Does Size Matter?
If you’re expecting and overweight, should you try to lose or just eat for two? Here's how to have a healthy plus-size pregnancy.
When she got pregnant with her first daughter, now 5 years old, Christy McDonald weighed 160 pounds, which was 15 pounds over her longtime weight of 145. She never imagined that being slightly overweight then would lead to a struggle with 65 unwanted pounds after her second daughter was born. “I’d hoped to get back to 145 before conceiving again,” says the 5-foot-7-inch graphic designer from Berkeley, Calif., “but I started my next pregnancy 10 pounds heavier than I started the first.” During the year after her second delivery, her weight hovered around 210 pounds.
McDonald’s story is not unique: Close to 50 percent of first-time American moms begin pregnancy overweight, and 85 percent of them gain more than is recommended while pregnant. Entering a first pregnancy overweight also makes it more likely that a woman will start subsequent pregnancies even heavier. Experts now believe this cycle of weight gain is a major contributor to female obesity and the nation’s obesity epidemic.
Overweight: a peril during pregnancy Carrying around too much weight may cause health problems at any time of life, and pregnancy is no exception. “There can be a number of complications, depending on the degree of obesity or overweight,” says Sharon Phelan, M.D., a professor of obstetrics and gynecology at the University of New Mexico School of Medicine in Albuquerque. These include problems with blood pressure and diabetes and difficulty assessing the fetus’s growth and well-being.
Overweight women also tend to spend more time in the first stage of labor—an average 7.5 hours, compared with 6.2 for normal-weight women. Delivery often is more difficult, too. “With my first labor, I had to push for three hours, and afterward I was too tired to hold my baby,” McDonald says. “If I hadn’t been so heavy, I might have had more stamina.”
What’s more, very heavy women are more likely than lean ones to deliver by Cesarean section, and less likely to have a successful vaginal birth after a prior C-section. Larger women also tend to have larger babies requiring a Cesarean. In keeping with the statistics, both of McDonald’s babies weighed more than 9 pounds, and her second arrived via C-section.
“A mother’s gestational diabetes or genetics may play a role in larger infant size,” Phelan says, “but so might her excessive weight gain from a prenatal diet high in simple carbohydrates like pastries and white bread that allow the fetus to grow larger.”