Losses & Gains: The Maternal Weight Battle

by | Sep 16, 2020

Many moms worry about weight gain during pregnancy, but usually this is more about not fitting into their clothes and less about the impact of their weight on their and their baby’s health. Pippa Naudé explores the healthier ways to manage your body weight during pregnancy.

Unfortunately, when it comes to having a baby, weight does matter. It affects the mother’s health during (and sometimes after) pregnancy. It also affects her baby’s health – not only from conception to delivery, but in many other significant ways for the rest of the child’s life!

Why weight matters
The American College of Obstetricians and Gynecologists (ACOG) outlines the following associated risks with a pregnant woman being under or overweight:
Underweight women are more likely to have a low birthweight baby. This has been associated with certain risks during labour, and increases the likelihood of prematurity. Additionally, low birthweight has been linked to health and behavioural problems for the child in later life, including a higher risk of chronic lifestyle diseases like obesity and type 2 diabetes. Lise Eliot, Ph.D. and assistant professor of neuroscience at The Chicago Medical School, adds that low birthweight babies tend to have a smaller head and smaller brain, which has been linked to a lower IQ.

Overweight and obese women are more likely to have a large baby, which can cause labour complications and increases the likelihood of requiring a caesarean delivery. Additionally, there is a higher chance of miscarriage or stillbirth, and a slightly increased risk of birth defects, such as heart or neural tube defects.

Recent research at the University of California also suggests that obese mothers could be up to 67% more likely to have a child with Autism Spectrum Disorder (ASD) and twice as likely to have a child with other developmental disorders, compared to normal-weight mothers.

The following pregnancy complications are also more prevalent in overweight or obese mothers:
Gestational diabetes: This form of diabetes is present during pregnancy and also puts the mother at risk of developing diabetes post-partum.

Preeclampsia: This is a serious disorder where high blood pressure can lead to kidney and liver damage and, if left untreated, can result in seizures, a condition called eclampsia, and even strokes.

Sleep apnoea: This happens when a person stops breathing for short periods of time during sleep. The ACOG says, “Sleep apnoea not only can cause fatigue, but also increases the risk of high blood pressure, preeclampsia, eclampsia, and heart and lung disorders.”

What can women do?
Now that we have terrified you about the implications of your weight, you would probably like to know what you can do to better your and your baby’s health!
The best case scenario is to reach a healthy weight pre-conception, in order to avoid or minimise the above risks, and to give your baby the best opportunities for optimum health and wellbeing. Incidentally, being under- or overweight also decreases fertility, so addressing this could also help women to fall pregnant if they are struggling.

However, if you are not at an ideal weight at the start of your pregnancy, it does not mean you should resign yourself to a negative outcome. It simply means you need to be extra sensible about your weight gain throughout your pregnancy.

How much is good?
The Institute of Medicine’s May 2009 report, Weight Gain During Pregnancy: Re-examining the Guidelines, provided these guidelines for weight gain during pregnancy. The guidelines are based on body mass index (BMI) measurements for women at conception.

These guidelines are for women pregnant with only one child; those carrying multiples would be expected to pick up slightly more weight. And take note that nearly all weight gain should happen only in the second and third trimesters.

Keep in mind that these types of guidelines cannot be applied universally so, because of individual differences, it is always advised that expectant mothers discuss their weight gain and get advice from a medical professional.

Gain is a must
It’s important to note that all women need to gain weight during pregnancy, regardless of their weight at conception. As registered dietitian, Certified South African Lactation Consultant and ADSA spokesperson Catherine Day says, “Weight loss during pregnancy is discouraged as there is a great concern that it may have a profound effect on the developing foetal brain and baby’s growth in general.” However, weight gain should be derived from a balanced and healthy diet, with lots of fresh fruit and vegetables, and not from sweets and junk food.

Slow and steady wins the race
Day says, “The saying ‘eating for two’ has been taken way out of context. For example, during your first trimester, you don’t need any additional energy. It is only during the second and third trimesters of pregnancy that you need a small amount of extra energy to support the growth demands of your baby.”
She gives the following breakdown of extra energy requirements for a pregnant mom who falls into the normal weight category:
First trimester = no additional calories should be required
Second trimester = an extra ±350 kCal per day
Third trimester = an additional 112 kCal per day = ±460 kCal per day

Underweight and overweight moms would need to consume slightly more and less than this, respectively. To find out exactly how much, Day recommends these moms seek the advice of a trained health professional with a special interest in nutrition, such as a registered dietitian, who can create a meal plan specifically suited to them.

