancy. The new standards allow a woman of healthy weight to gain 25 to 35 pounds and an obese woman to gain 11 to 20 pounds during pregnancy.

Raul Artal, professor and chairman of the department of obstetrics and gynecology and women's health at the St. Louis University School of Medicine, was among the leading voices to protest those recommendations.

Artal says the guidelines allow too much weight gain for women who begin their pregnancies overweight and argues that the recommendations "were driven by one concern: If women don't gain adequate weight, there's significant risk that their babies will be growth retarded. But the scientific evidence for that is very weak," he says. Meanwhile, we know that overweight women "in pregnancy develop all kinds of co-morbidities."

Those conditions include gestational diabetes and increased risk of preeclampsia. Many women who develop gestational diabetes, Artal notes, develop diabetes and hypertension later in life. Babies born to obese women often are larger than average and require delivery by C-section, which increases the risk of harm to mother and baby. And those babies, though large, often have delayed organ development, respiratory ailments and other health problems, Artal says.

Artal has published research that demonstrates that obese women should not aim to gain any weight at all while pregnant and should work with their doctors to devise an appropriate exercise and diet program. "Pregnancy should not be a time of confinement and indulgence," he says. Even -- or especially -- women who have never learned to eat "judiciously" or to exercise should do both during pregnancy, he says.

To an obese woman, Artal says, those 300 extra calories per day "are 300 additional calories per day" that she doesn't need.

Largeman-Roth floats the notion of obese women's dieting during pregnancy without endorsing it outright; she recommends overweight women consult their doctors before making such a decision. But she does suggest that overweight women who are not yet pregnant but hope to become pregnant lose weight before conceiving. Otherwise, she says, you set yourself up for a lifelong weight struggle.

"If you're a bigger gal," she writes, "I realize that all of this information is super-depressing. I'm basically telling you that if you're already heavy, you're just going to get heavier when you're preggers, and then stay that way forever."

UPDATE: Join me and Feed the Belly author Frances Largeman-Roth for a chat Thursday at 1 p.m. ET on eating healthfully while pregnant.

Did you gain lots of weight when you were pregnant? How did that affect your health? Did you have trouble losing that weight later? Please take today's poll!

Let's tweet! The other Local Living writers and I are on Twitter at @wposthome/local-living. And keep track of my "Me Minus 10" effort to lose 10 pounds before I turn 50 at twitter.com/jhuget.

By Jennifer LaRue Huget  |  March 16, 2010; 7:00 AM ET
Categories:  Motherhood , Nutrition and Fitness , Obesity , Pregnancy , Women's Health  
Save & Share:  Send E-mail   Facebook   Twitter   Digg   Yahoo Buzz   Del.icio.us   StumbleUpon   Technorati   Google Buzz   Previous: Coffee's clean bill of health
Next: You get weighed at the doctor's office. Then what?

Comments

Ok, so I don't normally indulge shameless promotion of websites, but SparkPeople.com has a sister site for managing a healthy pregnancy at babyfit.com.

Both resources are completely free and can help you track both food intake and activity.

Posted by: lady_flynn | March 16, 2010 11:32 AM | Report abuse

What the what? "I'm basically telling you that if you're already heavy, you're just going to get heavier when you're preggers, and then stay that way forever." THAT's how you deliver health promotion information?!? Give me a break. I was overweight when I had my son, gained 50lbs and then lost all 50 plus another 30 while breastfeeding for a year while not excercising one bit. And I kept it off until my next pregnancy. Typical? Probably not. Possible? Absolutely. You simply can't provide good health advice by lumping all women into one group and no health professional can say with any certainty what state a human being will be in "forever."

Posted by: iansmom1 | March 16, 2010 12:32 PM | Report abuse

I think that every woman and every pregnancy is different, so blanket advice is rarely applicable to most. And most OBs that I've talked to say that the weight guidelines are generally bunk; that is, it is more important to eat healthy and keep active than it is to watch the scale, no matter what size you are.


