Tuesday, February 1, 2011

Are you really eating for two?

Carla Morrow, CNM
Did you know in general pregnant women only need an extra 300-350 calories a day to support the growing baby? The need for extra calories doesn’t even come into play until several months into the pregnancy so in the early days many won’t even need to up their calories. That definitely doesn’t jive with the “eating for two” mantra we’ve all grown up with.

So what’s a pregnant mom to do to sort out her nutritional plan while pregnant?

Let’s face it. Almost no one likes getting on the scale. And knowing someone else – even a medical professional – sees your number makes it even tougher. Add in pregnancy hormones and some possible guilty feelings over succumbing to last night’s craving and weight can become a sensitive topic.

But the reason that your doctor or midwife will discuss nutrition and weight gain – in detail – at your appointments is because it’s crucial for you and your baby. Some women often feel embarrassed about their weight even dreading the weigh in process. Hopefully you have chosen a provider who is sensitive to your individual needs and who approaches weight gain counseling with a candid and understanding manner. The bottom line though is that Research over the past 20 or so years indicates that gaining too much weight puts both the mother and baby at risk.

Every woman and every pregnancy is different and therefore guidelines for gaining weight will also be different.  Prenatal counseling about weight gain should be individualized specifically for each woman.  According to the Institute of Medicine’s weight gain in pregnancy guidelines, each pregnant woman should gain weight according to her pre-pregnancy weight classification. Women will often ask “How much weight should I gain?” The answer really depends on what her BMI (Body Mass Index) is at the onset of her pregnancy. For example a woman who is underweight when she begins her pregnancy will need to gain more weight than a woman who is overweight.

To check how much weight The March of Dimes recommends you should gain during pregnancy, click here.

To calculate your body mass index, click here.

Women who are underweight or not gaining enough weight can be at risk of having a stillbirth, preterm delivery or a smaller than average infant. Due to morning sickness many women have trouble gaining or maintaining their weight during the first trimester. Fortunately during this time the baby does not require much nutrients or calories. Once the first trimester has passed, those requirements increase and it is important that these mothers gain weight steadily throughout the remainder of their pregnancy in order to prevent giving birth to a malnourished infant.

Most women who are overweight and or gaining too much weight will have perfectly healthy pregnancies and deliver a healthy baby without complications. However, these women also have an increased risk for developing the following complications: gestational diabetes, high blood pressure, difficulty hearing the heart beat, difficulty measuring the size of the uterus, difficulty obtaining ultrasound imaging, preterm delivery, stillbirth, difficult administration of spinal or epidural anesthesia, difficult vaginal delivery if the infant is larger than average, cesarean section, use of vacuum or forceps to delivery the baby, postpartum weight retention, unsuccessful breastfeeding, failure of labor induction, and increased length of labor.

The following self care tips can help make your pregnancy a healthy one for your and your baby:

o    Ideally be at a healthy body weight before you become pregnant
o    Always avoid smoking and alcohol consumption during pregnancy
o    Avoid gaining too much or too little weight
o    Chose healthy foods and observe your calorie intake
o    Keep a food diary and consider seeing a dietitian if you are gaining too much or too little weight
o    If you are not gaining enough try eating whole milk dairy products instead of low fat products and add snacks between meals
o    If you are gaining too much try switching to low fat and lean protein and incorporate daily exercise into your daily routine (always check with your provider before beginning an exercise program)
o    Discuss your concerns about weight gain with your doctor or midwife.

So while it may not be a fun conversation, talking about weight at your prenatal appointments can be an easy way to head off any complications before they develop. Personally I’d rather have a sticky conversation with a mom-to-be’s diet than to have to tell a laboring mom that her baby has had complications that possibly could have been avoided. And I’m sure in the end the moms would rather it be that way too.

Carla Morrow is a certified nurse-midwife on the medical staff at Texas Health Harris Methodist Hospital Cleburne.

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