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Pregnancy Weight Gain: When the Guidelines Might Not Be Right for You

Monday, May 19th, 2014

When you find out you’re pregnant, one of the first things your doctor will probably want to discuss with you is how much weight you should gain over the course of your pregnancy. The guidelines say that most pregnant women should gain between 25 and 35 pounds – more if they start out underweight, less if they are overweight to begin with. How does that weight gain break down?

  • 1  pound for the placenta
  • 2 pounds for amniotic fluid
  • 2  pounds for the increased weight of the uterus
  • 1 pound for increased breast size
  • 3 ½ pounds for increased blood volume
  • 6 ½ pounds for maternal fat stores
  • 6-7 ½ pounds for the full-term baby

All of this adds up to between 22 to 24 pounds that a healthy woman of normal weight can safely gain during her pregnancy.  The operative term here is “normal weight”.

However, many women don’t start pregnancy at their ideal weights. For a woman who is very underweight, somewhat more weight gain may be optimal, and may be the natural outcome of eating enough nutritious food to nourish herself and her growing fetus.

A much more common problem, though, is that of the woman who starts her pregnancy overweight. One in five pregnant women (20%) are obese at the start their pregnancy.   Gaining too much weight during pregnancy is one of the most preventable causes of complications, ranging from gestational diabetes to preeclampsia to overly large babies that require cesarean deliveries.

A woman who is overweight or obese can safely gain less than 25 pounds during her pregnancy as long as she eats a healthy diet. Keep in mind that “eating for two” should mean that you are eating twice as well, not twice as much.  The fetus usually weighs less than 1/20 of its Mom’s weight. So for an overweight or obese woman, switching to the healthy diet she needs for pregnancy may actually mean a reduction in calories, and gaining less than the recommended amount or even losing weight may be the natural result.  And, an obese pregnant woman shouldn’t get overly concerned about it.  If you are obese, you already have a fluffy substrate or matrix upon which your pregnancy will grow.  A numerical end-point, i.e., weight gain or loss, should not be used in obese pregnant women, but rather a healthy, balanced nutritional intake should take priority. 

This is perfectly fine as long as your doctor agrees (always discuss matters related to your pregnancy with your own doctor, because your situation is unique), and as long as your diet contains all the necessary nutrients and fluids you and your baby need.  I, as the principle investigator, have done the original research and have published the first and, to date, the only randomized clinical trial regarding the outcomes of nutritionally monitored obese pregnant women.  A well-balanced diet is the way to go resulting in less problems during the pregnancy.

A pregnant woman should be drinking lots of water – at least eight cups a day – and another four cups of skim milk, leaving very little room for soda or fruit juice (which are both mostly sugar). And eating all the fresh fruits, vegetables, lean meats, fish, and whole grains you need does not, for the most part, leave room for junk food.

The occasional treat is fine. A cup of coffee, a small serving of chocolate, and the like do not have to be abandoned entirely for nine months, and trying to do so would most likely set you up for failure anyway as the temptation to “cheat” would be too great. Tell yourself you can have treats – just not every day and not in large amounts.

Exercise will also help you feel better and keep your weight in check during pregnancy. Walking, swimming, and using a stationary bicycle are excellent exercises now. Keeping track of everything you eat and which exercise you perform each day and for how long can help you stay accountable and motivated.

Just because countless people – even strangers – will tell you that you “should” be gaining 25-35 pounds does not make this necessarily right for you. They don’t even know you!  Talk to your doctor to determine whether you can safely gain less; delivering a baby in better shape than they were in nine months ago is a very real possibility for many women. See my book, Inside Information for Women, for much more information on this and other women’s health issues.

– Yvonne S. Thornton, M. D., M. P. H

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Gut Flora of Babies Delivered by Cesarean Altered for At Least Six Months

Thursday, September 5th, 2013

One of the things I discuss in my book, Inside Information for Women, is the modern trend of cesarean on demand, or elective cesareans. For many women, cesarean delivery sounds like a simpler, easier alternative to labor and pushing, and to the many doctors who agree with them, it sounds like a good time management technique – preventing their sleep or other activities from being disrupted by inconvenient spontaneous labor. Women should remember that cesarean delivery is major surgery and carries the same significant risks of all major surgeries. Besides, the postoperative recovery period is more difficult following a cesarean than the recovery period following a vaginal delivery. And now, new studies show an additional reason to avoid cesarean whenever possible – the altered gut flora of babies born this way.

The early bacterial colonization of the intestine in newborns is an essential part of development, and now we have a new understanding of what factors can affect this colonization – and what effect altered colonization has on a child. A recent study shows that babies delivered by Cesarean have disturbed intestinal flora for up to, and sometimes longer than, six months after delivery. Two dozen babies were tested and then followed for up to two years. Fecal samples were tested one week after birth, and for up to 24 months in order to identify certain types of bacteria.

The results were striking. A particular type of bacteria known as Bacteroidetes was found less often in babies delivered by cesarean compared to those delivered vaginally, with a delayed colonization of this bacteria and significantly lower immune responses.

