How to Have a Healthy Plus-Size Pregnancy

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.

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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."

Bouncing back from a C-section can take longer if you're overweight because there is an increased risk of complications, adds Laura E. Riley, M.D., medical director of labor and delivery at Massachusetts General Hospital in Boston.

Then there's the effect of excess maternal weight on the baby. The chance of birth defects rises in babies
of women with a BMI of 25 and increases with every point above that. And heavier moms may have more difficulty initiating breastfeeding, though if they keep trying, success is just as likely as it is for normal-weight women.

Don't panic—act! If you are overweight and pregnant, your reaction to all this talk of risk may be to start worrying. Don't: Anxiety isn't good for you or your baby. With proper care and simple lifestyle changes, your pregnancy can go smoothly. McDonald, for example, never developed gestational diabetes or other complications, probably because she was careful to eat well and exercise regularly.

Putting the negative odds into perspective will also help you relax, says Brette McWhorter Sember, co-author of Your Plus-Size Pregnancy: The Ultimate Guide for the Full-Figured Expectant Mom (Barricade Books, 2005). "If you say overweight women have double the risk of something, that sounds awful," she says. "However, if an average-size woman has a 1 in 100 risk, this means an overweight woman still has only a 2 in 100 risk." The best way to enjoy this special time of life is to recognize that there's a lot you can do now to ensure that you have the most trouble-free pregnancy, delivery and recovery possible.

Get Moving Unless you have complications, such as vaginal bleeding or dizziness, exercise is one of the best things any pregnant woman can do for herself. Physical activity helps prevent excess weight gain, combats fatigue and gets you in better shape for labor and postpartum recovery. It may seem like a huge challenge to work out while battling nausea and carrying extra weight, especially if you've never been a fan of physical activity. But effective prenatal exercise can be as simple as a walk around the block. "Walking is not a difficult exercise for women who have been sedentary," Riley says. "Just ease into it, increasing walks to at least 30 minutes per day."
Prenatal exercise may have extra benefits for larger women. A Canadian study suggests that strength training can decrease the need for insulin in overweight women with gestational diabetes. And Brazilian researchers recently found overweight moms-to-be who get regular aerobic exercise maintain their cardiovascular fitness despite the tendency of most women to become less fit as pregnancy progresses.

Eat Right Pregnancy is the perfect time to start eating better, says Yvonne S. Thornton, M.D., M.P.H., a professor of clinical obstetrics and gynecology at Cornell University Weill Medical College in New York. You'll never be more motivated, and the more you learn about nutrition now, the less likely you'll head into your next pregnancy heavier than ever.

Some experts believe that to prevent birth defects, overweight women need extra pre-conception intake of folate, also known as folic acid. Once pregnant, Phelan advises shooting for 1,800 to 2,200 high-quality calories daily, depending on height and target weight. "Many overweight women don't gain all that much on a healthy pregnancy diet because they're no longer eating empty calories," she says.

Manage Weight Gain There's nothing I can do about my weight now, many an overweight pregnant woman has thought. I'll worry about it after my baby is born. But while pregnancy is no time to diet, it's also not a green light for overindulgence. "The eating-for-two mentality has contributed to the obesity crisis," Thornton says. "Pregnancy only takes 300 extra calories per day." That's the equivalent of just three cups of nonfat milk.

If you're used to overeating, limiting yourself to the neighborhood of 2,000 calories daily may seem like dieting, but if you think of it instead as a prenatal nutrition program, you'll be more likely to stick to it.

Current medical guidelines recommend a prenatal weight gain of 15 to 25 pounds for overweight women and up to 15 pounds for those who are obese. However, some experts are questioning whether the guidelines encourage women of all sizes to put on too many pounds. "Gaining 25 pounds during pregnancy if you're already overweight is too much," Thornton says. "A 15-pound limit should be the goal."

The good news is that being overweight before pregnancy doesn't guarantee staying heavy forever. Swedish researchers found women who are overweight before conceiving have no higher risk of retaining their extra weight postpartum than normal-weight women.

Despite the 65 or so pounds Christy McDonald gained during her pregnancies, she's on her way back to her ideal weight with a focus on good nutrition and walking and cycling with her daughters in tow. "I've stopped worrying about what I should do for exercise and started fitting it in when I can. I'm taking baby steps," she says, "but I'll get there."

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