Weight Gain: The Pregnant Woman's Dilemma

From the WebMD Archives

March 2, 2001 -- Ask any women who's been pregnant, and she'll tell you: "It ain't easy."

Women who have been through it know just how tough it is for a pregnant woman to balance the needs of her baby and her body against gaining too much weight and then trying to lose the extra pounds in the months following childbirth. Dieting is hard enough for the rest of us, but it is even harder for an overwhelmed, sleep-deprived mom who is trying to get healthy meals on the table and fit in any exercise, all while handling the needs of her family and the erratic schedule of an infant.

To get at how big of a problem this actually is, a California research duo reviewed 13 studies on how and if pregnancy-related weight gain affects body weight changes after pregnancy.

They found that a single birth results in a 4.4 pound to 6.6 pound higher body weight and raises the risk of being overweight within one year to several years after delivery. Overall, up to 20% of women were found to sustain significant weight gain following their pregnancy, according to a review article in a recent issue of the journal Epidemiology Review.

More research is needed to determine why some women have trouble dropping the extra weight and others do not, conclude Erica P. Gunderson, PhD, of the Kaiser Permanente division of research in Oakland, Calif., and Barbara Abrams, DrPH, RD, an associate professor of epidemiology and public health nutrition at the University of California at Berkeley.

"Body weight change during the [postpregnancy] period is probably a retention of [pregnancy-related] weight gain and weight change caused by the lifestyle alterations associated with childrearing," they conclude.

Today, there is an "overweight epidemic," according to the authors. More than 45 million U.S. women are overweight; that accounts for about 50% of all women, with even higher percentages in certain ethnic groups being overweight. Excessive weight gain in pregnancy may lead to a lifelong problem, especially if a woman adds on pounds from each pregnancy.

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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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