Gestational Weight Gain: When, How, How Much, and Why?

This weekend I read an interesting study published in the American Journal of Obstetrics and Gynecology concerning excessive gestational weight gain and how it may increase the risk of obesity and high blood pressure in children. (Emily Okin et al., “Gestational Weight Gain and Child Adiposity at Age 3 Years,” American Journal of Obstetrics and Gynecology (2007), vol. 196, no. 4. )

In this study of over 1000 mother-child pairs, the researchers “found that mothers with greater gestational weight gain had children with more adiposity at 3 years of age, measured by skinfold thickness as well as by BMI.” This association persisted even when researchers controlled for parental BMI, maternal glucose tolerance, breastfeeding duration, and child behaviors, indicating that the specific environment in the uterus, perhaps the overabundance of calories or the strong insulin surge produced by an unhealthy diet, was the determining factor. The children of mothers who gained more weight also had higher systolic blood pressure, “a cardiovascular risk factor related to adiposity even in young children.”

The researchers say that, similar to the United States population as a whole, “many mothers and their children in this cohort were overweight, and a majority of mothers gained more weight than is currently recommended by the Institute of Medicine.”

And interestingly enough, compared with mothers who had inadequate gestational weight gain, even mothers with so-called adequate gain had a substantially higher risk of having children who were overweight,” while showing “no difference in risk of undesirable birth outcomes such as small or large for gestational age birth or cesarean section.” Those women who gain less than recommended have babies with a lower risk of obesity, and no increased risk for negative birth outcomes. Maybe the guidelines, then, need changing.

The researchers do conclude that the Institute of Medicine may need to reevaluate its recommendations for gestational weight gain, in order to help control “the rising tide of childhood obesity,” and the Institute of Medicine did indeed revise its weight gain guidelines in 2009, encouraging women who were overweight preconception to gain less weight during pregnancy.

Seems pretty obvious, right? While it is an obviously good recommendation not to gain a lot of weight when you are already carrying around too much, I think that these new guidelines are simply attempting to treat a symptom, and are not even approaching the root of the problem, which is the terrible nutritional quality of the standard American diet. Until that changes, obesity (in children and adults) is still going to be widespread, as will be the preventable diseases of civilization, diseases stemming from inflammation issues, autoimmune disorders, dental caries, you get the picture.

But I digress. The current guidelines for weight gain during pregnancy are different for women who were underweight, at a healthy weight, overweight, or obese preconception. These classifications are based on the BMI – do not even get me started on what a flawed tool that is for determining who is at a healthy weight, but I digress again. The basic idea, nonetheless, makes sense. Women who have inadequate fat stores should gain more weight throughout pregnancy (18-40lbs) in order to support the nutritional needs of a growing baby, women at a healthy weight do not need to gain quite as much (25-35lbs), overweight women should only gain 15-25lbs, as they already have more than adequate fat stores for themselves and the child, and obese women should gain only 11-20lbs.

I am situated safely within the “at a healthy weight” preconception category, so I am one of the women who is supposed to gain 25-35lbs, according to these guidelines. My weight gain, it is important to add, is supposed to come in the second and third trimesters of my pregnancy, not now, during the first trimester. So far, I have gained no weight at all; even though my belly is a bit thicker than it used to be, the numbers on the scale are not moving. When I am somewhere around week 14, my goal is to gain .8 to 1lb of weight per week. And, because of the conclusions of studies like this one, I am aiming for the lower end of the weight gain spectrum – somewhere around 25lbs. And I will do so by eating a few hundred calories more per day of nutrient-dense real foods. The more I read, the more it seems like the healthiest choice for my unborn child, and heck, it will make getting back in shape postpartum a little bit easier for me.

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