"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!
Jennifer LaRue Huget
March 16, 2010; 7:00 AM ET
Categories: Motherhood , Nutrition and Fitness , Obesity , Pregnancy , Women's Health
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