I had an interesting conversation with one of our older semi-retired high risk OB docs this week. These days, we call them perinatologists or MFMs (maternal fetal medicine). He works mainly with our diabetic patients, and he really encourages minimal weight gain in his patients. For many of them, successfully maintaining their weight during pregnancy is an empowering experience, because it’s the first time in their lives that they’ve been successful at something related to their weight.
We also started talking about normal weight women. He actually thinks it’s better for normal weight women to gain on the lesser side. His thought process is this- besides the baby, one gains over 20 lbs from everything else like the amniotic fluid, increased blood volume, etc. Until recently, food was generally scarce, which is why women have evolved to have more insulin resistance in pregnancy. So he thinks that our bodies are better evolved for food scarcity, and therefore we probably do better if we actually are leaner than our baseline. In other words, if a normal weight woman gains 25 lbs, then she’s leaner than her pre-pregnancy weight because she has gained 25+ lbs of baby + pregnancy-related body changes.
And by do better, he means healthier pregnancies- women feel better, have less physical symptoms, more energy. Though I did tell him that my little guy is still sucking the life out of me, and I feel fatigued all the time. And babies will tend not to get too big if one doesn’t gain excess weight.
I’ve never talked Paleo with him, but I did find it interesting that his thought process is similar to what those of us familiar with the Paleo lifestyle already know. The basis of our Paleo lifestyle has in part to do with the scarcity of food as mentioned above, particularly the sugar and carbs. It hasn’t worked for me, but many partake in intermittent fasting as well.
What also took me by surprise is that he guessed how much weight I’ve gained so far- 18-19 lbs, which was right on the money. At 33 weeks, I’ve gained about 19 lbs now. I suppose I’m “lucky” in that I still feel a little sick if I eat too much, so that has prevented me from excess weight gain. But I know that is not the case for most of my patients, and I am still with everyone when it comes to pregnancy cravings/inclinations. I’m more inclined towards carbs and sugar- maybe because my husband’s in France, I’ve been wanting pastries lately. I try to be reasonable with that stuff, but I can see that it’s a challenge for most women. We live in a day and age where this kind of food is all around us, easily available. And it’s really, really hard to fight one’s inclinations toward certain foods in pregnancy.
It’s also tough because one already feels guilty for many things during pregnancy. I try not to beat myself up too much when I have one of my carb binges. A lot of my patients, who of course are less knowledgeable than I am, get worried about too many little things. When I talk about excess weight gain with my patients and their partner is with them, it’s interesting how the partner will rat them out on what they’re eating too much of. But on a day-to-day basis, the partners are trying to be supportive, and don’t want to be too mean and turn into the food police. My own husband keeps reminding me that I’m doing a good job taking care of Little Willie, since my inclination is to feel bad when I do things I think I shouldn’t do, like down a whole bag of cheese popcorn in one sitting (hey, at least it was organic!). I can see how it would be tough for partners to try to remind the patients to be more careful about what they’re eating- telling a hormonal woman, with various daily discomforts, to hold back on her cravings?!
Ultimately, there’s no easy answer and every woman is going to have an individual experience. I do agree with the high risk OB doc that it’s best not to gain too much during one’s pregnancy. Just wish it were easier for most women.