HYANNIS – Traditional advice for pregnant women was to get as much rest as possible and eat for two to ensure proper growth of the baby. Pregnancy was considered a time of confinement rather than keeping up with your regular pace of your life.
Now those misguided notions are considered to be contributing to the obesity epidemic in this country, according to a recent study done at Penn State College of Medicine. Regular exercise and keeping gestational weight gain to a more moderate level is far healthier for both the mother and the baby.
It’s past time to put the myth of eating for two to bed, said obstetrician Richard Heywood, DO, FACOG at Falmouth Women’s Health in Mashpee.
“When you really boil it down, you only need 200 to 300 extra calories a day when you’re pregnant,” he said. “That could be something as small as one granola bar a day. You don’t have free license to eat anything you want.”
Dr. Heywood usually advises women to gain between 25 to 35 pounds, if they are starting within the normal recommended body mass index range.
“Somebody who is a little lighter to begin with may have a little more leeway. Somebody that’s heavier, we usually try to get them to gain less. When we have morbidly obese patients, they should not be gaining any weight at all,” he said.
About 45 percent of current mothers-to-be begin their pregnancy overweight or obese, compared to 24 percent in 1983. Research shows that women who are already overweight or obese at the start of their pregnancy are two to six times more likely to gain more than the recommended weight and also much more likely to retain the weight after their pregnancy.
The problem can become intergenerational because excessive maternal weight gain is a known contributor to the risk of obesity in their off-spring. That can lead to health risks for the child down the road that are completely preventable.
Adds to Complications
Medical complications to both mother and child that can arise from excess weight gain during pregnancy, according to Dr. Heywood, include:
Elevated maternal blood pressure
Increased risk of miscarriage in early pregnancy
Pre-eclampsia
Gestational diabetes
Baby gaining too much weight, which can lead to birth injuries
Increased risk of shoulder dystocia in the baby
Increased risk of a significant tear and bleeding for the mother during delivery
Increased risk of caesarian section
As important as it is, discussing weight with patients who are overweight can be tricky for physicians and other providers. Dr. Heywood has found that asking, “What are we doing about your extra weight?” is a non-threatening way to open the conversation. He then starts to talk about numbers.
“Weight loss is just math,” he said. “If you put fewer calories in the tank and take more calories out of the tank, you will lose weight.”
He often recommends that overweight patients download a calorie counting app to track how many calories they are consuming. He knows that can be annoying to do every day, but he suggests people try it for just a few days to get a sense of where the excess calories are that can be eliminated.
For example, in today’s world it’s not uncommon for someone to stop at a coffee shop and order a beverage full of cream and sugar every day.
“People have to stop thinking about that as a daily routine and start thinking about it as a special treat,” Dr. Heywood said. “If you don’t do it every day, you can afford to do it once a week.”
He also advises patients to only shop the outer aisles of the grocery store because that is where the healthy produce, meat and dairy products are. The inner aisles are where you get into trouble.
When Dr. Heywood was doing his residency about 15 years ago, conventional wisdom was that when it came to physical activity, whatever the pregnant woman did before pregnancy should be continued during pregnancy, even if that activity level was minimal.
Current research shows that exercise is good for pregnant women, he said, but he cautions those who have been sedentary to make changes slowly. The advent of a pregnancy is not the time to start training for a marathon if you’ve never run one. Start with an activity like daily walking and build up to the CDC-recommended 150 minutes a week gradually over the time period of a few weeks.
“I tell patients that they need to keep active because at the end of this whole pregnancy is a big physical challenge called labor,” he said. “You need to train and you need to be physically active throughout your pregnancy to prepare for it.”
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