Pregnancy has always been a good excuse for gaining weight.  It seems like this is the one time where you don’t have to worry about what you eat or how much weight you gain.  And other people also do not bat an eye at any amount of weight you gain as long as you can look them straight in the eye and say that you are pregnant.  Yet recent studies have shown that maybe pregnancy is the time when women should be the most concerned about their weight and how much weight they gain. 

And women who are already overweight or obese tend to gain even more weight than what is recommended during pregnancy.  This is not surprising. If someone is having a hard time with their weight as it is, it will be even harder to control weight when you add pregnancy plus the stresses that go along with pregnancy with it.  Also, this excessive weight gain may be especially hard to lose after you have the baby.

The solution? Start healthy eating habits, exercise habits, lifestyle habits, and thinking habits long before you become pregnant.

This issue is so important that I have included the recent article from MSNBC news in full below.  You can also find the article here, called Obese and Pregnant?

WASHINGTON – Eating for two? New guidelines are setting how much weight women should gain during pregnancy — surprisingly little if they’re already overweight.

The most important message: Get to a healthy weight before you conceive, says the Institute of Medicine in the first national recommendations on pregnancy weight since 1990. It’s healthiest for the mother — less chance of pregnancy-related high blood pressure or diabetes, or the need for a C-section — and it’s best for the baby, too. Babies born to overweight mothers have a greater risk of premature birth or of later becoming overweight themselves, among other concerns.

Meeting the guidelines could be a tall order, considering that about 55 percent of women of childbearing age are overweight, that preconception care isn’t that common and about half of pregnancies are unplanned.

Once a woman’s pregnant, the guidelines issued Thursday aren’t too different from what obstetricians already recommend, although about half of women don’t follow that advice today.

Among the new recommendations:

  • A normal-weight woman, as measured by BMI or body mass index, should gain between 25 and 35 pounds during pregnancy. A normal BMI, a measure of weight for height, is between 18.5 and 24.9.
  • An overweight woman — BMI 25 to 29.9 — should gain 15 to 25 pounds during pregnancy.
  • For the first time, the guidelines set a standard for obese women — BMI of 30 or higher: 11 to 20 pounds.
  • An underweight woman — BMI less than 18.5 — should gain 28 to 40 pounds.

What if a mom-to-be has gained too much? On average, overweight and obese women already are gaining five more pounds than the upper limit.

But pregnancy is not a time to lose weight, stressed guidelines co-author Dr. Anna Maria Siega-Riz of the University of North Carolina, Chapel Hill.

“It’s not, ‘Hey you gained enough, now you need to stop,’ ” Siega-Riz said. “Let’s take stock of where you’re at and start gaining correctly.”

A pound a week
Indeed, underweight and normal-weight mothers should put on a pound a week for proper fetal growth in the second and third trimesters, the guidelines say. The overweight and obese need about half a pound a week.

Hopping on the scale during prenatal checkups makes for a sensitive moment, especially in a culture that cherishes the stereotype of late-night ice cream-and-pickles snacks.

Implementing the guidelines may take a move “to change the whole culture about pregnancy” and eating, Siega-Riz said. She noted that in studies of the overweight, “most of these women will tell you that they’ve never been told how much weight to gain.”

The guidelines call for increased nutrition and exercise counseling during pregnancy, saying doctors or midwives may need to consult a dietitian to tailor a woman’s care no matter her starting weight. Also, providers should discuss whether a woman plans to breastfeed, which not only is optimal for the baby but helps the new mother shed pounds, too.

“It’s really a teachable moment,” said guidelines co-author Dr. Patrick Catalano, obstetrics chairman at Ohio’s Case Western Reserve University. “When women are pregnant, they may be more accepting” of weight discussions “because it’s also in the best interest of their babies.”

Obstetricians, who have struggled with how to advise heavier women as U.S. obesity rates have soared over the past two decades, welcomed the guidelines — especially the recognition that babies born too large tend to grow into overweight children at risk for their own health problems. Not too many years ago it was rare to see a 9-pound, or larger, newborn.

“Pregnant women should not be eating for two,” said Dr. Ellen J. Landsberger, who specializes in high-risk pregnancies at New York’s Montefiore Medical Center. “You want a healthy baby? On both ends, you have to eat the right amount.”

Nutritional needs
But is it realistic for obese women to gain as little as 11 pounds?

