weight gain in pregnancy

A friend of mine always hates her job. Every job she has ever had has been "the worst." She moves from job to job and inevitably after the 2 month mark in a new job complains how terrible it is. I once bought her a greeting card that read "You hate your job? Why didn't you say so? There's a support group for that. It's called 'everybody' and they meet at the bar." She didn't laugh like I did.

Well, I don't hate my job. In fact I think I like my job more than anyone I've ever met likes theirs. I truly love what I do. Of course there are a few things that bother me: slow test results, when I am double booked, and appointments Friday at 4pm! My complaints come out when I am sitting aroung with fellow doctors. One friend of mine is an ob/gyn with lots of complaints. Anyway, she often complains how hard it is to deliver babies from pregnant women who are obese. She'll complain the deliveries are challenging whether they are vaginal deliveries or c-sections. She apparently tells her patients how much weight is good for them to gain. She follows the Institute of Medicine guidelines, which I think most Ob/Gyns do, that suggest a healthy amount of weight loss, based on your pre-pregnancy body mass index (BMI):

  • BMI < 18.5 kg/m2 gain 28-40lbs
  • BMI 18.5 - 25 kg/m2 gain 25-35lbs
  • BMI 25-30 kg/m2 gain 15-25lbs
  • BMI > 30 kg/m2 (obese) gain 11-20 lbs

To gain these amounts of weight in pregnancy, most women need not consume many extra calories in the first trimester but should increase their intake in the second and third trimesters (after 14 weeks gestation) by about 400 kcal/day. That's not a lot of calories - a bagel and an apple will nearly get you there. You should NOT calorie restrict in pregnancy unless advised by a specialist. If my friend's patients are on track for gaining more than this range of weight she nags them to slow down their weight gain. She does this not just to make the delivery easier, but because excessive weight gain can increase the risk the child will be miscarried, have a neural tube defect, be stillborn, or develop diabetes and heart disease later in life.

I get asked a lot about diet in pregnancy when I see women in the first trimester. I tell them eat a balanced diet that their stomach can tolerate (often bland foods). I suggest they avoid unpasturized cheese and milk, raw seafood, seafood known to be high in mercury, undercooked or cured/deli meats and not to consume more than about 150 mg of caffeine per day (about 1-2 cups of coffee). Eat like you'd want your baby to eat. Now, you don't have to be perfect of course. Potato chips taste very good when pregnant and so does Dairy Queen ice cream. Just saying.

As we learn how important the environment the baby grows in is for the child's future health it's important to think about how many extra calories you eat in pregnancy and just how good those calories really are.