Too Much Mama

Why experts are rethinking the pregnancy weight-gain guidelines.

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Before Jennifer Griola, then 30, of West Orange, N.J., became pregnant, she weighed just under 300 pounds. Griola lost 30 pounds, but at 5 feet 10 inches tall, she was still considered obese when she found out she was expecting. During her pregnancy, Griola gained back the 30 pounds and developed borderline hypertension and gestational diabetes. At week 34 she went into labor and delivered her daughter, Sarah, via emergency Cesarean section because her placenta ruptured. Sarah was in the neonatal intensive care unit (NICU) for 10 days, a harrowing time for Griola and her husband.

After giving birth, Griola was determined to take the weight off and lost 55 pounds. During her second pregnancy six months later, she gained only 15 pounds. That time around, her blood pressure and blood sugar levels were normal and her second daughter was delivered at term. Today, two years after her first pregnancy, she has lost 92 pounds.

Fortunately, Griola learned from her first pregnancy experience. As in her case, being overweight or obese even before becoming pregnant puts you and your future baby at increased risk for complications, including C-sections, preeclampsia, gestational diabetes, preterm birth, stillbirth, birth defects and the child's own risk of obesity later in life. The heavier you are, the greater the risks (see box below). Experts agree that the best way to reduce those risks is to achieve a healthy weight before conceiving. If that's not possible, the next best thing is avoiding excess weight gain during pregnancy.

Your weight's toll on both of you Some experts partly blame the nation's obesity epidemic on excessive weight gain during pregnancy. It's much harder to lose weight after a pregnancy if you gain too much, and this can lead to a lifetime of obesity. "When obese women are asked how they got so heavy, the majority says it happened during pregnancy," says Marie Cedergren, M.D., a maternal obesity expert in Sweden.

Studies also show that excessive weight gain in pregnancy contributes to a too-high birthweight and, later, childhood obesity, says Emily Oken, M.D., M.P.H., an assistant professor of prevention at Harvard Medical School. Maternal obesity raises the risk of birth defects; the strongest association is to spina bifida (double the risk, which means that very heavy women may need higher doses of folic acid), but also linked are heart defects, short limbs, hernias and other problems. Plus, babies born to obese women have a greater risk of preterm birth and, among babies born at term, a low Apgar score, a sign that a baby may need to spend time in the NICU.

Rethinking the guidelines The federal government's Institutes of Medicine (IOM) published pregnancy weight-gain guidelines in 1990, but because most experts believe the weight ranges are too high, they are currently being revised. Not everyone adheres to even the current guidelines, however: In 2003 (the most current statistics available), 38 percent of pregnant women gained too much weight; 25 percent put on more than 41 pounds during a singleton pregnancy. Adding fuel to the idea that current weight guidelines are too high is one study that found overweight or obese women who stayed within the recommended ranges still had children who were four times more likely to be overweight at age 3.

Recent studies show that overweight women can reduce their risk for complications by gaining less weight while expecting and that some obese women can even safely lose weight while pregnant. "My recommendations are that obese women gain very little, if any, weight during pregnancy," says prenatal weight and exercise expert Raul Artal, M.D., chairman of the department of obstetrics, gynecology and women's health at Saint Louis University in Missouri.

Safe weight management Artal and other experts also agree on another problem: The current weight-gain guidelines neither establish an upper limit for obese women (recommending instead that they gain at least 15 pounds) nor distinguish between different degrees of obesity. To address these oversights, the chart above indicates the weight gain (or loss) that recent research has shown can lower the likelihood of complications without raising the risk of having a low-birthweight baby.

The IOM and other medical groups have not yet sanctioned these suggested guidelines, so talk to your doctor before trying to limit your weight gain. Artal strongly advises that obese expectant women who try to do so or even to lose weight should be under the supervision of a high-risk OB and a nutritionist or dietitian who specializes in pregnancy and can create a personalized diet and exercise plan.