It’s time for that monthly ritual that most women dread: Stepping on the scale at the doctor’s office. Gain too much, and you feel like you’ve been overeating and not active enough. Gain too little, and you feel as though you’re under-nourishing your child. Stepping off the scale, most women hear four little words in their head: I just can’t win!
The fact is, weight change during pregnancy varies considerably from woman to woman. A few pounds here or there make very little difference in terms of pregnancy outcomes, so it is not something to obsess over. The key word when it comes to weight gain during pregnancy is moderation. Gaining a reasonable amount of weight during pregnancy is a sign that the baby is getting the nutrients he or she needs. It also helps to ensure your health during and after the pregnancy, and will make blood glucose levels easier to manage.
Weight Gain Guidelines
Goals for weight gain are different for women who are of average weight prior to the pregnancy, underweight prior to the pregnancy, or overweight prior to the pregnancy. A woman of average weight prior to pregnancy (defined as a BMI* of 18.5 to 25) should gain approximately 25-35 pounds by the time she delivers. Underweight women (BMI* < 18.5) should gain a bit more… 28-40 pounds is considered optimal. Overweight women (BMI* > 25) should gain less: 15-25 pounds if moderately overweight, and even less if obese. If you are expecting twins, expect approximately ten additional pounds of weight gain.
* BMI is a relationship between height and weight. You can calculate your own BMI by taking your weight (in kilograms) and dividing by your height (in meters) squared. Or, just go to the BMI calculator here: http://www.nhlbisupport.com/bmi/bmicalc.htm
The rate of weight gain during pregnancy is also evaluated at each visit to your doctor. A woman of average weight (BMI 18.5-25) should gain approximately 2-4 pounds in the first trimester (up to week 12), 10-11 pounds in the second trimester (weeks 13-26), and 12-13 pounds in the third trimester (weeks 27-40). This represents an average of one pound per week during the last two trimesters. Accordingly, underweight women should gain approximately 1 ½ pounds per week in the second and third trimesters.
By the end of the pregnancy, only about 8 lbs of the weight gained (give or take a few pounds) is “baby weight”. So where does the rest come from? Below is a typical breakdown of weight accumulated during pregnancy:
Baby: 8 lbs
Placenta: 2-3 lbs
Amniotic fluid: 2-3 lbs
Breast tissue: 2-3 lbs
Addl. Blood supply: 5-9 lbs
Uterus growth: 2-5 lbs
Le’ Grande Total: 25-35 lbs
Managing the Weight Gain
After the first 12 weeks of pregnancy, most women require an extra 300 calories per day, as well as a modest increase in protein (see last month’s article, nutritional needs during pregnancy, for details regarding vitamins, minerals and micronutrients).
What can you do if you are gaining significantly more or less weight than recommended during pregnancy? Keep in mind that in most cases, it is not a good idea to lose weight during pregnancy. The goal is to develop healthy behaviors. Physical activity and a healthy diet will benefit both you and your baby.
Moderate physical activity, with the approval of your physician, of at least 30 minutes per day is generally recommended. Cardiovascular exercises such as swimming, walking or cycling help you to stay fit and burn extra calories. Muscle-building exercise can also be highly beneficial because it helps to increase your metabolism. Incorporate activity into your daily life – walk to the store instead of driving, or take the stairs instead of the elevator. Minimize the amount of time you spend engaged in sedentary activities such as watching TV or using the computer.
In terms of your diet, be sure to eat a variety of foods to meet your nutritional needs. Having the same exact foods day after day may produce more consistent blood glucose levels, but you may shortchange yourself and your baby. If you are gaining too much weight too quickly, ask yourself why? Consider the sources of your calorie & fat intake, the preparation methods, your snack frequency & choices, and your fluid/beverage intake. In addition, think about how often are you eating out or having take-out food.
The following are some nutritional tips to help slow unwanted weight gain during pregnancy:
Preparation: Use low fat preparation methods when cooking. Do not fry foods in oil or butter. Frying increases the calories and fat content of the meal. Instead, bake, grill, broil or steam foods.
Use added fats in moderation: Margarine, butter, oils, salad dressings, sour cream, cream cheese, sauces and gravies can easily add hundreds of extra calories to your meals. To save calories, try substituting non –fat cooking sprays, low fat salad dressings, butter substitute sprays, and low fat or fat free cheese.
Choose lean cuts of meat: A woman’s daily protein requirements do increase during pregnancy, but most Americans already consume a relatively high amount of protein in their diet. Therefore, most women will meet the increased protein needs of pregnancy (70-80g per day) with their usual diet. Look for lean sources of protein: skim milk, egg white, beans, tofu, soy, fish, white-meat poultry (without the skin), and loin or round cuts of beef or pork.
Choose low fat milk/dairy products: Calcium needs increase in pregnancy. Most women should consume 3-4 servings of dairy products per day. By choosing 1 % or skim milk over 2 % or whole milk, you can save almost half of the calories. You can also save calories by choosing low fat yogurt and reduced fat cheeses.
Choose snacks wisely: Potato and other snack chips, donuts, cookies and cakes provide lots of extra calories and very few nutrients. Limit your intake of these types of high-fat snacks to one time per week. Read the food label to choose snacks that have less 4 grams of fat per servings. Better options include fresh fruit, pretzels, lite popcorn, low fat yogurt, and low fat ice cream. Also, manage the frequency of your snacks. “Grazing” not only makes blood glucose very difficult to control, it also contributes to mindless caloric intake. Instead, plan your snacks. One or two, spaced evenly between meals, should be more than sufficient.
Eat fiber rich foods: A high fiber diet helps you feel fuller longer. It also minimizes blood sugar “spikes” after meals. For those who experience constipation during pregnancy, fiber can help to reverse the problem. Fiber-rich foods include oats, beans, peas, lentils, fruits, seeds, fruits, vegetables, and whole grains. Don’t forget to deduct the fiber grams from the total carbohydrate when carb counting and determining mealtime insulin doses!
Limit extra calories from beverages: Fluid needs increase during pregnancy. Pregnant women need about 10 cups of fluid per day. Plan to meet most of those extra fluid needs in the form of water instead of soda, juice or whole milk. Alcohol, which is high in calories and potentially damaging to your developing baby, should be avoided entirely.
Limit added salt in the diet: Avoid adding salt to foods in cooking as salt causes your body to retain fluid weight.
Eat out less: Restaurant food is notoriously high in fat and calories. Portions tend to be much larger than home-prepared meals, and carb counting can be a real challenge. Prepare your own meals as much as possible. When you choose to dine out (or order take-out), choose lower fat items such as broiled foods over fried foods. Limit sauces and gravies. Ask for salad dressings, margarine and sour cream on the side. Limit the use of high fat condiments such as mayonnaise; ask for mayo to be used lightly on sandwiches. Choose plain bagels or plain baked potatoes. Ask for sliced tomatoes, fruit, or side salads instead of potato chips, fries, onion rings, or mozzarella sticks. And try to limit desserts to only special occasions. (no, “it’s the weekend” does not qualify as a special occasion!)
Being pregnant can give you the motivation to take really good care of yourself, and that includes healthy eating and exercising. The grand prize for all your efforts includes a healthy newborn and a decent weight (i.e. not too much to lose) after the pregnancy. If you find yourself gaining weight faster or slower than you should be, take a step back and evaluate your diet & activity patterns. If you can’t seem to find the answer, talk it over with your friendly neighborhood dietitian or diabetes educator.