“We think it’s possible. We also think it will be a challenge,” said Cornell University nutrition specialist Dr. Kathleen Rasmussen, who chaired the Institute of Medicine committee.

In the Bronx, Nyree Paten illustrates that challenge: She had been putting on weight for three years and discovered she was pregnant at her peak, just over 300 pounds, seriously obese even for someone 6 feet tall. Her doctor diagnosed diabetes at her first prenatal checkup. Landsberger found Paten, 35, a nutritionist and prescribed insulin for the diabetes. Paten said she’s gained only about 2 pounds by week 24, while regular ultrasounds show her baby is growing well.

“Thank God I’ve been doing good,” says Paten, who feels more energetic because she’s eating better. So is her 8-year-old son. First to go: sugary sodas and juices in favor of water.

“It’s all about knowing and being educated on how to eat,” adds Paten, who’s lined up the nutritionist to help her lose weight once her baby is born.

The guidelines say women expecting twins can gain more: 37 to 54 pounds for a normal-weight woman, 31 to 50 pounds for the overweight, 25 to 42 pounds for the obese. There’s not enough information to set recommendations for triplets or more.

The institute stressed that the guidelines are aimed at U.S. women, not for parts of the world with different nutritional and obstetric needs.

Gaining too much weight during pregnancy is not just an issue of physical appearance.  There are many medical complications for the mother.  But more recently, there have been studies showing medical complications for the baby as well.  The following list has been taken from www.pregnancy-info.net:

Complications For Mom
If you are obese during pregnancy, you are at risk of several serious health complications, including: 

  • Preeclampsia: Preeclampsia is a condition which causes high blood pressure, fluid retention, and swelling during pregnancy. When serious, preeclampsia can restrict placental blood flow, endangering baby.
  • Gestational Diabetes: Gestational diabetes is a form of diabetes that develops during pregnancy. It prevents your body from breaking down sugar and can put your baby at risk for gaining too much weight in utero.
  • Cesarean Section: Women who are obese during pregnancy have an increased risk of experiencing problems during delivery. Labor is more likely to be slow and prolonged, increasing the likelihood of cesarean section.
  • Postpartum Infection: Obesity during pregnancy also makes you more vulnerable to experiencing a difficult postpartum recovery. In particular, if you have had a C-section, you are at risk for developing dangerous postpartum infections.

It is not certain why obesity is associated with pre-eclampsia, although obesity has always been known to be one of the causes of high blood pressure. There is one study that explores this association between obesity in pregnancy and preeclampsia.

Complications for Baby
If you are obese during your pregnancy, you baby is also at risk for developing some dangerous health issues.

  • Macrosoma: Macrosoma is a condition in which your baby puts on too much weight during development. This can complicate labor and delivery, making it difficult for your baby to enter and exit the birth canal. Some large babies have their shoulders injured during birth. This is known as shoulder dystonia.
  • Neural Tube Defects: Babies born to obese mothers are also at increased risk of suffering dangerous neural tube defects during development. Neural tube defects, like spina bifida and anencephaly, are often associated with low levels of folic acid during the first trimester. These defects can frequently be detected early in pregnancy through the use of ultrasound imaging. However, women who are obese often produce poor ultrasounds. Because the ultrasound waves have trouble penetrating extra layers of fat, blurry images are produced. As a result, neural tube defects aren’t always detected in these babies.
  • Childhood Obesity: Studies show that babies who are born to obese mothers are more likely to suffer from obesity by the time they reach the age of four. In one recent study, 29% of children born to obese mothers were also obese by the age of four, compared with only 9% of babies born to mothers of normal weight.

Admittedly, adding neural tubes defect to this list of complications of obesity during pregnancy is a stretch.  The actual issue is that obesity can lead to not being able to get good ultrasound images of the baby, which can lead to a missed diagnosis of neural tube defects, such as myelomeningocele.  Basically, this can lead to an increased risk of having neural tube defects only if you are working on the assumption that if your baby was diagnosed with a neural tube defect, then you definitely would have had an abortion. 

However, this article speaks to the fact that there is in fact a true direct link between obesity in pregnancy and neural tube defects, cleft lip and palate, and hydrocephalus.  This may be due to the association of obesity with other nutritional deficiencies, including a deficiency in folic acid (folate deficiency), which is a known risk factor for neural tube defects, cleft lip and palate, and hydrocephalus.

