Recently I have been looking into pregnancy complications related to Gestational Weight Gain (GWG), or weight that women gain during pregnancy. This is of personal interest to me because during my first pregnancy, I gained over 50lbs, (and then stopped looking!) well over the guidelines. However, I had a very healthy pregnancy, a complication-free home birth, a beautiful smart baby, and I lost all the weight a little over a year.
Despite the GWG guidelines, I propose that poor outcomes are actually caused by poor health, especially high blood pressure and diabetes (aka metabolic syndrome/insulin resistance). Each of these can be prevented by living a nutrient dense active lifestyle. Pregnant women should be educated not on the numbers on the scale, but on how to eat a nutrient dense diet to foster a healthy baby.
Here are the official American College of Obstetrics and Gynocology (ACOG) guidelines:
Despite the GWG guidelines, I propose that poor outcomes are actually caused by poor health, especially high blood pressure and diabetes (aka metabolic syndrome/insulin resistance). Each of these can be prevented by living a nutrient dense active lifestyle. Pregnant women should be educated not on the numbers on the scale, but on how to eat a nutrient dense diet to foster a healthy baby.
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Here are the official American College of Obstetrics and Gynocology (ACOG) guidelines:
| Prepregnancy Weight Category | Body Mass Index* | Recommended Range of Total Weight (lb) | Recommended Rates of Weight Gain† in the Second and Third Trimesters (lb) (Mean Range [lb/wk]) |
| Underweight | Less than 18.5 | 28–40 | 1 (1–1.3) |
| Normal Weight | 18.5–24.9 | 25–35 | 1 (0.8–1) |
| Overweight | 25–29.9 | 15–25 | 0.6 (0.5–0.7) |
| Obese (includes all classes) | 30 and greater | 11–20 | 0.5 (0.4–0.6) |
And here's a link to the official 2009 document which reexamines these guidelines.
There are also special guidelines for short women, but I have not listed them here. They are advised not to gain as much. This makes sense to me, since 10 lbs on a woman who is 5 feet tall looks and feels more significant than 10 lbs on a woman who is 6 feet tall. Right? But where are the guidelines for taller women? Or athletic women with lower body fat?
The Institute of Medicine and the National Research Council had really good intentions writing this document, and enlisting OB's and midwives to educate pregnant women on weight gain. I think they wanted to do a couple of main things: reduce pregnancy/birth complications which may be correlated to excess or deficient weight gain, and to reduce the likelihood of women becoming overweight or obese long term due to weight gain during pregnancy. I remember when, during my first trimester, I was gaining "too much weight", my dear husband asked our OB what the danger of this was. And he said "you will have to lose it". And there's even a study that confirms this phenomenon! :) hahaha. love that.
When I talk about something being correlated to something else, this is what I mean. We know that as children get older, they typically get taller, so we can say that a child's height is correlated to her age. Similarly, we could say the air is warmer when the sun is close to the earth, so the temperature is correlated to the distance from the sun. These two examples are somewhat indisputable ideas, however many medical studies try to find these kinds of probabilistic connections with diseases and risk factors. They want to know what causes disease, but the closest things we can study sometimes are just conditions which often appear together, or are "correlated".
But clinical studies about maternal health and gestational weight gain do not always support the idea that gestational weight gain is correlated to poor health, let alone causes it. Some specific poor pregnancy outcomes listed in this thorough review paper are gestational diabetes, gestational hypertension, pregnancy discomforts, gallstones, premature rupture of membranes, preterm labor, induction of labor, length of labor, mode of delivery, lactation, and fat retention, to name a few. There was a correlation between hypermyces - intense nausea and vomiting- and weight gain. These women didn't gain much weight. That makes sense, since they're often vomiting daily. The review paper also found lower weight gain associated with inability to lactate. So we see that there are big problems with inadequate weight gain as well!
Many of the studies they reviewed in that paper actually found that a woman's pre-pregnancy or pregravid BMI correlated better with the health problem of interest than her gestational weight gain.
In fact, a report on 2012-2013 data considering thousands of women in over 46 states in the US found that most women gained more than the guidelines, but especially overweight and obese women gained excessive weight during pregnancy. Herein, I believe, lies the problem. Women across our country, and maybe especially less educated women are not equipped to make wise diet and lifestyle choices to stave off excessive weight and the health problems which come with it ("comorbidities"). Pregnancy only exacerbates this because during pregnancy we become tired (less activity) and hungry (more eating).
