HEALTHY MOTHER, HEALTHY BABY
Weight Gain in Pregnancy

Over one-third of adult Americans struggle with obesity, according to statistics from the Center for Disease Control and Prevention (CDC). While this increased trend toward obesity has affected literally every strata of Americans, the effect is most marked among adult women.

The CDC reports that 36 percent of American women are considered overweight with an increased prevalence among African American females (52 percent) and Mexican American females (50 percent).

Because many of these women are in their childbearing years, this trend raises concerns about the ability of these women to experience healthy, successful pregnancies.

To begin with, the risk of infertility in the obese woman is higher, according to Bridget Swinney, MS, RD, pregnancy nutrition expert and author of Eating Expectantly, A Practical and Tasty Approach to Prenatal Nutrition.

For women contemplating pregnancy, Swinney advises getting as close to ideal body weight as possible by eating a healthy diet and by exercising regularly. "You will have better luck conceiving and you will more likely have an uncomplicated pregnancy," says Swinney.

RISKS FOR MOTHER AND BABY
Overweight women who become pregnant require close monitoring and counseling to achieve a healthy pregnancy. The added weight increases their risk for complications such as gestational diabetes, high blood pressure, stress incontinence and a cesarean delivery.

Obesity in pregnancy also poses a serious threat to the baby's health, including a higher occurrence of miscarriage, preterm delivery and macrosomia (birth weight greater than 4000 grams or 8 pounds, 13 ounces). Macrosomic babies are at greater risk of birth injuries such as shoulder dystocia, a condition where the shoulders literally get stuck during delivery.

Of particular concern for the fetus is the exposure to hyperglycemia when the mother develops gestational diabetes. Studies indicate that infants of diabetic mothers may face a higher than normal chance of developing insulin resistance, diabetes and obesity during their childhood.

Recent reports suggest that infants of obese mothers run a greater chance of congenital malformations, particularly neural tube defects (NTD). While the risk of NTDs is normally diminished when women take supplemental folic acid in early pregnancy, new studies indicate that this protective effect may not occur in the overweight pregnant woman.

WEIGHT GUIDANCE
With all the concern about the health risks associated with obesity during pregnancy, a logical question is "Why gain any weight at all?" Indeed, the common medical practice in past years was to restrict weight gain during pregnancy, particularly in a woman who was already overweight.

Studies show, however, that even the heaviest woman needs to gain a minimum of 15 pounds to ensure the health of her baby. In a Minnesota study of 683 obese women and 660 normal-weight women, physicians Laura E. Edwards, Wendy Hellerstedt and their colleagues discovered that obese women who gained no weight or lost weight during pregnancy were 4.2 times more likely to deliver low birthweight babies and almost three times more likely to deliver babies who were small for gestational age. The obese women with the most favorable outcomes had weight gains in the recommended 15-25 pound range. The chart below highlights the most current weight gain recommendations issued by the National Academy of Sciences (NAS).

According to Swinney, "As much as thirteen pounds of the weight gained during pregnancy is the fetus itself and the products of gestation, including placenta, amniotic fluid, uterus and breast tissue, fluid and blood."

Because these essential components are necessary to produce a healthy baby, it is easy to see how gaining less than 15 pounds can profoundly affect fetal development.

On the other end of the spectrum, Edwards, Hellerstedt, et al. found that obese women who gained more than 35 pounds were almost three times more likely to deliver large weight babies. In a study done by Barbara Luke and colleagues, they found a "point of diminishing return" whereas weight gain above recommended levels no longer contributed to a more healthy fetal weight but instead contributed to increased maternal obesity.

Perhaps the most crucial factor is the pattern of weight gain during pregnancy. In one study, excess weight gain early in pregnancy was a strong predictor of how much weight the women retained after delivery. A steady but gradual weight gain is recommended during the first two trimesters with the bulk of the weight gained the last trimester, the period when the baby is adding weight and growing the fastest.

EATING & EXERCISING FOR TWO
The last thing an overweight woman may want to hear is that she needs to gain more weight to ensure a healthy pregnancy. It is critical, however, that she understand that the added weight will go primarily towards the production of a healthier baby.

To achieve a small but steady weight gain, the overweight woman needs to focus on a nutrient-dense diet. Foods that are nutrient dense provide a high nutrient-to-calorie ratio. Examples include whole grains, beans and legumes, vegetables, fruits, lowfat dairy products, and lean protein sources. Foods with low nutrient density contribute fat and/or sugar to the diet but few other nutrients.

With a little fine tuning, the Food Guide Pyramid forms the basis for the optimal prenatal diet. The daily diet should consist of 9-11 servings of grains (emphasizing whole grains), 3-4 servings of vegetables (especially the nutrient-rich dark green and deep orange varieties), 3-4 servings of fruit, 4 servings of lowfat dairy products or calcium-fortified soy products and 6 or more ounces of a protein source.

For the woman who finds herself gaining too much weight, it may be helpful to keep a detailed food diary in order to pinpoint sources of high-calorie foods and patterns of overeating. When reducing calories, it's important to cut down on foods such as full-fat salad dressings, margarine, butter and other added fats first. Candies, cookies, ice cream and other dessert items should also be limited if weight gain is accelerating too rapidly.

