“I just left my OB/Midwife appointment and they told me that I’m gaining too much weight!”
This same or similar post has been posted in the birth month group that I am in on Facebook several times over the past few weeks. It seems that providers all over the US and around the world are reminding their patients not to overdo their weight gain during pregnancy.
In 2009, the Institute of Medicine (IOM) released new guidelines after nearly two decades since their initial release. The new guidelines are based upon the pre-pregnancy Body Mass Index (BMI) of the mother (Table 1). It indicates a range for the total amount of weight that the mother should gain, as well as a rate per week during the second and third trimesters. In addition, the IOM indicated in their report that maternal obesity increased the risk of “high blood pressure, gestational diabetes, and an increased chance of needing a Cesarean delivery.” But I wasn’t able to find how much your risk increases for those conditions. Whether it is a 1% increase or a 90% would make a big difference.
So where do all those pounds go? According to the Mayo Clinic, here’s the break down:
- Baby: 7 to 8 pounds (about 3 to 3.6 kilograms)
- Larger breasts: 2 pounds (about 1 kilogram)
- Larger uterus: 2 pounds (about 1 kilogram)
- Placenta: 1 1/2 pounds (about 0.7 kilogram)
- Amniotic fluid: 2 pounds (about 1 kilogram)
- Increased blood volume: 3 to 4 pounds (about 1.4 to 1.8 kilograms)
- Increased fluid volume: 3 to 4 pounds (about 1.4 to 1.8 kilograms)
- Fat stores: 6 to 8 pounds (about 2.7 to 3.6 kilograms)
By that count, there are 31.5 pounds total to be gained. And that is if your baby is not more than 8 pounds (My son was 10!). So is it realistic to expect women who are overweight or obese to gain less than that? These guidelines are important because providers want to ensure that women aren’t gaining too much weight – more than they can safely lose post-partum. But what do they mean for those of us that already struggle with our weight in the first place?
Before this pregnancy, I weighed 170 pounds and I am 5′ 4″ tall, giving me a BMI of 29.2. According to the IOM table, I should only gain 15-25 pounds during my pregnancy. So here I am, 25 weeks pregnant and I’ve already gained my allotted 25 pounds. Which makes me wonder: What is more important, gaining within the guidelines or maintaining a healthy lifestyle?
I have continued to run during this pregnancy, even participating and finishing in long distances races like the Army Ten Miler at 23 weeks pregnant. I usually run 2-3 times per week for 30 minutes at a time – the same as before pregnancy just at a slower pace. I have continued a healthy and balanced diet, and added several vitamins to my intake to ensure that I’m getting everything that I need to stay healthy. On average, I have been gaining one pound per week. I was unable to find well reviewed research regarding the direct effect of Thyroid Cancer on weight gain during pregnancy, but my assumption is that it would not help the situation.
During my first pregnancy, I gained more than 60 pounds. I did not monitor my diet at all and only took the prenatal vitamins given to me at the military treatment facility. I participated in the Army Pregnancy Physical Fitness Program, but it was largely a joke to me – mostly walking in slow circles around the small on post gym because they were so averse to us running on our own outside. As my due date approached, the pounds piled on. After my son was born, I lost all but five pounds of it within the first six months and lost another 20 by the time he turned one.
I think it is more important for women to maintain a healthy lifestyle than to chain themselves to a weight gain requirement. My goals for this pregnancy have included:
- Run two to three times per week until I must switch to walking, and then continue to walk.
- Decrease cravings based on deficiencies by adding vitamin and nutrient supplements with the goal of eliminating unneeded calories due to cravings.
- Gain less weight than I did during my first pregnancy (60 pounds).
So far, I’m doing well in sticking to these goals.
I think it is unrealistic for providers to expect every woman to stay within the boundaries of the IOM guidelines. I think it adds unnecessary stress for some women to worry about their weight when it may not necessarily be a dramatic risk factor in their pregnancy. And as these providers continue to tell most women that they are gaining too much weight, it starts to dull the effect of their concern. Like the boy who cried “Wolf!” they will be less effective at getting women who truly do need to be concerned to pay attention.