The Skinny Pregnancy
Date: July 1, 2009
Tips to have a healthy pregnancy without worrying about weight gain, diets or extreme exercise
Watching pregnant celebrities is the new national sport, with analysis of how much they've gained and how well they're keeping their figures a hot topic in national gossip magazines. Pregnancy used to be about "eating for two," but today the dangerous trend is that more and more women are gaining less than the recommended amount of pregnancy weight.
About one in every four or five women gains an inadequate amount of weight during pregnancy. Some of this is tied to socioeconomic status - women who begin pregnancy without good nutrition, who smoke, or lack financial or nutritional resources. But many others are women who purposefully control their weight gain. "Women in general are certainly spooked about putting on a lot of weight, especially when they hear from media and friends that it completely changes your body or won't come off easily," says Melinda Johnson, a registered dietician and spokesperson for the American Dietetic Association.
The ABCs of Weight Gain
How much you should gain during pregnancy depends on how much you weighed before you got pregnant. Use your pre-pregnancy weight to calculate your Body Mass Index. BMI uses a formula to compare weight with height. Calculate this online here.
Underweight pre-pregnancy - BMI of less than 18.5 should gain 28-40 pounds
Normal weight pre-pregnancy - BMI of 18.5-24.9 should gain 25-35 pounds
Overweight pre-pregnancy - BMI of more than 25 should gain 15-25 pounds
The Skinny on Staying Skinny
There is a common misperception that in order to gain weight in a healthy way during pregnancy, all or most of the weight gain should go straight to your stomach. In fact, the experts say women who gain weight only in the stomach (creating those cute basketball tummies) are the exception and should not be looked to as ideals. "When women gain only in the abdominal area, it usually means that they have not gained enough weight," says Dr. Toya Ellis, a fellow of the American College of Obstetricians and Gynecologists and OB/GYN at Kaiser Permanente Colorado Region.
Most women, she says, gain weight everywhere during pregnancy and there is no way to control where those pounds will go. The goal is not only to gain enough weight to grow a baby, but also to allow your body to build up fat stores so that you can successfully breastfeed.
Failure to gain enough weight creates a 50 percent risk of having a baby who is low birth weight. These babies have higher risks for infant mortality, admission to intensive care, cerebral palsy, sight and hearing problems and learning difficulties. Women who do not gain enough weight in pregnancy face elevated risks of anemia, preterm labor and osteoporosis later in life. According to Ellis, "The more underweight you are, the more risk there is."
Slim and Pregnant
For many women, body image and a lifelong focus on being thin are very powerful attributes that are difficult to move past. Molly Kimball, a registered dietitian and sports and lifestyle nutritionist at the Ochsner Clinic Foundation Elmwood Fitness Center in Louisiana says, "I find there are societal pressures across the board to be thin. It's a huge compliment to many women that they are tiny except for their belly."
Karen Stealey was determined not to gain a lot of weight in her pregnancy. "I watched all my friends gain 35, 45 and even 65 pounds. I did not want that to happen to me." Stealey has always been tiny - a size 2 or 4. When she got pregnant, she went to a nutritionist, followed a food plan and kept a food diary. She also continued to do yoga and a cardio class. Her net gain was 19 pounds. "Although I was due in October, I did not look pregnant until August." Stealey's healthy baby weighed 8 pounds, 5 ounces. She says she is pleased that she now has no stretch marks or roll of fat or skin around her middle. "I think my experience is proof that if you don't just say, "I'm pregnant, I'm going crazy," then you don't have to gain a lot of weight."
Striving for Gain
It can be difficult to gain weight during pregnancy, even if you want to. Although some weight gain is recommended in the first trimester, failure to gain is not a deal-breaker. "I often tell patients that weight loss in the first trimester is common," says Ellis, due to nausea, food aversions, or fatigue. If you don't gain in the first trimester, talk to your health care provider, but don't panic. "Babies are very capable at extracting nutrients from our stored resources in the first trimester." She cautions however, that failure to gain in the second trimester is a more serious problem.
