How much weight should you gain during pregnancy

In this episode of the Nutrition Diva podcast, I discuss  how much weight it’s OK to gain during pregnancy as well as the dangers of not gaining enough weight. Unfortunately, there are some dangerous trends at both ends of this spectrum.  Pregnancy isn’t an excuse to stop paying attention to your weight—but it’s also not a time to obsess about staying thin. This is the time to find a safe and healthy middle path.

This article is available as a podcast. Click to listen:

As the number of overweight and obese Americans has risen, so has the number of expectant mothers who are overweight or obese. In fact, according to the American College of Obstetricians and Gynecologists, fully 50% of pregnant women are now overweight or obese.

Some women are overweight or obese when they become pregnant. Others start out at a healthy body weight but gain too much weight during their pregnancies. Either way, maternal obesity has a host of negative effects on both the mother and the baby.  For the mom, obesity and/or excessive weight gain during pregnancy dramatically increases your risk of gestational diabetes and pre-eclampsia, and other serious complications. You’re also more likely to require a Caesarean section. Things don’t go any better for the babies. They are at increased risk of miscarriage, stillbirth or premature delivery. They are also much more likely to struggle with childhood obesity.

If you are overweight or obese and pregnant, you can reduce the risks for both you and baby by limiting the amount of weight you gain during your pregnancy. Instead of the usual 25-35 pounds, your doctor may suggest that you limit your weight gain to 10-20 pounds instead.

But this needs to be done carefully. The last thing you want to do is to deprive your baby of the nutrients she needs to grow and develop. If you are restricting your calorie intake in order to limit your weight gain during pregnancy, it is extra important that you make every calorie count by choosing wholesome, nutrient dense foods such as fruits, vegetables, lean protein, whole grains, legumes, and healthy fats.

I’m equally concerned about another less common but growing trend: women who begin their pregnancies slim or even underweight and are so determined not to get “fat” during their pregnancies that they actually diet and exercise to extremes to avoid gaining weight. These misguided moms—who often have a history of eating disorders or disordered body image—are egged on by unrealistic media coverage of celebrities who stay impossibly slim during their pregnancies and are photographed in bikinis, seemingly minutes after delivery.

Refusing to eat enough to sustain the appropriate amount of weight gain during pregnancy puts your baby at extreme risk. When you aren’t eating enough calories, you likely not to be getting enough protein, iron, and other nutrients that are essential to healthy development. When mom is undernourished, the babies are more likely to be born pre-term and may suffer from learning and behavioral disorders and other disabilities. And how’s this for irony? A recent study found that babies born to mothers who do not gain enough weight during pregnancy are at increased risk of childhood obesity. In fact, they are almost as likely to be obese as babies born to obese mothers.

When pregnant women don’t consume enough calories, the fetus essentially develops a starvation metabolism, programmed to grab and hang onto every calorie that comes its way. That metabolism becomes permanently encoded and sets him/or her up for a lifetime of weight struggles. Sometimes, of course, a mother’s inability to enough gain weight is due to factors beyond her control. If you’re having trouble gaining weight, please consult your OB or a nutrition professional for support. But please don’t intentionally put your baby at risk in order to preserve your figure. You’ll only be pregnant for 9 months but your baby could be affected for a lifetime.  If you have had an eating disorder or feel uncomfortable about pregnancy weight gain, please enlist your OB as well as a nutrition and/or mental health professional to give you the medical, nutritional and emotional support you need throughout your pregnancy.

The ideal scenario, of course, is to be at a healthy weight when you get pregnant and to monitor your weight gain carefully throughout your pregnancy…gaining neither too much nor too little. Then again, 50% of pregnancies are unplanned. So, why wait? Even if you’re not trying or planning to get pregnant, here’s one more good reason to prioritize achieving and maintaining a healthy body weight.  (Please check out the resources I’ve put together at Weighless.life.)

Guide to Calories and Weight Gain During Pregnancy

This chart shows how much weight you should gain during your pregnancy and about how many calories you should be eating to stay on course.

First, you’ll need to calculate your pre-pregnancy BMI to find out how much weight you should gain over the course of your entire pregnancy. Then, use this calculator to estimate your baseline (non-pregnancy) calorie needs, if you don’t already know them. Finally, see how many calories you should add to your baseline during each trimester of pregnancy.

NOTE: These numbers are only general guidelines; please discuss these recommendations with your obstetrician and/or nutrition professional and adjust your intake as needed to stay within recommended weight gain ranges.

Please do not attempt to lose weight during your pregnancy. The lower number in the recommended range is just as important as the upper one!

BMI at Beginning of PregnancyRecommended Weight Gain During PregnancyApproximate Increase in
Daily Calories
<18.528-40 pounds1st trimester: Baseline + 100 – 200

2nd trimester: Baseline + 300 – 400

3rd trimester: Baseline + 400 – 500
18.5-2525-35 pounds1st trimester: Baseline + 0 – 100

2nd trimester: Baseline + 200 – 300

3rd trimester: Baseline + 350 – 450
25-3015-25 pounds1st trimester: Baseline

2nd trimester: Baseline + 150 – 200

3rd trimester: Baseline + 250 – 350
>3011-20 pounds1st trimester: Baseline

2nd trimester: Baseline + 100 – 200

3rd trimester: Baseline + 200 – 300

More resources:

Healthy Weight During Pregnancy (Academy of Nutrition and Dietetics)\

Pregnancy Weight Tracker (Baby Center)

 

References:

American College of Obstetricians and Gynecologists. Obesity in Pregnancy Committee Opinion 549, January 2013. Link to report.

Paden MM, Avery DM. Preconception counseling to prevent the complications of obesity during pregnancy. Am J Clin Med. 2012 Winter; 9(1): 30-35. Link to paper.

Sridhar SB, Darbinian J, Ehrlich SF, et al. Maternal gestational weight gain and offspring risk for childhood overweight or obesity. Am J Obstet Gynecol 2014;210. In press.  Link to Abstract.

Thangaratinam S, Rogozińska E, et al. Effects of interventions in pregnancy on maternal weight and obstetric outcomes: meta-analysis of randomised evidence. BMJ 2012;344:e2088. Link to paper.

 

 

 

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