Often believed is the fact that when you are carrying, you must eat. This is to nourish your baby and also to strengthen yourself, to efficiently address the bodily changes during pregnancy, delivery and breastfeeding. This is also important during the post delivery phase. The wear and tear of the body, also needs to be considered and good nourishment can help you brace for this. However many a times women seem to go overboard sometimes under their own myths, as convenience or under the pressure of the family. Overeating, eating for two, cravings, food aversions, food for emotional stability etc are often practised. This may cause women to put on unhealthy excess weight or no weight at all. Many seem to be concerned about no weight gain while excessive weight gain is commonly ignored and many times excuses such as lack of time for cooking nourishing healthy food or exercise or underlying diseases, such as hypothyroidism or diabetes are given. The other day I had a young punjabi woman telling me and I quote “ I have to eat golgappe everyday madam, otherwise my baby is unhappy and I am a punjabi kudi, so we have to eat all this in large amounts. ” Later in the pregnancy, she had put on over 18 kilos, and we had tough time treating her for both, severe hypertension and diabetes, both of which could have been avoided by simple diet control. The baby was born very large with a cesarean delivery and needed to be in the NICU for macrosomia ( a condition where the baby is excessively large and can suffer from respiratory distress, hypoglycaemia and complications such as death ) for a fortnight. On the other side of the spectrum, I had Tishta who is a model by profession and has requested to help her to put on, only so much weight, so as to have a healthy baby and she wants to go back to her pre-pregnancy self. She is ready to cooperate with our nutritional and exercise guidelines and she also showed me the pictures of Princess Kate Midleton (Duchess of Wales ) immediately after her delivery back to her original fit self. Yes, weight gain during pregnancy should be scientific and women should not have any residual weight retention after delivery. Proper planning and right dietary habits help. This write up today will help you to
understand how should one plan the weight gain and what is the current evidence on this. Why do women gain weight during pregnancy ? How much is the total weight gain in pregnancy ? There are phenomenal bodily changes to accommodate pregnancy and to prepare the body for childbirth. These involve changes in the blood volume, breasts, the womb, the baby and the placenta. Ideally, 11 kg weight gain is recommended over and above the pre-pregnancy weight. This weight gain has a cause and is attributed to the following
Blood volume: 1.5 kg
Breasts : 0.5 kg
Womb : 1.0kg
Baby : 3.0 kg
Placenta : 0.5 kg
Fluid around the baby : 1 Kg
Protein and fat storage : 3.5 kg
Thus the total weight gain is about 11-12 kg
What guides me to put on weight ? What happens if the BMI is low ? What happens if the BMI is high ? How should the weight gain be distributed ? Today the baseline or pre pregnancy BMI is used as a guideline for weight recommendation. Ideally the pre-pregnancy BMI ( BODY MASS INDEX ) (BMI =weight (kg) /Height ( M)2. Ideal prepregnancy BMI should be 20-23 to ensure healthy pregnancy outcomes. Low BMI is associated with complications such as small babies who haven’t grown well, preterm births and increased needs for interventional delivery and nice admissions It can cause, raised blood pressure and diabetes ( abnormal sugars ) in the mother. Baby can become growth restricted or large in size. The mother can also be at risk of developing stroke due to blood thickening ( thrombosis of blood in lower limbs leading to dislodging of the clot in the brain, lungs etc : ) and heart failure. Increased operative interventions leading to increase morbidity are associated. Don’t expect any weight gain during the first trimester. Gradually the weight should grow at the rate of
750- 900 g per month in the second trimester to
1-2 kg per month in the third trimester. Sudden weight gain is a sign of water retention and wrong dietary habits. It also causes bloating , heaviness and difficulties in breathing and stretch marks. Proper gradual weight gain and good diet can prevent these stretch marks and under pigmentations. If there is inadequate weight gain, what does that mean ? It means that your baby is not thriving. The doctor will need to confirm this on ultrasound. Sometimes certain abnormalities in the baby can be responsible for failure of proper growth. Sometimes the baby may be normal but the placenta is not able to sufficiently transfer nutrients to the baby and this also is studied by sonography. Sometimes the mother may not be taking adequate and balanced diet. Lack of carbohydrates and proteins in the diet can cause such an issue. Colour doppler examinations may be suggested by your doctor to identify and correctly differentiate the plausible causes.
Excessive weight gain, is it safe then ? But I feel hungry, tired and everyone forces me to eat ? No, excessive weight gain can cause more problems too. As mentioned above the mother can acquire diseases such as diabetes and hypertension which can cause serious threat to the life of both the baby and the mother. Please get correct nutritional guidelines from your doctor. These are to be structured properly and tailor-made to your needs, taking into account your existing dietary practices and underlying issues. Overeating and wrong eating is hazardous ( you can refer to my earlier blog “ what should I eat doc? “ posted on 12/8/2017 ). Remember if you eat well, your baby will grow well. If you don’t eat well, only you will grow. Why structured weight gain is important during pregnancy ? Your eating habits and the resultant growth of your baby will determine the future health of your baby. Your baby is going to get programmed for its future health while inside you from the time of its conception itself. So your responsibility of weight management begins before you plan to become pregnant. It has been proved beyond any doubts that the nutritional influences during the
intrauterine life are responsible for the baby’s future health. Growth restricted baby or macrosomic baby or baby born to mothers who suffered illnesses during pregnancy have greater possibilities of developing diseases in their future lives. Examples of these are early onset blood pressure, diabetes, asthma and obesity or improper physical growth. Thus weight gain during pregnancy needs scientific approach and guidance from an expert and cooperation from the mother. As I always say the health of the entire society is intervened in the antenatal clinic. Thus this is a joint responsibility of the doctor as well as the patient and the entire family. If we nourish mothers well, we can ensure healthy future generations to be delivered and dream of healthy society and nation !!