Weight Gain in Pregnancy: A Big Topic

How many of you have had this reaction??

Not every topic on this blog will be about cosmetics.  In fact most will be about pregnancy and life in general.

“I’m eating for two!!”

“I can’t help it, I have cravings for a half dozen Krispy Kreme Donuts!”

Kim Kardashian gains 65lbs and is only 6 months pregnant!!

Everyone is talking about weight gain and weight loss:  Biggest Loser, Celebrity Trainers, Weight Watchers…the list is endless.  But that’s because obesity is a GLOBAL epidemic.

And it is even bigger in pregnancy.

In the good old days, when a woman became pregnant, she was given a platinum card to eat whatever she wanted!

“Ice cream and anchovies…..Sounds good!”

“A full Pizza at 3am for a snack because THE BABY woke me up!……Go For It!”

But now we are smarter.   We know that when you are pregnant you need to have your weight gain INDIVIDUALIZED.  It’s not an open 30-40 lbs for everyone.  We are all different, and need individualized healthcare recommendations.

But so what??  So what if you gain 70lbs during your pregnancy??   We all know someone who did, the baby did fine…what’s the big deal?

Pregnancy is a unique situation in which there are two patients, the mother and the baby.  It’s not just all about the baby.  If you gained 70lbs during your pregnancy, you would probably lose about 25 immediately after, but that still leaves an excess 45 lbs.  Those extra pounds turn to fat, and then they cause reactions in your body; the first is insulin resistance, and increasing your risk of becoming a diabetic.  The second is the excess weight can lead to increased blood pressure.  Increased weight also places stresses on your joint, and can lead to arthritis, and joint injury.  These changes won’t occur immediately after delivery, but the process gets started, and becomes a problem for you a few years down the line.  This has been recognized in medicine through observation and now we are addressing this issue.

Body Mass Index (BMI) is used as a screening tool to identify possible weight problems.  You can enter your weight and height on any website BMI calculator and it will give you a number (http://www.nhlbisupport.com/bmi) .  If you are 25kg/m2 or less then you are appropriate.  If you are 25-30 kg/m2 then you are considered overweight.  And if you are 30-40kg/m2 then you are considered obese.  You may want to ignore those numbers, but beware, the higher your BMI, the higher your risk of developing Gestational Diabetes (diabetes in pregnancy).  This occurs because of insulin resistance, and with it comes a 50-60% chance you will develop true diabetes in the future.  Even more concerning to the baby, is that the babies of diabetic mothers have a higher chance of developing childhood obesity and diabetes later in life.

So let’s assume that you went to the website, and entered your height and weight and got a number…now what??  What does it mean?  How much weight should you gain??

The Institute of Medicine (IOM) released a statement about weight gain in pregnancy for the first time in 2009.  (http://www.iom.edu/~/media/Files/Report%20Files/2009/Weight-Gain-During-Pregnancy-Reexamining-the-Guidelines/Report%20Brief%20-%20Weight%20Gain%20During%20Pregnancy.pdf).  This was the first any medical advisory board addressed the issue of weight gain in obese women.   Their recommendations were based on BMI and divided into underweight, normal weight and obese.  Although their recommendations were individualized, their recommended weight gain was considered excessive by some.    The American College of Obstetricians and Gynecologists (ACOG) issued a recent statement this year in which they stated for the overweight pregnant woman who is gaining less than the recommended amount BUT has an appropriately growing fetus, no evidence exists that encouraging increased weight gain to conform with the current IOM guidelines will improve maternal or fetal outcomes (http://www.acog.org/Resources%20And%20Publications/Committee%20Opinions/Committee%20on%20Obstetric%20Practice/Weight%20Gain%20During%20Pregnancy.aspx) .  I too restrict my obese patients’ weight gain to less than the IOM recommendations, but I ensure their diet is adjusted to maximize nutrition, and minimize “empty” calories.  We also ensure appropriate vitamin supplementation.  Simple prenatal vitamins do not appropriately give all the vitamins and nutrients needed for an adult let alone for a pregnant woman with the additional needs of the fetus.  But that is another topic for a blog!!!I

Note:  As always have a discussion with your obstetrician before embarking on any intervention that may affect your pregnancy!