Jan. 30, 2001 -- If you're pregnant, chances are that a double bacon cheeseburger and triple chocolate shake sure sound good right now. Besides, if you're eating for two, you can tell yourself that you can afford the extra calories. But before you sit down to a big bowl of pasta or reach for a second helping of potatoes, heed a warning from researchers who say that many women head down the path to obesity during pregnancy.
Once the baby arrives, you may not drop the extra weight, especially if you are not breastfeeding. The pounds may become permanent and increase with each passing child and year, putting you at risk for a number of diseases often triggered by obesity, such as diabetes, heart diseases, and high blood pressure.
Researchers from the Cornell University Division of Nutrition in Ithaca, N.Y., and the Research Institute of Bassett Healthcare in Cooperstown, N.Y., studied 577 women from early pregnancy through one year after the birth of their first child. They found that 38 of the women, none of whom was obese in early pregnancy, had become so by the end of pregnancy, based on standard weight recommendations set forth by the Institute of Medicine.
Indeed, the scientists, lead by Christine Olson, PhD, RD, a Cornell professor of nutrition, say that one year after delivery, more than one-quarter of the women in the study were 10 or more pounds heavier than they were at the beginning of their pregnancy.
"We found that excessive gestational weight gain during pregnancy -- more than is recommended by the [standard guidelines], is a likely predicator of obesity postpartum," Olson tells WebMD. She says that women who gain more than the recommended amount are four times more likely to be obese one year after giving birth than mothers who stay within the recommended limits.
Olson believes that the epidemic of obesity in the U.S. is partially due to so many women gaining excessive amounts of weight during pregnancy. Her study showed that 38% of normal-weight women, 67% of overweight women, and 46% of obese women gained more than the recommended amount of weight while they were pregnant.
"Many of the women seen at obesity clinics, when asked when they started gaining weight, say, 'It all started when I started having kids,'" Olson says. "What's going on during childbearing years is contributing to obesity."
Some researchers have even laid blame partially on the Institute of Medicine for raising the recommendations for pregnancy weight gain about six years ago. The standards allow 15 pounds of weight gain during pregnancy if you are already in the obese weight group; 15-25 for those who are overweight; 25-35 for normal weight; and 28-40 for those who are considered thin.
In a paper several years ago, John W.C. Johnson, MD, and Michael K. Yancey, MD, wrote that the objectives of the new guidelines reportedly were to decrease deaths, prematurity, and poor growth of babies.
No evidence exists that less maternal weight gain affects these outcomes, they wrote in the January 1996 American Journal of Obstetrics and Gynecology, adding that increased weight gain during pregnancy could cause serious health consequences for the mother.
Olson says that one of the most disturbing findings of her study was that 56% of the women who became obese during the study could have avoided it by staying within the guidelines for pregnancy weight gains.
The two most important factors in not packing on the pounds while you're pregnant are the same as in any healthy lifestyle: Don't eat too many calories and, if your doctor permits, try to burn up enough through exercise.
The only difference is that you need to add about 300 calories a day while you're pregnant, Olson says. But that doesn't justify a daily pigout -- three cups of skim milk contain almost 300 calories.
Rose Landon, RD, an outpatient dietitian with Harris Methodist Fort Worth Hospital, says milk is a good choice because pregnancy menus call for four cups of milk a day. Experts recommend 1% or skim/nonfat milk to get the extra boost of calcium.
It's also important to eat three healthy meals a day and three snacks. "This is so you aren't eating a huge amount at once, which can also contribute to weight gain," Landon tells WebMD. These meals should be full of fiber, fruits, and vegetables that will provide folic acid and vitamins C and A -- all important to mom and baby. But stay away from alcohol and fatty, fried, and processed foods, she recommends.
Good snacks, Landon says, are a couple of graham crackers with a little peanut butter or a piece of whole wheat toast, a piece of fruit, and a glass of milk.
"People use pregnancy as an excuse to eat everything and anything they want," Landon says. The important thing is to determine the calorie needs according to the weight at the beginning of pregnancy. "We're not trying to get them to lose weight," she says, "just not to gain more than necessary."
As for exercise, the experts say there is no medical reason not to continue most of the activities you participated in prior to pregnancy, unless your doctor believes you have a risk of premature labor or other health considerations.
Landon says that it's also important to cut the extra calories out of the diet once your baby is born and to resume physical activities. If you are breastfeeding, you will need some extra nutrients and calories. Ask your doctor or lactation consultant about losing weight while breastfeeding your baby.
Olson and her team will follow the women they studied through two years after birth. They also will be looking at the women's attitudes and satisfaction concerning body image and the health implications of excessive weight gain during pregnancy.