Posted by: skm1 | March 16, 2010 12:45 PM | Report abuse

This advice is ridiculous. Baby accounts for 8 pounds of weight gain, and fluid and placenta accounts for another 12 pounds. Pregnant women shouldn't overindulge, but they shouldn't starve themselves or be so fixated on their weight that they're not getting proper nutrition. Even though you don't need many more calories in the first trimester, many pregnant women are doing their best to keep down what they can. I am currently pregnant and during my first trimester I ate fast food because that's what I could hold and I was way too tired to cook. In my second trimester, I have the energy to exercise, keep a food journal, and my normal appetite for a healthier diet has returned.

Posted by: loved1 | March 16, 2010 12:50 PM | Report abuse

I think there is a whole body of health/science as it relates to those who have a significant weight problem, but to give blanket advice to all PG women based on those with pre-existing issues seems silly and designed to play to our worst fears.

Listen to your body and eat when you're hungry, but listen to your head and eat what you know is smart. Something tells me that if you have a craving, there is something there that your body needs. Also, I refuse to lecture, or be lectured by, someone who has never had cravings/nausea/no time to cook a 3 course meal from scratch.

I gained 55lbs with twins, and have carried an extra 5lbs since they were 1mo old. I refuse to beat myself up; I'm too busy with my boys to worry about getting back into a swimsuit and have settled for healthy and happy.

Posted by: newtodc1 | March 16, 2010 1:56 PM | Report abuse

SKM1 - so with you and loved1...

I am a very fit 39 year old who gave birth 3 months ago. I gained 6 pounds before I even knew I was pregnant - eating salads and yogurt.

I exercised throughout my pregnancy (til 2 days before his delivery) - more than an hour a day 5 x a week. I had morning sickness the entire pregnancy and really only managed to eat carbs, but not much at that.

I gained 50 pounds.

I was back to running 7 days after giving birth and back to a very healthy vegetarian diet. I lost 25 pounds quickly and haven't been able to lose a pound in the past 4 weeks. This is despite exercising for up to 2 hours a day and breastfeeding my son.

I know I have a long road ahead but 1 size fits all pronouncements don't help nor do they apply to us all.

Posted by: LTL1 | March 16, 2010 2:03 PM | Report abuse

"If you're a bigger gal," she writes, "I realize that all of this information is super-depressing. I'm basically telling you that if you're already heavy, you're just going to get heavier when you're preggers, and then stay that way forever."

That is the most ridiculous advice I've read regarding weight. I was overweight, gained 20 lbs. during pregnancy, then lost 40 within six months of delivery. I nursed exclusively but barely exercised. Since then, I've lost another 25 lbs. (via excerise and careful eating) and am at the low end of the normal BMI. Nobody is doomed. Having a child can be the motivator to eat healthily!

Posted by: drl97 | March 16, 2010 2:06 PM | Report abuse

This is just one more time when I am glad that even though most people would consider me "a bigger gal" - my doctors and OB trust that I am healthy.

I've tried to keep myself as thin as possible my whole life through a very rigid diet and regular exercise, and as soon as I got pregnant I went on http://www.mypyramidtracker.gov and found that they reccommended that the average pregnant woman eat nearly twice the calories that I consume per day. (Now that was depressing)

Obviously I did not double my calories, but instead I continue to eat a balanced diet and increased only the amount of organic dairy products I consume. And still eat significantly below a 2000 calorie a day diet.

Still, I've gained about 25 pounds - with 3 weeks left to go in my pregnancy. I found this article to be overly general and one more time where some health practictioners over-generalize and rely too heavily on BMI.

Luckily, with knowledge of my anxiety over gaining weight, my OB has encouraged me to keep track of things like my measurements - which -with the exception of my belly- have barely changed (less than an inch on any part of my body).

All this to say, I think this article is way overgeneralized and could really reinforce the negative body image of slightly larger woman at a time when it's hard enough to feel positive about all the changes going on.

I'm all for encouraging a healthy lifestyle- it's not only my own personal obsession, but my husband's business, but let's do that for EVERYONE, big, small, short and tall - and stop assuming that there are a different set of rules for larger people.

Posted by: karmadarling | March 16, 2010 2:13 PM | Report abuse

Eating for 2 is a fallacy. You eat for 1 and your body will take care of the baby.
And a lot of it is WHAT You eat. If you eat right for yourself it will promote better health for your baby.

