DEL.ICIO.USHEALTH / WOMEN'S HEALTH
Big weight gains for pregnant women lead to trouble
Newhouse News Service
Thursday, November 13, 2008
First a woman gapes at the positive pregnancy test, then she stares with the same blinking disbelief as the number on the scale shoots past wedding day weight and crests well north of her pizza-bingeing college weight.
Horrifying, yes, but pounds gained for the sake of the baby can’t be bad, right?
What does an "ideal" pregnancy weight gain look like? Depends whether you're at a healthy weight to begin with, according to the Institute of Medicine and the American College of Obstetricians and Gynecologists. These guidelines for how much to gain (based on your pre-pregnancy weight) are nearly 20 years old, and a review of them is under way.
- If you are:
- Underweight: 28 to 40 pounds
- Normal weight: 25 to 35 pounds
- Overweight: 15 to 25 pounds
- Obese: at least 15 pounds
Expecting twins, triplets or beyond? Check with your doctor.
To find out the weight gain best for your height and weight, go to the U.S. Department of Agriculture's MyPyramid site.
It will tell you how many calories to consume each trimester to maintain a healthy weight gain.
Related health articles:
- Topics: Atlanta hospitals | Weight loss | CDC | Cancer | Swine Flu
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Not so fast.
More research has emerged that points to the harmful effects of excessive maternal weight gain, and it’s coming as the Institute of Medicine has undertaken a comprehensive review of guidelines set in 1990. Mothers who gain more than 40 pounds — the maximum recommended during pregnancy — are nearly twice as likely to give birth to a heavy baby, researchers from the Kaiser Permanente Center for Health Research report.
Bigger babies cause more momma trauma. Blood loss. Tearing. Moreover, research says heavy babies are more likely to grow into overweight or obese children and adults. Other research ties an adult’s risk of coronary heart disease and type 2 diabetes to birth weight, with the risk increasing as birth weight crosses the 9-pound mark, says Kent Thornburg, director of the heart research center at Oregon Health & Science University.
Still, 43 percent of women nationally who gave birth in 2006 surpassed the ideal weight-gain ranges recommended by the Institute of Medicine and the American College of Obstetricians and Gynecologists, according to the Centers for Disease Control and Prevention.
As for the Kaiser study, it looked at 41,540 pairs of mothers and babies among Kaiser patients from Washington state, Oregon and Hawaii. More than 20 percent of the mothers gained more than 40 pounds. Those who did doubled their chances of having a baby that weighed 81/2 pounds or more.
“This extra weight gain is overfeeding the babies and changing them metabolically, as well,” says Teresa Hillier, an endocrinologist and senior researcher at Kaiser’s Center for Health Research. “Our study provides one more good reason to gain the ideal weight during pregnancy.”
Many pregnant women already struggle mightily to control weight gain, Hillier acknowledges.
They want what’s best for the baby but are knocked off track by hormones, hunger, boredom and anxiety. And perhaps they feel a hint of resentment over giving up coffee, AND alcohol, AND sushi, AND lunchmeat and squelch it with an entire loaf of bread and a vat of delicious spinach artichoke dip.
At least, one hears this happens.
As for Katrin St. Clair of Gresham, she still smiles at the memory of the “chips, chips, chips” she enjoyed during her first pregnancy six years ago. She’d immigrated from Germany in the sixth month of her pregnancy and, delighted by the panoply of American fast-food outlets, sampled prodigiously.
Her smile fades as she describes the 60 pounds she gained, and disappears entirely when she recalls the experience of delivering a 9-pound, 6-ounce baby girl.
Sometimes, as was the case with St. Clair, the mother needs an episiotomy to deliver a big baby; other times, a big baby requires a Caesarean section delivery. Rarely, a heavy baby can break a collarbone on the way out or suffer shoulder dystocia, when a shoulder gets wedged behind the mother’s pubic bone, says Kim Vesco, a researcher and obstetrician with Kaiser who co-authored the weight gain study.
All the more reason for doctors to make a priority of talking to their patients about weight gain, says Vesco, also St. Clair’s doctor. Yet a 2005 study found fully a third of expectant mothers received no weight-gain advice at all from their health care provider.
“Some women think now that they’re pregnant they can eat whatever they want, but you don’t really need to eat that many more calories,” Vesco tells her patients.
Or, she’ll say, “It looks like you’re about 20 weeks pregnant and you’ve gained 20 pounds. The recommended weight gain is 25 to 35 pounds. Over the next few weeks, we only expect you to gain about half a pound a week.”
Vesco’s patients who have health problems such as diabetes and hypertension generally respond to that approach. St. Clair has. She began her current pregnancy overweight, but motivated by her previous experience and an early diagnosis of gestational diabetes, St. Clair modified her eating. She has restricted her carbohydrates and eats small portions every couple of hours. Thirty-two weeks into 40 weeks of pregnancy, St. Clair has lost 12 pounds, and her baby is growing normally.
But gently counseling patients has not worked for Michael Klotz, an obstetrician and gynecologist at Providence St. Vincent Medical Center. He’s found pregnant women are not, in general, receptive to weight-gain advice.
“You have to be delicate,” Klotz says. “I bring up the risk, but I don’t harp on it. Some doctors do, and the patient leaves in tears.”
He says the majority of his patients start out their pregnancies overweight. He tells them to go to a nutritionist, watch their intake and exercise, yet:
“I see 60-pound, 70-pound weight gains for pregnancy, routinely,” Klotz says. “Pregnancy has profound effects on how you metabolize.”
Klotz says revised weight-gain guidelines won’t be enough, and that expecting mothers need intensive nutrition and exercise guidance.
“It’s very difficult,” Klotz says. “I applaud my patients who are overweight and have a normal pregnancy weight gain.”
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