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    Weight Gain: The Pregnant Woman's Dilemma


    Women who are obese have a two- to threefold increased risk of dying from any cause compared to their nonobese counterparts. And even moderate degrees of overweight and weight increases during adulthood are of concern, according to researchers.

    Alli D., a 30-year-old New York City mother, who asked that her full name not be used, had an easier time than most dropping her pregnancy-related weight gain. Her tried-and-true advice: "Breastfeed," she says. "It helps you take weight off faster -- not to mention the other health benefits of breastfeeding."

    Alli gained 26 pounds with her first child; a month after the birth, she had lost about 19 pounds.

    "Watch what you eat," she says. "It shouldn't be a free-for-all with food when you are pregnant, and when you are not pregnant, that's all gotta stop."

    Unfortunately, that's easier said than done.

    "If one invokes common sense, a pregnant women should gain 25-35 pounds during the course of her pregnancy," says Yvonne Thornton, MD, PhD, a perinatologist at St. Luke's Roosevelt Hospital Center in New York City. "If she begins her pregnancy overweight based on her height, she should gain just 25 pounds, and if she is obese to begin with, she should gain only 15 pounds.

    "The 'eating for two' mentality has been the leading cause for postpartum retention of excessive weight gain during pregnancy," she says. But "women should be eating twice as well, not twice as much, during pregnancy.

    "Women should NEVER diet during pregnancy," she stresses. But a pregnant woman should only be consuming 300 more calories per day than she was eating before she conceived. "That's roughly a quart of skim milk," she says.

    "You lose 18 pounds when you give birth in terms of the baby, blood volume, and swelling; then that remaining 7 pounds is just extra maternal fat," she says.

    "It should take six weeks to lose the pregnancy weight if you gain 25 pounds, but if you gain 40 pounds to 100 pounds, perhaps you'll never lose it," Thornton says.

    But the real catch-22 is that "if you enter your pregnancy overweight, you will gain more weight than expected during your pregnancy, have difficulty getting it off, and your eating patterns will then be passed on to your children," she says. "And children will, in turn, be more likely to become obese. It's the centralist issue of the obesity epidemic."

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