Managing weight gain in pregnancy

by Dr. Karen Nordahl

As printed in the Spring 2006 issue of Urbanbaby & Toddler magazine.

We don't need research to show us that Canadians are weighing more. All we need to do is walk down any street. But it has presented new challenges for health professionals who see pregnant patients in their offices.

In the 1950s, when pregnant women were eating less, the medical profession developed an 'eating-for-two' policy. Today, with 34 percent of the pregnant population starting out moderately overweight or obese, eating for two can be dangerous to both mom and baby.

An overweight woman is defined in the research as any woman weighing over 88 kg. (194 lbs) at any time during pregnancy. This weight (or higher) has been associated with an increase in the incidence of gestational diabetes, pregnancy-induced hypertension, blood clots in the leg, induction of labour and Caesarean section. If the mother weighs over 210 lbs, the incidence of anaesthetic complications increases, as does the rate of post-Caesarean section wound infections.

Research has also demonstrated that childhood obesity control starts in the uterus. What we do for our children when we are pregnant can influence the rest of their lives.

In my practice, pregnancy is a significant motivator to changing habitual behaviours. What we may not do for ourselves (eat healthy, exercise) we will often do for our baby. Provided being overweight is not due to an underlying medical illness (thyroid disorders, depression) there are ways to help you through this difficult time. You need to remember that your baby will take what it needs from you, but you still need to feed yourself in a healthy way.

I will often have patients attempt to achieve a lower overall weight gain during their pregnancy if they start out overweight. Instead of the usual 25 to 35 lbs, I have the goal decreased to 18 to 25 lbs of total weight gain.

Research also suggests that the more sweets you eat early in your pregnancy, the more weight you gain during your pregnancy. So we try and make the appropriate lifestyle changes as soon as we can.

Here is some simple advice I give my patients:

Avoid all processed food. A good rule of thumb comes from dietitian Patricia Chuey, who advises her clients not to eat anything that will not rot on your counter after one month. I go a bit further with my patients, telling them not to eat anything that comes from a package in their cupboard. I am hopeful they will take my advice at least half of the time!
Eat more fruits and vegetables. Mother was right on this one. This can mean eating more salads, or sneaking vegetables into your meals.
Do not double the Canadian Food Guide.
Get access to a dietitian. Resources include: www.eatingforenergy.com or Dial-A-Dietitian at 604-732-9191 (Greater Vancouver) or 1-800-667-3438, www.dialadietitian.org.
Quick snack foods from a package are not your friend.
Get some exercise. This can be as simple as 30 minutes of walking per day, in 10-minute intervals. You may be able to do this on your lunch hour. Walk with a group of friends to make it more enjoyable.

Here is a simple walking program that you can follow on your lunch hour or after dinner.

Do a walking routine up to 30 minutes.
Walk at least two to three times per week with a day of rest in between.
If you were not a previous exerciser start by walking a couple of blocks two to three days a week and then progress slowly up to a 30-minute walk. In your second trimester you can increase your exercise if you feel things are going well (check with your caregiver prior to increasing your walking program).
If you were walking for the first trimester you are able to walk for at least 30 minutes comfortably.
In the second trimester you can begin to combine walking and power walking.
If you are tired on any given day try a 15- to 20-minute easy walk and try to power walk another day when you are feeling better

Finally, pat yourself on the back...you are doing a wonderful thing for yourself and your baby.