Those lower immune responses could mean a higher incidence of the development of allergies or asthma later. This could be because intestinal microbes influence and regulate certain parts of immune function all through the body. There was also less microbial diversity in the babies delivered by cesarean. That this off-balance mix is linked to allergies and other problems later is the conclusion of several recent studies.

There are factors that still need to be studied, but this is an interesting first step in understanding the link between gut flora and allergies and is a testament to the benefits of natural vaginal birth – Mother Nature knows what she is doing. So, as if there weren’t already enough reason to avoid unnecessary cesareans, the new information gleaned from the studies on intestinal flora confirm that women should avoid surgical birth any time it is safe to do so.

– Yvonne S. Thornton, M. D., M. P. H.

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A Cesarean Delivery Will Not Lower Your Chances for Incontinence

Thursday, April 4th, 2013

Obviously, childbirth can really do a number on a woman’s lower body. While we have all dreamed of the day we become mothers since we were little girls, we have also all feared it. Both women and men alike understand the pain and discomfort of childbirth. Some of that discomfort can even last beyond the pregnancy itself. Many women report incontinence after they’ve delivered a baby. Whether it’s a long bathroom line or a hearty laugh, you might find yourself darting to the nearest empty stall in horror as you realize you don’t have the bladder control you used to. It’s a common misconception that women who opt for Cesarean delivery are impervious to incontinence postpartum. Believe it or not, studies show that the mode of delivery actually has no influence on whether or not a woman will experience incontinence after she gives birth.

You’re probably wondering what causes incontinence postpartum then since the mode of delivery has no effect. If you are having bladder control problems after you give birth, it’s more likely a result of your age. Older women are more susceptible to incontinence to begin with, so childbirth will only bring it on sooner. Also, genes play a role. If your own mother was incontinent postpartum, there’s a better chance you will be also. Finally, your lifestyle might also play a role. Women who maintain a healthy weight and exercise regularly become incontinent less often. By avoiding those fatty pregnancy temptations and resisting the urge to become a couch potato during your gestation, you will be preventing incontinence.

If you’re thinking about having a Cesarean for health reasons, don’t let the potential for incontinence sway you. You have just as great a chance of becoming incontinent from a Cesarean delivery as you would from giving birth vaginally. Make other adjustments in your pregnancy if you are hoping to avoid incontinence. Stay healthy, plan the age at which you conceive wisely, and talk to your family members about their own incontinence postpartum to determine whether or not genes might play a role. While incontinence is embarrassing, it is temporary for many new moms who struggle with it for the first time.

 

– Yvonne S. Thornton, M. D., M. P. H.

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A Little Known Side Effect of Cesarean Deliveries

Thursday, February 21st, 2013

For women who deliver their baby by Cesarean, there are a few extra considerations that must be taken into account both on the due date and during the baby’s infancy. Whether the Cesarean was elected or required for the baby and mother’s health, there are a few ways in which the outcome differs from a vaginal delivery. Of course, the new mom will need to care for her surgical incisions to make sure they heal properly, and doctors will have to pay extra close attention to a baby’s vital signs during the process. However, there is one Cesarean side effect that few women know about the first time around.

Studies show that babies who are delivered by a Cesarean do not have as much healthy intestinal bacteria as those delivered vaginally. Specifically, the research indicated that Escherichia-Shigella and Bacteroides were not abundant in the gut. These bacteria are essential to a healthy intestinal balance.

The reason the mode of delivery might have an effect is a matter of how the baby might obtain the bacteria. When a baby passes through the birth canal, he or she will come into contact with the vaginal bacteria present in the mother’s body. During a Cesarean, the baby rarely comes into contact with such bacteria, and any contact is usually limited to bacteria found on the skin.

As adults, our gut flora and bacteria can be upset by antibiotics and other medications that upset the natural balance of cells. When a baby is delivered, it is really the first time she is making contact with the outside world, so it’s no wonder the bacteria she ingests will have long-term effects on her internal balance.

Another little-known fact about babies delivered by Cesarean is that they are more likely to make a detour and visit the neonatal intensive care unit (NICU) for respiratory distress or difficulty breathing following their birth.  Why? Because the natural act of compressing it’s little chest during the birthing process by way of passing through the vagina and thereby squeezing out the excess fluid in the lungs is not present during a Cesarean.  This retained fluid, as it were, can cause rapid, distressed breathing of the infant, known as transient tachypnea of the newborn (TTN) requiring time in the NICU for some drying out.  Fortunately, the condition rarely progresses to a more serious complication.

So, Mother Nature, for the most part, does know what she’s doing when it comes to birthin’ babies. The frequency of Cesarean birth has skyrocketed over the past two decades, some for medical indications and more recently, at mother’s (or obstetrician’s) convenience.  Just know that if Mother Nature wanted babies to be born abdominally, she would have put a zipper above the pubic bone.

 – Yvonne S. Thornton, M. D., M. P. H.

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