Posted by: Krazijoe | March 16, 2010 2:15 PM | Report abuse

Ever since I was a little kid, I noticed normal appearing women would have kids and become whales. They would have the babies and not appear to change much physically afterward. Many would get larger with each kid and few seemed to get smaller later such that they remotely resembled what they looked like before the first kid.

I have always thought this didn't make sense but so many people would say "you gotta eat for two" and "you have to gain such and such pounds to have a baby" that I kept my questioning trap shut.

Later in life, I noticed the "workout" and "runner" moms doing their thing while pregnant and not ballooning (other than the "baby bump"). I have also noticed people whose job it is too look good (movie stars, rock divas, etc) not ballooning because of kids (e.g. Kate Winslet). In no case of non-ballooning moms that I am aware of, were there problems with pregancies or the delivery of healthy babies.

Just some zero calorie food for thought.

Posted by: mi-ti-bear | March 16, 2010 2:28 PM | Report abuse

I think the spirit of the researcher's work is correct: too many women consider pregnancy a blank check to eat whatever and however much they want. I think saying that no calorie increase should occur in the first trimester is ridiculous because that is when most women are most hungry, and that hunger often leads to morning sickness (stomach acids and low blood sugar creating nausea).

The fact is that each woman is different, as is each pregnancy, and blanket recommendations probably will not apply to every expectant mother. Still, women should very carefully watch not only how much but what they eat and try to pack their daily regimen with whole grains, lean proteins, fruit and veg, and low-fat dairy--and nothing artificial.

I am on my fifth pregnancy, and, with each of the others, I gained exactly 20 pounds (including large babies). I was very disciplined, but I certainly did not attempt to gain the same exact amount each time; I think it was just my body's pregnancy default. After each birth, I wore my prepregnancy clothes home from the hospital and was toned up within a few months--while breastfeeding for more than a year for each child. It's all about taking care of oneself and being disciplined.

Posted by: GrainofSalt1 | March 16, 2010 2:46 PM | Report abuse

"become whales"????

Jesus. We're never going to get a break, are we? WHAT DOES IT MATTER THAT SOMEONE IS FAT?!?! Criminy, stop JUDGING each other!!!

Posted by: sigmagrrl | March 16, 2010 2:51 PM | Report abuse

mi-ti-bear

That's one of the hard things to imagine because, reading your email and looking at me, you'd think I was a normal mom who became one of your 'whales'. (granted it has only been 3 months) Not so, I am a 'runner' mom who was skinny when I got preggers.

Its really so individual. I eat less than 1500 healthy calories a day and work out more than most people. Yet 4 weeks and not a pound lost..

Some people are lucky genetically speaking - as for the people who's job it is to look good, I'd love to have their job (getting paid to work out and having enough money for a personal chef and trainer) instead of having to slide my work out in at 5 am (on 5 hours of sleep) with a run at lunch.

I had this vision of being 'super prego' girl, and worked hard at it. But I've come to learn that there are certain things you can't really control.

Posted by: LTL1 | March 16, 2010 2:52 PM | Report abuse

GrainOfSalt -

My point is you can be incredibly disciplined and still gain weight and struggle with losing it. You are only one variation of what is possible regardless of it happening five times for you.

Posted by: LTL1 | March 16, 2010 2:57 PM | Report abuse

After watching my weight to stay a perfect size 4 from age 12 to age 27, I was thrilled to "eat for two" for 9 months! I finally got to eat fries instead of salad with a sandwich, ice cream without guilt, pasta AND bread in the same meal, plus all my usual veggie and lean protein favorites. Oh, and I kicked back nearly a half gallon or organic skim milk a day. It was great! Being pregnant means being fat, wear boring clothes and flat shoes, nauseaous, moody, can't drink alcohol or eat favorite foods like sushi and nice cheese, AT LEAST you get to eat! I put on 50 lbs and lost it all in less than a year (9 months to put it on, 9 months to take it off!). It's all worth it for my beautiful (and perfectly sized) and healthy baby girl and to keep happy and sane while preggers. Different story if you're fat to begin with, but if you aren't eating for two is a bonus. As soon as I get pregnant with #2 I am having a hot fudge sundae.

Posted by: calidem1 | March 16, 2010 4:21 PM | Report abuse

Sigma,
Being considered fat is not a judgement from other people. It is an observation.