When I talk about something being correlated to something else, this is what I mean. We know that as children get older, they typically get taller, so we can say that a child's height is correlated to her age. Similarly, we could say the air is warmer when the sun is close to the earth, so the temperature is correlated to the distance from the sun. These two examples are somewhat indisputable ideas, however many medical studies try to find these kinds of probabilistic connections with diseases and risk factors. They want to know what causes disease, but the closest things we can study sometimes are just conditions which often appear together, or are "correlated".
But clinical studies about maternal health and gestational weight gain do not always support the idea that gestational weight gain is correlated to poor health, let alone causes it. Some specific poor pregnancy outcomes listed in this thorough review paper are gestational diabetes, gestational hypertension, pregnancy discomforts, gallstones, premature rupture of membranes, preterm labor, induction of labor, length of labor, mode of delivery, lactation, and fat retention, to name a few. There was a correlation between hypermyces - intense nausea and vomiting- and weight gain. These women didn't gain much weight. That makes sense, since they're often vomiting daily. The review paper also found lower weight gain associated with inability to lactate. So we see that there are big problems with inadequate weight gain as well!
Many of the studies they reviewed in that paper actually found that a woman's pre-pregnancy or pregravid BMI correlated better with the health problem of interest than her gestational weight gain.
In fact, a report on 2012-2013 data considering thousands of women in over 46 states in the US found that most women gained more than the guidelines, but especially overweight and obese women gained excessive weight during pregnancy. Herein, I believe, lies the problem. Women across our country, and maybe especially less educated women are not equipped to make wise diet and lifestyle choices to stave off excessive weight and the health problems which come with it ("comorbidities"). Pregnancy only exacerbates this because during pregnancy we become tired (less activity) and hungry (more eating).
As I research, what continually comes up as risk factors for poor pregnancy outcomes are obesity, high blood pressure and diabetes. All of which come down to long term proper nutritional and lifestyle prevention. None of which are resultant just from gaining weight during nine months. And what causes all of these health problems? Eating too much, and specifically, eating too much refined foods like sugar and polyunsaturated vegetable oils. High stress and low levels of movement don't help!
Unfortunately, what I have heard from friends and experienced myself, is undue stress placed on healthy weight, active pregnant women about how much weight they are gaining. There is some evidence to show that increased maternal stress levels can negatively impact fetal cognition, health and educational attainment. The stress, as others have written before me, should be on WHAT the woman is eating, not HOW MUCH weight she is gaining. The goal should be growing the healthiest baby possible, not gaining the least amount of weight possible. And doing this requires proper nutrients. Lots of nutrients.
For myself, and my taller friends out there, in particular. I want to tell a bit about my Fatherland ;). Yes, my dad is from the Netherlands, in my opinion, the utopia of natural birth. And it also happens to be home of the tallest population on earth. My dad and two of his three sisters were born at home. This is still common throughout the country, where about 20% of births happen at homes, and universal health care subsidizes postpartum doulas. AWESOME. I want that.
Anyways, in Holland, I have heard, many doctors and midwives don't even weigh women during their pregnancy! This seems stress free and wonderful to me. Check out some of the simple pregnancy nutrition guidelines from this pamphlet from the Netherlands Nutrition Center:
- Eat more products from the categories meat (and processed meats), fish, chicken, eggs and meat substitutes: 125-150 grams per day rather than 100-125 grams per day.
- Eat fish twice a week, including oily fish at least once a week.
- Do not make a conscious effort to eat more than you did before the pregnancy.
- Overweight women should try to lose weight before becoming pregnant, so that they start the pregnancy at a healthy weight. During the pregnancy, do not diet in an attempt to lose weight.
So good. Why can't these be our guidelines? Why does the scale have to own us in America? Honestly, I think I needed a good amount of that fat that I gained during pregnancy to sustain the baby and then nurse that little eater exclusively for six months. There is certainly anecdotal evidence of athletic women gaining more during pregnancy than others. But these are exactly the kind of women who will be sure to loose the weight and return to their active lifestyle after pregnancy. What if our bodies are wiser than we are?
Again, I think we need to go back to "what are you eating?" Are you getting adequate nutrients? Because honestly, if you are, you will hardly have room in that tummy (which is being taken over by the world's cutest parasite), for junk food. If you are looking to foster a healthy baby, please check out the Weston A Price Foundation Diet for Pregnant and Nursing mothers. Men and women should start this way of eating before trying to conceive, since nutritional deficiencies in dad also affect the child!
As always, if you have specific nutritional concerns, I would love to help, please email or call me to schedule a consult.
And if you're trying to lose baby weight, over a year after giving birth, check out my post on Intermittent Fasting, and the post specifically for women it may be just the ticket! If you're still nursing exclusively, forget losing weight and focus on nutrient dense foods for the sake of your baby!
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