At times, it can be difficult for the overweight woman to gain weight. A detailed food diary is also a useful tool for identifying diet shortages. Eating small, frequent meals and snacks made up of nutritious foods is the best way to increase caloric intake.

While exercise is an important component of a healthy pregnancy, it is vital that the overweight pregnant woman be evaluated by her physician or health provider before starting an exercise program.

"Since the extra weight puts more demands on the body, it's especially important to warm-up, cool down and follow exercise guidelines for pregnant women. Above all, a pregnant woman should listen to her own body. If there is discomfort, stop," advises Swinney.

Low-intensity activities such as walking, swimming and low-impact exercise classes designed for the pregnant woman can contribute to better health for both mother and baby. The risk of gestational diabetes is also reduced in the pregnant woman who follows a fitness routine.

RECOMMENDED WEIGHT GUIDELINES
PREPREGNANCY WEIGHT SUGGESTED WEIGHT GAIN

Underweight 28-40 pounds
(10% below ideal body weight)

Normal Weight 25-35 pounds
(Average weight for height)

Overweight 15-25 pounds
(20% or more over ideal body weight)

Source: Nutrition during Pregnancy: Part I, Weight Gain: Part II, Nutrient Supplements, Subcommittee on Nutritional Status and Weight Gain during Pregnancy, National Academy of Sciences.

ASK CONNIE: When to Wean?

Q. Friends and family members have hinted that I should begin weaning my 6 month old. When is it best to stop breastfeeding?

A. If breastfeeding is going well for you and your baby, there is no reason to stop at this time. Breast milk provides the most optimal source of nutrition matched precisely to your growing baby's needs. Studies show that breastfed babies have fewer ear infections, less diarrhea, and a lower risk of allergies, serious bowel disorders and other illnesses.

"It is best for your baby to breastfeed the whole first year of life," says Dr. William J. Klish, MD, FAAP, professor of pediatrics at the Baylor College of Medicine in Houston, Texas. According to the American Academy of Pediatrics, the longer a woman breastfeeds, the greater the nutritional and health benefits will be to the infant and the longer these benefits will last.

While Dr. Klish acknowledges that it isn't always realistic for breastfeeding to continue for a year, he encourages mothers to aim for a six month goal. "Then if baby and mother are comfortable with that, continue," he says. Benefits such as mother-baby bonding and protection against illness have their greatest impact early in life, so any time spent breastfeeding will be beneficial, he added.

TEACHER TIP: The Walking Classroom

According to Carolyn Johnson, a Portland, Oregon elementary teacher, "just about anything you teach in the classroom can be done on a walk."

Carolyn, a serious walker herself, "takes her classroom beyond four walls" by integrating walking into all areas of her curriculum. She divides walking into three categories: fitness walking, "taking a break" walking, and walking field trips and games.

FITNESS WALKING When Carolyn takes her class on a fitness walk, she emphasizes a pace that is consistent, steady, and relatively uninterrupted. She works on warming up, cooling down, stretching, appropriate pacing and good posture with her students. During fitness walks, she exposes her class to different walking paces and varying terrains.

TAKE A BREAK Carolyn takes her class on short walks as a type of mental break. "Studies show that short walks can give us an energy boost and help to improve our mood," states Johnson. She gives her class walking breaks before an assembly when quiet sitting will be expected, when they need a "breather," and when they have been working hard and need a change of pace. She also walks with her class the first few minutes of each recess.

DISCOVERY WALKS Carolyn incorporates academics into walking by taking discovery field trips around the school neighborhood. Her students become meteorologists--observing, graphing, and measuring weather, evaporation rates of puddles, and creating big books based on their findings. They watch trees change throughout the seasons, note different colors, shapes, sounds, and different types of transportation. After a visit to a farm, her class walks to a neighborhood grocery store to see where the harvested food goes (and later develop a classroom grocery store based on their newfound knowledge).

Carolyn naturally incorporates her teaching of nutrition and healthy lifestyle habits into her classroom walks. "Perhaps the greatest reward from our daily walks is the growth of each child's self-esteem. Everyone is successful at walking and everyone has fun," she emphasizes.

EXCERPTED FROM: How to Teach Nutrition to Kids, ©1995.

© 1999, by Connie Evers, All Rights Reserved. There is a modest reprint fee for reproducing the material in this newsletter in either print or electronic publications. Please send an email to reprint@nutritionforkids.com for details and rates.

The information contained in this newsletter is not intended as a substitute for medical and/or nutrition advice. See your physician and/or registered dietitian for individual health and/or dietary concerns.

Connie Evers, MS, RD, is the author of How to Teach Nutrition to Kids, the companion LEADER/ACTIVITY guide and a number of additional resources located at http://nutritionforkids.com.

• For an order form that you can print and mail or fax to us, click here.

• To order online, please visit our secure shopping cart.

• Did you know that Connie is available to speak at state and national conferences on child nutrition topics? Email her at connie@nutritionforkids.com to discuss.

 
Nutritionforkids.com home