How Much Weight Should Pregnant Women Gain?
August 15, 2007
I can’t believe that doctors are still arguing about how much weight women should gain during pregancy. A big Institute of Medicine report in 1990 seemed to have settled the question. It said that the amount you should gain depends on how much you weigh before getting pregnant. On average, women of normal weight should gain 25-35 pounds, underweight women could gain up to 40 pounds, and overweight women should restrict weight gain to 15 pounds. Doctors are now worried that the upper limits are so high that they encourage women to gain so much that they can’t lose it afterward. These doctors want the guidelines revisited. Perhaps they should be. I had my children in the era when normal weight women like me were advised not to gain more than 15 pounds and the doctors yelled at us if we gained a pound or more between appointments. Those of us who followed the advice, dieted during pregnancy (yikes!), and didn’t gain so much had smaller babies than women do now. Weighing more–up to a point–is better for babies. It will be interesting to see how the new Institute of Medicine committee manages to balance the benefits of heavier infants against too heavy a weight gain in the moms. Weight recommendations have changed drastically in my lifetime and the advice still isn’t settled.
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Well, getting my cynicism on–I could suggest that rather than relying on almost entirely arbitrary weight ranges, OBs could learn something about nutrition such that they can effectively evaluate their individual patient’s needs and give sound advice. At the very least, advice beyond “take a prenatal vitamin.” It is sad that good nutrition, the single most crucial factor for a healthy pregnancy that is under a woman’s control, is ignored nearly entirely in obstetric training and, as such, ignored in all patient consultations as well.
Comment by Robyn M. — August 15, 2007 @ 3:46 pm
I agree with commenter #2. Nutrition advice for pregnant woment is abysmal. When I was pregnant, I was diagnosed with gestational diabetes. At that point I had just started to gain weight at a more rapid pace. If I had kept that up, I would have gained too much. I thought I had been eating pretty well, but definitely not the right balance of nutritients. But because I needed to keep my blood sugar evenly controlled after the diagnosis, I followed a strict carb restricted diet (not calorie restricted at all!!!!) and gained weight moderately after that, about 28 pounds in total. I ate much healthier that way, with more nutrient dense foods like vegetables, meat, low mercury fish, eggs, and fatty acids without all those carbs (& I had always been a “whole grain girl” up to that point). Every bite had to be nutritionally dense (there’s nothing in sugary and starchy foods that one can’t get in other foods) so I ate a lot more unprocessed fat and protein and only carbs from non-starchy vegetables (lots of those). Even fruit put my blood sugar up too high so that was limited. I was able to avoid insulin with my diet.
I gave birth to a healthy 7 lb 9 oz boy (induced, but without any anesthesia or painkillers) and only had 14# to lose when I left the hospital. After 6 mos of breastfeeding I was at a great weight, a bit below my pre-pregnancy weight. After I weaned I started to gain about 5 pounds a year because I was eating pasta and bread type things again (whole grain, too). Since 2004 I have followed a carb restricted diet to maintain my weight and more recently, to maintain good blood sugar control (it’s clear I am at high risk for diabetes).
My sister, on the other hand, just barely passed her GTTs and avoided the Gestational Diabetes diagnosis with her two pregnancies. She gained too much weight (50 & 65 pounds), had babies a bit larger than 9 pounds, and had trouble losing her excess weight. During the second pregnancy she had major sugar cravings and ate a lot of junk and drank orange juice (very high in sugar). She constantly battles weight gain and sugar cravings.
But even the dietician I was sent to gave terrible advice at first. The ADA diet was way too high in carbs to keep my blood sugar in range. I think the typical carb-heavy diet is one of the reasons so many women gain so much weight and there are so many 9+ lb babies now — too much emphasis on foods that riase lood sugar and insulin levels. Those babies exposed to high blood sugar (even borderline high) while fetuses develop larger pancreas to make more insulin and it affects them for th erest of their lives. They are at much higher risk for developing T2 diabetes later — perhaps one of the reasons for the sharp increase in children with T2 DM now (epigenetics - am exciting area of research).
Comment by Anna — August 17, 2007 @ 2:43 pm
This is one of those situations in which individuals differ in response to all the physiological changes in pregnancy. You are lucky that you figured out what to do. I taught nutrition to medical students for 10 years and have many stories about that experience. Nothing has changed since, and it won’t until we get a health care system that cares more about prevention.
Comment by Marion — August 24, 2007 @ 5:28 pm
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MD’S NEED TO STOP WITH THE WEIGHT CONCERN AND FOCUS ON NUTRITION AND THE HEALTH OF THE BABY AND MOTHER,I GAINED 60 LBS WITH EACH CHILD AND LOST ALL THE WEIGHT IT CAN BE DONE HAS ANYONE EVER HEARD OF EXERCISE AND PUTTING THE FORK DOWN!!!!!!!!!!!!!!
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