There's nothing OK about being overweight, especially with mothers of young children. Study after study shows that kids of overweight parents are exponentially more likely to become overweight themselves. They pick up the eating habits and the acceptance of being unfit. If not for any other reason, young mothers should strive to live a healthy lifestyle because of their children's future.

Posted by: booerns14 | March 16, 2010 4:27 PM | Report abuse

She's a gainer. More of you to love baby. I love your mind anyways.

Posted by: tossnokia | March 16, 2010 4:42 PM | Report abuse

At the gym, I love when I see the pregnant women working out with weight and doing cardio work. They're the women who really do care about their baby's health.

Posted by: Skeptic1 | March 16, 2010 5:02 PM | Report abuse

Skeptic - as one of those preggers women who did workout, I have a whole lot more understanding for women who cant or dont.

So many people including doctors and books scare you in to not working out with vague threats to your baby's health. It takes tremendous strength of will to get past the misinformation that is so prevalent, and the misinformed doctors and every other well intentioned busybody.

Couple that with women with legit health issues or women for whom pregnancy is a miserable 9 months that they survive for the sake of the baby and you have plenty of women who care about their baby's health but aren't at the gym.

Each person's experience is individual and personal and hard and wonderful. What it is not, is an opportunity for strangers to judge.

Posted by: LTL1 | March 16, 2010 5:16 PM | Report abuse

I think that almost all of the posters have missed the point here. Everyone has a different story, you may have worked out, ate well, and still gained weight. The post is not about you. This post is about the folks who make the excuse that they're eating for two, and can therefore use that as an excuse to indulge every craving. Cravings CAN be a way to determine that you may be lacking in something, but only if you are craving something of nutritional value.

Posted by: MzFitz | March 16, 2010 5:40 PM | Report abuse

I gain 25 lbs while pregnant and had a healthy boy at 6 1bs 10 ounces. (My cravings were popsicles and fruit cups - so I lucked out).

HOWEVER, after losing all my pregnancy weight fairly quickly, I've since gain a lot back. I am now eating almost for 2 because I tend to eat my food and my 5 year old son's leftovers and I no longer have time for exercise.

Posted by: ADmom | March 16, 2010 5:54 PM | Report abuse

I gained 35 pounds and mostly lost it after wards. It was after the second child that losing became harder. I was older and I had two little kids to tend. They can make a lifestyle for losing weight harder.

A downside of the 35 pound gain for me was that the baby ended up weighing 10 pounds and that made the birth harder. Everybody was fine but I would advise gaining less for a less traumatic birth.

Posted by: RedBird27 | March 17, 2010 7:13 AM | Report abuse

I guess I am the oddball because I lost weight while pregnant (on balance), without really trying. I have always been moderately overweight(10 - 25 lbs)though not obese. In my first pregnancy, I gained a total of 5 pounds and my daughter was 7.5 lbs; for my son I gained a bit more, 20 lbs and he was a little over 8 lbs. After my first pregnancy I was 15 lbs lighter than when I began, the second time maybe 5 lbs lighter.

My apetite and habits just changed while pregnant. I didn't like the taste of anything sweet or greasy. And of course I didn't drink any beer. I did have a decent diet, nutrition-wise. I didn't have significant morning sickness but I just didn't feel like eating a lot.

But then, after each birth I gained weight and got back pretty much to where I started. I think it was the inactivity and boredom of caring for a newborn, but probably just my body and appetite changed back to my normal state. Can't really account for it.

The odd thing was, in my first pregnancy when I was losing weight the first few months, my doc asked me about it but when I said I was eating a good diet he believed me and left me alone. But for the second pregnancy I had a different set of doctors, and they pestered me constantly that I wasn't gaining enough. But I just shrugged them off. It all worked out OK.

I just think everybody is different. I have NO idea why I tended to lose weight while pregnant but I just did.

Posted by: catherine3 | March 17, 2010 1:43 PM | Report abuse

But it's SO fun and freeing to "eat for 2"! You only do it once, though. In my case, after giving birth to my first and packing 30 extra lbs., I realized the Ben & Jerry's binges were for me, not him.

I was way more judicious the next time.

http://mamasoncall.com

Posted by: drmama | March 21, 2010 7:56 PM | Report abuse

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