A Weighty Issue: the More Pounds, the More Problems

“Eating for two” has long been the slogan that has summed up a woman’s eating habits during pregnancy. Whatever the baby wanted, the lady got! From pancakes to pizza and grilled cheese to goat cheese, it was bottoms up (no matter how big your bottom, your top, or your baby got)! The sky or the sundae was the limit, and weight was not a worry. But pregnancy is no longer bon bons and “baby on board” tee shirts. Food choices are important, and OB/GYNs are making weight gain a weighty issue during pregnancy.

During pregnancy, both you and your baby sort of are what you eat. Long gone are the days of limitless donuts and Doritos. And although cravings don’t need to be curbed, more recent medical data show that they should be curtailed. Additionally, monitoring what you put out as well as what you put in is recommended. Caloric intake and energy output can make a sizable difference in your baby’s size and even his or her future health. In 2009, the Institute of Medicine (IOM) released a new set of guidelines for weight gain during pregnancy. These recommendations are based on your pre-pregnancy body mass index (BMI). So get out your calculator and, ugh, that dreaded scale.

To calculate BMI, you take your weight (in kilograms) and divide it by your height squared (in centimeters); so if you are 5’5 and weigh 135, your BMI would be 22.46. Your next question is: what does that mean? Is 22 a good number?

A “good” number as defined by the IOM is a BMI between 18.5 and 24.9; this is considered a normal weight. The highs and lows go like this…a BMI less than 18.5  is underweight. A BMI between 25 and 29.9 is overweight, and a BMI greater than 30 is obese.

With these numbers in mind, the recommendations are as follows:

• Women who are underweight should gain between 28 and 40 pounds during pregnancy.
• Women who are normal weight should gain between 25 and 30 pounds during pregnancy.
• Women who are overweight should gain between 15 and 25 pounds during pregnancy.
• Women who are obese should gain between 11 and 20 pounds during pregnancy.

While one size never fits all, there are exceptions to the rule, particularly women who are carrying multiples. If you are doing double duty, you don’t need to double your weight gain, but you do need to put on a few extra pounds. Recommendations are not rules, and even some rules are meant to bend and be broken. Don’t beat yourself up every time you step onto that scale: you are not trying to make weight for a wrestling match. These numbers are a guideline, not a guillotine.

Why do we care so much? Can’t there just be nine months when you are not a slave to your scale? We care because excessive weight gain during pregnancy has been linked to a whole buffet of problems: diabetes during pregnancy, fetal macrosomia, high blood pressure, birth defects, premature delivery, stillbirth, cesarean section, complicated vaginal deliveries, and childhood obesity. The menu of problems is large and continues to grow with more research.

We as OB/GYNs are pressing the issue and pressuring you to watch your weight because really bad things can happen to both you and your baby when you don’t. Last, the more weight you gain during your pregnancy, the harder it is to lose after pregnancy is done. While most of us can’t be Heidi Klum at a Victoria’s Secret fashion show one month after delivery (I mean, really, how did she do that?), how much you gain during pregnancy is equal to how much you will need to lose post-pregnancy. So fill your plate the first time, but resist the urge to go back for seconds. It’s not worth it.