Weight gain during pregnancy has to be gradual and optimal. The weight gained should not be a result of excessive water retention, which can occur if a balanced diet is not taken. Pregnancy hormones increase the tendency for salt and water retention, which can get exaggerated by lack of physical activity, dependency (too much sitting or standing), and the pressure of the growing womb. Inadequate protein consumption, iron deficiency (anemia determined by HB levels), and no exercise can add fuel to the fire. This increased weight can signal a rise in blood pressure and diabetes complicating pregnancy.
Obesity (a BMI of more than 25) is a bigger problem in India than malaria and tuberculosis. This rising curve of obesity was experienced in America in the 70s and that is the place where we are now in India. The obesity in women and the programming of obesity in the offspring are determined by the nutrition and the weight gain of the pregnant woman during pregnancy. The average weight gain throughout the entire pregnancy should be in the range of 8 to 10 kgs. This is determined by the pre-pregnancy weight of the mother, especially the BMI, which is calculated by dividing the weight in Kgs by the square of the height in meters. The ideal body weight to embark on pregnancy is 20 to 25 Kg/M square. Further, for Asian women, the ideal BMI is 23.
Women in India have been observed by the #BanegaSwasthIndia survey to be malnourished. Please note, malnourished, and not undernourished. It’s been seen that only 50 percent of women consume a wholesome diet regularly. Only 47 percent consume green vegetables daily; 46 percent consume fruits once a week; 45 percent consume pulses daily; and only 30 percent consume meat fish, or eggs daily.
No wonder we have issues such as excessive weight gain, hypothyroidism, PCOS, Diabetes, Hypertension, preterm deliveries, abnormal babies, and several issues challenging the woman's reproductive health.
If mothers are improperly nourished during pregnancy, the newborns are already programed to NCDs, meaning Non-Communicable Diseases such as cancer, diabetes, and blood pressure abnormalities.
Much insistence is given by all in the family about weight gain and force-feeding or accusative comments on the food eaten by women during pregnancy. Sadly enough provisions to eat a protein and fiber-rich diet are not made. If families have pregnant women, the entire focus has to be to ensure that she is fed with a well-balanced diet, provisions are made and no criticism is meted towards her.
A balanced diet is determined by the woman’s BMI, BMR, eating schedules and preferences, and specific needs. Physical activity level also determines the Daily Dietary Allowance and requirements. Overall carbohydrates should be adequate to maintain sugar levels and avoid starvation and the energy consumed should be 30-35 kcal/ kg body weight. The source of energy (calories) should be 40% from carbohydrates, 20% from proteins, and 40% from healthy fats. Obese women should practice calorie restriction to the tune of 25kcals/kg. Large quantities of micronutrients and antioxidants should be consumed from natural dietary sources rather than completely depending on the prenatal supplements prescribed.
So the mantra is not "Eat for two" or "Eat what you like” but it is "Eat what is Right," because if you eat well your baby will grow if you eat wrong, you will grow. Maternal weight gain is now a very superficial context and no more the reflection of a baby's growth. A growth assessment of the baby is done by the doctor by various means and that needs to be followed diligently and not get worried about how much weight the woman has gained. Of course, extremes in weight gain or weight loss are detrimental. I will write more .details on this sometime later.
Dr. Girija Wagh, MD, FICOG FICS
Gynecologist and Women’s Health Activist