Elizabeth Johnson didn't gain a single pound during her third pregnancy, despite her efforts. Four and a half months of morning sickness put a huge dent in her appetite. When she did eat, she was careful to choose very nutrient-dense foods in multiple food groups and did not concern herself with counting calories.
"Everything was measuring OK, so my doctor wasn't concerned. But about my sixth month, he started ordering more ultrasounds." Her baby ended up weighing in at a healthy 8 pounds, 8 ounces. "At my postpartum check up, I was 25 pounds under my pre-pregnancy weight," she says.
Nausea isn't the only culprit. Ellis says, "Women who are thin often have to work harder to gain the weight. Sometimes they exercise and need to eat for both the exercise and the pregnancy. At times, they just have higher metabolic rates."
Melanie Nicsinger has always been a size 3. By her 20th week of pregnancy, she had gained nothing, although her doctor wanted her to gain at least 28 pounds and possibly as much as 35.
"It's hard for me to gain weight, even if I try, and pregnancy was no exception." She ate and ate, but no matter what she did, she couldn't gain any weight. "I definitely think it is possible that women who are naturally thin can experience trouble putting on pounds." Johnson concurs with this thinking. "Sometimes it is simply in the woman's genes not to gain much weight during pregnancy."
Eight million people in the United States experience eating disorders, so many women come to pregnancy having either overcome an eating disorder or still struggling with one. Ellis recommends being open with your healthcare providers about eating disorders.
"I very frankly discuss with (women) at the first visit that we will be focusing on her weight at each visit," says Ellis. She recommends women who have had eating disorders see a registered dietitian and a mental health provider if they think they will feel the urge to diet or purge during pregnancy.
If your health care provider is not worried about your lack of weight gain, you shouldn't be either. When you know you're doing everything you can to have a healthy baby, it doesn't matter what other people think or say.
Nicsinger remembers hearing a lot of comments about how she was too thin and speculation about how great it would be to see her big and fat. "People think they can make comments about how you look when you're thin. I just wish people would realize that no one wants to hear that they're ‘too' anything, especially when you're pregnant."
Ellis agrees. "Women need to be encouraged to embrace their pregnant and post-partum bodies and give themselves the gift of love, care and forgiveness. Society needs to support women during pregnancy and not hold women to impossible, unreachable weight standards."
How to Tip the Scale
To gain weight, add 300 calories to your diet per day and aim for a daily total of 2000 calories. Focus on nutrient-dense foods that give you the most bang for your buck. Take advantage of the times when your appetite is at its peak and eat then. Try to eat every two to three hours.
"Keeping it small is helpful for those who get nauseated easily," says Kimball. An easy way to add calories is to substitute higher calorie beverages. If you tend to fill up quickly, eat carbs and proteins first, then have salad or vegetables. Replace light, diet, or lowfat foods with the regular equivalents (such as salad dressing, bread, mayo, sour cream, milk, cheese, yogurt, sweeteners, soda, etc).
Aliza Sherman Risdahl is a naturally thin woman who had four miscarriages in two years. This experience convinced her she needed to gain weight to have a healthy baby.
"I stopped thinking of my body as one of my assets in being attractive and started thinking of it as being an asset toward carrying a baby. I lived in starvation mode without realizing I was depleting my body of essential fats and nutrients but thinking I was just a super healthy eater and self-disciplined," says Risdahl. "I think if women can't get over that psychological need to be thin, because they think it makes them more attractive, then they will have a hard time with weight gain for sure. It isn't that you have to eat fat or get fat, you just have to nourish your body not starve it. It is about health, not looks."
Brette Sember is a mother of two and author of Your Plus-Size Pregnancy (Barricade Books, 2005) and Your Practical Pregnancy Planner (McGraw-Hill, 2005).
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