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Achieve healthy weight control during pregnancy

by Dr Wenus Ho
Friday, August 5, 2022

As we journey through pregnancy, we want what is best: to grow a healthy baby without compromising our own health. In order to achieve this, our body weight, body mass index (BMI) and health before we become pregnant are important factors, as is the quality of our diet, weight gain during pregnancy, and how active we are.

Pregnancy weight management can be a complex and difficult subject. In any case, gaining or losing too much or too little weight isn’t good for women or babies, as this can affect the pregnancy, delivery, and future health of both. Besides that, what else should you know? Let’s simplify this topic for you, and also explore how you can make small changes in your life that facilitate the process.

Why is gaining too little weight bad for the baby?

  • It significantly increases the long-term risk that your child will become overweight/obese in the future.
  • The risk of premature birth and low birth weight increases – even if the mom was overweight to start with. Low birth weight is one of the top risk factors for infant illness and death.

Why is gaining too much weight bad?

  • For the mother: the risks go up for gestational diabetes, high blood pressure in pregnancy/preeclampsia, and C-section delivery
  • For the baby: the risk goes up for stillbirth, premature birth, birth defects, obesity, diabetes, and having a very large foetus (over 4kg)
  • The risk is highest among women who are both overweight beforehand and gain excessive weight during pregnancy

What does gestational weight gain consist of?

It comprises the growth of the foetus, placenta, breast tissue, fluids (blood volume and amniotic fluid), and fat accumulation in the mother. The weight increase during pregnancy is necessary for the healthy development of the foetus but should be done gradually. The first 16 weeks of pregnancy should not see much weight gain.

The typically recommended weight gain is as follows, based on your weight when you become pregnant (Adopted from Institute of Medicine Guidelines):

  • for underweight women (BMI less than 18.5), it is 12.7-18.1kg;
  • for normal-weight women (BMI between 18.5 and 25), it is 11.3-15.9kg;
  • for overweight women (BMI between 25 and 29), it is 6.8-11.3kg;
  • for obese women (BMI of 30 or greater), the recommended weight gain during pregnancy is 5-9.1kg. For some women, this gain can be entirely accounted for by the normal foetal growth and changes of pregnancy, and obese women may not need to change calorie intake, but focus on improving diet quality. Don’t cut calories unless medically advised.

You can calculate your own BMI here.

Here are the 6 things you should pay attention to:

    • Ensure you are at a healthy weight before you conceive. If you are overweight, it is good to lose some weight (even just a little) before conceiving. Yes, even though you will gain weight in pregnancy.
      • Eat a nutrient-dense diet focusing on real foods. Limit processed foods (refined foods like ‘instant’ foods, snacks like chips, chocolates and cake, ‘white’ grains, fizzy drinks whether ‘diet’ or not, etc.) because they are less nutritious than whole foods.
        If you consume calories from real, whole foods, you’ll get more nutritional value: fruits, vegetables, nuts, seeds, eggs, legumes, meat, fish, whole grains, yoghurt and other dairies. Instead of a bag of chips, you could eat an apple with nuts, for example. But sometimes it’s perfectly OK to have the chips or ice cream – in moderation, remember? It’s not about starving yourself, but about eating the right types of food most of the time, for the best positive effect on your wellbeing. See a nutritionist if you need help tailoring a balanced way of eating that works for you.
    • You don’t need extra calories in the first trimester. Eat as normally and healthily as you can, given that you may feel nauseous and tired at times.
      • In the second and third trimesters (months 4 – 9), the general advice is to up your calorie intake by about 340 to 450 calories a day, depending on your activity level. However, this may not apply to you if you were overweight/obese to start with. You don’t have to eat all the ‘extra’ calories in one go, but here is just an idea of what that looks like with real food.
        • 300 calories are 100g plain Greek yoghurt + 1 medium banana + 15g almonds
        • 350 calories are 2 scrambled eggs + 1 slice of whole-wheat toast (buttered)
        • 400 calories are 100g fish + 100g sweet potato + 1.5 cups broccoli with 1 teaspoon dressing + 1 cup strawberries
        • 450 calories are 100g chicken in a soy-chilli-sesame sauce + 100g green beans + ½ cup cooked brown rice
      • You may need to change the way you eat as the pregnancy progresses. For example, due to pressure on the digestive organs, some women need to eat more often but with smaller portions to feel comfortable. By the way, you will actually need more calories for breastfeeding!
      • Stay active.
        • Obstetricians, gynaecologists and exercise physiologists advise pregnant women with no contraindications to be active daily throughout their pregnancy. For meaningful health benefits, they recommend at least 150 minutes (2.5 hours) of moderate-intensity physical activity each week (spread over 3+ days per week).
        • Many types of exercise are beneficial: aerobic, resistance training, and yoga/stretching.
        • If you’ve aren’t active, there are easy, enjoyable and safe ways to start moving your body more, like walking, swimming, dancing. It doesn’t have to feel like ‘a serious workout’ in order to benefit your wellbeing.
        • If you already exercise, there are ways to adjust your routines to be safe, effective and enjoyable during pregnancy.
        • Check with your doctor that you are cleared to keep exercising, and ensure your trainer is qualified to train prenatal and postnatal women and understands contraindications.

As we can see, pregnancy isn’t neither an invitation to “eat for two” calorie-wise nor a time to diet, starve, skimp on nutrients, over-exercise, ‘detox’ or do other things with a fear of weight gain. An optimal balance can be reached with moderation and targeted advice from your healthcare provider, based on your starting point health-wise as well as what comes up during your check-ups.

Weight management during pregnancy may first sound intimidating, but once you get into your momentum, things will feel a lot easier and like every other thing you are motivated to do, you will become proficient at it.

Sources and references:

Healthline – Weight Before Pregnancy Is a Bigger Health Factor Than Weight Gain During Pregnancy

Healthline – Don’t ‘Eat for Two’ While Pregnant

Healthline – Why Some Pregnant Women May Not Need to ‘Eat for Two’ to Stay Healthy

Healthline – Why Pregnant Women Shouldn’t Gain Too Much or Too Little Weight

Health Hub SG – Pregnancy Weight Gain Checklist

Grow by WebMD – Pregnancy Weight Gain Guidelines Explained

Grow by WebMD – The Importance of a Healthy Pregnancy Weight

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