Weight gain during pregnancy: how much is too much?

For many pregnant women, the nine months leading up to baby can mean cravings and altered eating habits, which can ultimately lead to uncomfortable weight gain. Stephen Lugo, MD, Parkview Physicians Group – OB/GYN, Hospital Medicine, knows the struggles of finding balance during this precious time and encourages new mothers to plan their pregnancy, whenever possible. By planning, you can work with your physician to start at a healthy weight and address any chronic health conditions. This promotes a successful pregnancy. We asked Dr. Lugo a handful of questions on the topic of weight gain and pregnancy, including the risks and recommendations.
 
What is the recommended weight gain?

Your physician will determine your recommended weight gain based on your BMI prior to pregnancy. It’s always important to know your numbers – including blood pressure, BMI and cholesterol, and become familiar with it regardless of whether you’re pregnant or not. Knowing your numbers helps you be mindful of how you’re doing.  

The World Health Organization breaks down weight into six categories – underweight, healthy weight, overweight and obese (obesity is broken down into 3 classes: class 1 - BMI 30-35, class 2 - BMI 35-40, class 3 - BMI greater than 40).

  • Underweight = BMI less than 18.5
  • Healthy weight = BMI 18.5 to 24.9
  • Overweight = BMI 25 to 29.9
  • Obese = BMI more than 30

When we look at pregnancy, we look at four categories – with obesity grouped together – and give a range of recommended weight gain:

  • Underweight - Between 28-40 pounds
  • Healthy weight – Between 25-35 pounds
  • Overweight – Between 15-25 pounds
  • Obese - Between 11 – 20 pounds

If you’re pregnant with multiples, your physician will recommend based on your BMI and the category you fall within, but increased weight gain will be recommended. If you’re in a healthy weight category, 35-50 pounds of weight gain is recommended. For triplets and quads, work with your physician to determine.

How is the weight distributed during pregnancy?

A healthy weight patient might gain 30 lbs. In this case, the average baby weight gain is 7.5 lbs., placenta is 1.5 – 2 lbs., amniotic fluid is 3-4 lbs., and the rest is the mom – increased vascular volume, organs, uterus, etc. Much of this weight gain will be lost during delivery. However, don’t expect to be at your pre-pregnancy weight when you walk out of the hospital. After your delivery, be sure you take time to stay active and take care of yourself, along with your baby. Eat right, go on walks – whatever you were doing before delivery to stay active, continue after.

How much weight gain is too much and what are the risks?

The more you gain outside of the recommended weight gain range during your pregnancy, the more you’ll retain postpartum. During your pregnancy, it also means the more weight the baby will put on as well. This could be a risk because it raises questions … Will you be able to deliver vaginally? Will you deliver by C-section? Studies show that increased weight gain increases the patients risk of delivering by C-section. For those who do have a C-section, the more weight you put on, the more blood loss, risk of proper wound healing, risk of deep venous thrombosis (DVT) and pulmonary embolism.

During pregnancy, excessive weight gain could lead to developing gestational diabetes and hypertension (which could lead to pre-eclampsia and eclampsia) as well.

How can a pregnancy woman avoid excessive weight gain?

Pregnancy is not a time for weight reduction. Studies show that weight reduction during pregnancy is actually harmful to the fetus. Those babies don’t develop to the potential size they could be. Remember, the baby will lose weight before mom does. Don’t go on a diet. This isn’t the time to do that.

If you’re in an overweight or obese class prior to pregnancy, weight reduction is important prior to pregnancy. But once pregnant, follow a low glycemic-type diet. Look at yourself almost like a diabetic. Be careful of how many carbs and calories you’re taking in.

Always exercise, be mobile and active. However, don’t become a marathon runner if you’re not already. Walk on a treadmill or on a stationary bike. Talk with your provider about what you’re already doing and they can work with you to modify as the pregnancy moves along. Your mobility will change as you go through your pregnancy. Your center of gravity has changed so you need to modify your exercise routine.

What if I gained too much during my first pregnancy and I’m pregnant again?

If you’re worried about getting pregnant again after you gained too much, studies show there is improvement from a mom’s first pregnancy to the second. The weight loss between the first and second pregnancies, improves the second pregnancy for both baby and mom. Don’t be discouraged! Set a goal that you’re going to move more, eat differently, etc. Work with your physician to determine how much to lose before becoming pregnant so you can be more successful during pregnancy.

Recommended resources for more information?

American college of OB/GYN – weight gain during pregnancy & exercise during pregnancy 

March of Dimes 

World Health Organization 

CDC 

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