Stay active
Exercise is usually recommended during pregnancy, as it has numerous benefits for both mom and baby. Head coach and owner of Fitness Logistics Toni Tebbutt agrees with this, but warns that a woman’s fitness level pre-pregnancy is an important factor in what she is able to do. “Many women who have never exercised before fall pregnant and then want to start training. This can be dangerous as their body is not used to exercise.” Instead, she recommends that moms-to-be are guided by what they did pre-pregnancy. If they hit the gym three times a week, they can continue to do this. If they never exercised, they should rather start with gentle workouts like walking, swimming, using a stationary bicycle, and low-impact or water aerobics.

This is general advice, so again the best course of action for expecting moms is to speak to a healthcare provider and get the green light to exercise, especially if there are existing weight concerns.

Tebbutt’s other pregnancy exercise advice includes:

  • Don’t overdo it! Avoid high-energy and heavy weight sessions, and rather keep workouts light.
  • Scale down exercise routines to suit energy levels and a growing bump.
  • Drinks lots of water.
  • Breathe properly. Often people hold their breath when exercising, but both body and baby need the oxygen!

Day warns against rapid weight loss post-partum, as it generally results in a suboptimal intake of vitamins and minerals. This could affect breastmilk supply and result in the baby not receiving proper nourishment. It could also compromise mom’s health and the recovery process.
Instead she recommends you do not diet, but maintain a healthy eating lifestyle including lots of fruit and vegetables, wholegrains, nuts, legumes, healthy oils (plant-based oils such as canola and olive oil), proteins such as lean meat and fish, and a reduced intake of red and processed meats and sugar-sweetened beverages. She also says you should not exclude any whole food groups, which means that extremely restrictive diets are not recommended.

How to lose it
Once you’ve delivered your beautiful baby and are on the road to recovery, you’ll probably start thinking about how to lose your baby weight. And getting back to a healthy weight is good for you, especially if you are planning your next baby.

Does breastfeeding help for weight loss?
For every 100 ml of breastmilk (which contains 75 kCal) it takes 85 kCal worth of energy to produce, which is why some women do lose weight when they breastfeed, admits Day. “But it should be emphasised that moms need to keep up a healthy and balanced eating plan and an active lifestyle for this to happen.”
She gives the following guidelines for the extra energy requirements needed per day for breastfeeding moms:

Get moving…
Exercise can help women lose weight. Normally moms can start to exercise six weeks after delivery, but again Toni Tebbutt advises you check with your healthcare professional first. When you are ready to begin, she says, “Start slowly; do the exercises you did while pregnant, and gradually work up the intensity and length of time working out. Don’t feel bad if you need to start small, because all the small things add up and do make a difference. Just commit to it, and do it.”

Of course, life with a baby is busy and it’s hard to find the time to exercise, so another good idea is to multi-task. Says Tebbutt, “Take your baby for long walks in the fresh air, which gives you a chance to exercise and spend time with baby. If pushing the pram is too easy, add some weights like small dumbbells or even full bottles of water, to increase the intensity.

She adds, “Once you have time to get away from baby and are ready to take your training to the next level, I would recommend a high intensity style of training like Crossfit or Bootcamp. Not only will this help get your body back in shape, but it’s a nice break from baby, having a laugh with adults and some time to work on yourself.”

…and take it easy
And finally – go easy on yourself. Don’t compare yourself to celebrities who are super skinny a few weeks after having a baby. That’s neither healthy nor realistic! As Day says, “You have just grown a human being for the last nine months and you are still adjusting to a new life. Focus on manageable lifestyle changes and building good long-term habits to role model to your little one.”

Do quick-fix diets work?
Day strongly criticises quick-fix or fad diets and dietary aids (pills) because they contribute to poor long-term success rates and may result in negative health effects over a period of time. She explains: “Often weight is lost quickly by following a fad diet, but as soon as you stop following the often overly restrictive diet, all the weight you lost is regained. Weight loss and subsequent weight regain (called yo-yo dieting or weight cycling) may disrupt your metabolism (making it slower), which in turn decreases your energy needs even further. This makes it ever more difficult to lose weight and maintain weight in the future. This can create a vicious cycle, which contributes to the development of poor self-concept, distorted body image and problematic attitudes towards weight and eating/food.”