What is very interesting is the fact that if a woman is obese just during the nine months of her pregnancy, this can effect the entire life of her child!  If she is having a girl, her daughter may end up staying obese until she is pregnant, and then have another obese child.  This can continue on for generations. This shows that in addition to genetic influences and environmental influences, there is this third cause of obesity that can appear to be genetic in origin but is in fact caused environmentally in the womb.

To this list of complications of obesity during pregnancy, you can also add other problems with being obese during pregnancy, including:

1. Congenital heart defects.  A recent study has shown that women who are obese when they become pregnant are 30% more likely to have children born with congenital heart defects.

2. Post-partum depression - A study conducted by the University of Utah in 2008 showed a link between being obese in pregnancy and having post-partum depression.  You can see a summary of the study here. 

This makes a lot of sense, since there are many underlying causes that can lead to both obesity and post-partum depressions, such as negative thinking, poor coping skills, a stressful environment, poor social support, and poor self esteem.  Also, increased fat tissue can itself cause depression in a purely physical way, since fat cells can convert estrogen into testosterone, leading to hormonal and emotional imbalances.  This is the same reason that depression has been associated with women with polycystic ovarian disease.

3.  ADHD – Being overweight or obese during pregnancy may be associated with ADHD in the child, at least the inattentive type.  This article, called Maternal Obesity During Pregnancy Increases Risk for ADHD, is rather convincing. 

4. Autism – The link between obesity during pregnancy is one of a few prenatal factors associated with autism, including having an older mother or father and having a mother being born abroad.  This association was discovered and discussed in a research paper conducted by American researchers in the British Journal of Psychiatry, in July, 2009.  A summary of this intriguing research paper is presented here.  Could the rise in obesity in pregnancy be the real reason for the recent rise in autism rather than the use of vaccines, I wonder?

5.  Blurry 3D ultrasound images.  Yes, obesity in pregnancy can lead to poor, blurry, and unclear 3D ultrasound images.  With the latest craze of 3D and 4D ultrasounds, pregnant women are now doing whatever it takes to get the best 3D ultrasound images for their baby album. If this motivates you to avoid obesity during your pregnancy, then I am all for it!  Not gaining excessive weight during pregnancy can prevent a whole slew of medical problems for you and your baby.  But the beautiful 3D ultrasound images can be a great reward for your efforts.  If you are in the Chicagoland area, feel free to reward yourself for not gaining too much weight in pregnancy by getting a 3D ultrasound at First Peek Ultrasound.

So what can you do as a pregnant woman to avoid obesity in pregnancy?  The following suggestions say it best, taken from www.pregnancy-info.net:

  • Lose Weight Before Pregnancy: If you are planning on getting pregnant in the near future, get your weight evaluated by your health care provider. If you are obese, consider losing weight through proper diet and exercise. Even minimal weight loss can help to radically reduce your risk of pregnancy complications. Those that are severely obese may want to consider obesity surgery.
  • Watch your Weight Gain: Even if you are obese, you should never try to lose weight during pregnancy. Weight loss or changes in diet can prevent your baby from getting the calories and nutrients she needs to grow properly. Instead, focus on gaining weight in moderation. Most obese women need to gain between 15 and 25 pounds, putting on the majority of the weight during the third trimester.
  • Exercise: Exercise should be continued throughout your pregnancy. Talk with your health care provider about exercise levels that would be appropriate for you. Even if it’s just walking around the block a few times, exercise can really help to reduce your risk of potential health complications.

More recently, the suggested weight gain during pregnancy for obese women has been seriously modified than what was even mentioned above.  In the MSNBC article mentioned first, the recommended weight gain for obese women, with a BMI greater than 30, is 11 to 20 pounds for the whole duration of your pregnancy.  In other words, basically, you should just try to not gain any weight at all and just hope that your existing weight rounds off and goes where it needs to go!

Eating for two? If you are obese, then maybe you shouldn’t.

Is anyone out there struggling with obesity in pregnancy? We would love to hear from your perspective.

Also, I apologize in advance if I offended anyone out there who is struggling with this issue of obesity in pregnancy.  Although I am not here to judge, as a pediatrician, I feel I have to speak out on anything that has this much of an impact on children which is preventable.  If you know anyone who can benefit from this article, please forward it to them.