Limiting Weight Gain

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.

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6 thoughts on “Limiting Weight Gain

  1. Jamie Bee July 26, 2015 / 3:46 am

    Very interesting. I just gave birth to my first child (a girl!) last week and had some of these same thoughts throughout my pregnancy. I started from a very lean, healthy weight for me (119 lbs) and gained a total of 22 lbs in my pregnancy. Interestingly, I gained 10 lbs in my 1st trimester, mostly by eating white breads, pastas, and pizza – all the paleo “no-no’s” – but despite the nausea my body just craved cheap carbs. In retrospect, maybe my frame needed the extra fat to sustain the pregnancy? Anyway, once I got to the 2nd trimester, my ‘normal’ appetite returned, and I ate carefully and healthily and stayed very active. I did not try to restrict weight gain, but I didn’t cave to the “eating for two” mentality, either. Either because of or despite my limited weight gain, I had few of the “classic” pregnancy symptoms – no varicose veins, no swelling, no hemorrhoids, no stretch marks. And the birth itself was, thankfully, straightforward and fast. My little one was born at 39 weeks and was 6 lb 11 oz at birth, but she was healthy and strong, and her small(er) size contributed to the easy delivery.

    It’s so hard to suggest that an uncomfortable pregnant woman, who is struggling with cravings and a myriad of other discomforts, should “watch her weight” – and you certainly wouldn’t want people depriving themselves of necessary nutrients by dieting! – but surely less weight gain is less of a strain on the body, and perhaps leads to better outcomes (with the caveat that too little weight gain of course has it own risks). The connection between evolutionary food scarcity and the paleo approach is fascinating, something I’d never thought of but makes intuitive sense.

    Thank you for chronicling your pregnancy here, I’ve very much enjoy your writing. You’re about 7 weeks behind where I was, and it’s been interesting to follow your pregnancy-related musings, usually with feelings of “yep, been there, done that”. I wish you all the best in the coming weeks!

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    • Paleo OB July 29, 2015 / 6:22 pm

      Thanks, and congrats on the arrival of your little one! So happy to hear you had a great pregnancy and delivery. I do strongly believe healthy and appropriate weight gain is best for mom and baby- and there’s research to back it up. I personally try to encourage it early on in pregnancy, but ultimately every woman has a different experience, and it can be tough when I only see my patients once per month. Guess once my little guy arrives and my complaints change to those of sleepless nights and poopy diapers, you’ll continue to say, “yep, been there, done that.” 🙂

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  2. PracticeBalance July 26, 2015 / 7:24 pm

    Was your weight gain gradual or more steep in the recent weeks? I am 20 weeks now, and I’ve gained *maybe* 2 lbs. However, I did gain 10 lbs right when I started IVF (I successfully conceived after a few cycles over a year or so). I’m figuring some of that weight might count at least… I had my structural US and everything is normal, so I guess I can expect more gains in the future!?

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    • Paleo OB July 29, 2015 / 7:04 pm

      Unfortunately the IVF will do that- most women gain weight on it. I personally had more of a gradual gain. I lost 5 lbs in the first trimester when I could barely eat because I felt so sick. But after that, it’s been gradual. I guess it depends on the person. Naturally the tendency is to gain more later as the kid gets bigger. You certainly don’t want to gain half your target weight in the first half of the pregnancy (when the baby is still tiny), because then you’ll most likely exceed your target!

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  3. Meg July 27, 2015 / 4:12 pm

    At 34.5 weeks I have also ‘only’ gained about 8.5kgs (19 pounds). I think I gained a little bit in the beginning but between 12 and 22 weeks I gained only 3 pounds. Most of the rest came between 24 and 28 weeks (baby also seems to have had a huge growth spurt then).

    In Australia, where I am, there are no official gain recommendations and no one has weighed me yet officially or said anything about it. Until I was around 6 months pregnant I had no interest in food. Even now, the thought of food/ eating feel yucky sometimes, though when I do eat my appetite is much better than it was. I haven’t restricted my diet in any way and the baby seems healthy. I haven’t worried too much about it. Just hoping I don’t blow up in the coming last month because so far I have had a very low key, low symptom pregnancy and I don’t want that to change! Not sure how true it is, but I attribute most of that to my weight gain being on the low side.

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    • Paleo OB July 29, 2015 / 7:09 pm

      Sounds like you’ve gained similar to me at this stage. I lost 5 lbs in the first trimester when I felt really sick, then have gradually gained since. That’s interesting that Australia has no recommendations. In the US, we recommend 25-35 lbs total for normal weight women, 15-25 lbs for overweight women (BMI 25+), and 11-20 lbs for obese women (BMI 30+). In the early pregnancy when the baby is still small, one shouldn’t gain too much, and then in the late second trimester and third trimester as the baby is getting bigger, one will tend to gain more. I do think that sticking to the weight gain guidelines will help with a healthy pregnancy, and less physical symptoms. But of course, some women have various physical issues that are not necessarily from weight gain.

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