February 16, 2015

To Feast or Not to Feast During Pregnancy

In “The Right Weight for your Due Date” I mentioned the recommended weight gain range during pregnancy for each woman. The weight gained during pregnancy is referred as Gestational Weight Gain (GWG).

So what’s the big fuss about weight gain during pregnancy and why are the doctor and staff being so darn annoying about this weight issue?

You’re pregnant, you’re hungry, the Crème brûlée was there, so was the creamy fettuchini.  Cream is milk. Milk is a great source of calcium and all! What’s his problem anyway, he’s never been pregnant and wouldn’t understand your cravings anyway? Besides, if you're in the middle east we all know where “w7am” would do to your baby!

You’re pregnant, you’re hungry, the Crème brûlée was there, so was the creamy fettuchini. Cream is milk. Milk is a great source of calcium and all!
 Besides, if you’re in the middle east we all know what “w7am” would do to your baby!

However, your doctor, and your inner healthy voice are both right. Your mom and mother in law are probably wrong. Most nutritionists will tell you “You are not eating for two”. This confuses me a bit, because you really are two. However, all it means is, even if you are two, you don’t “need” to eat as two adults. Just as an adult and a baby.

Side thought: Even though if anyone has seen babies nursing during the first few weeks, they might change their mind about babies not eating that much. 

What are the risks of gaining too much weight during pregnancy?

On to the importance that we fight off those cravings, if you gain above the recommended range as mentioned in  “The Right Weight for your Due Date” during the entire pregnancy, unfortunately, there are increased risks:

1. gaining too much weight during pregnancy increases the risk of DELIVERING A Large for gestational age baby (LGA) and influencing childhood obesity

A study published by the International Journal of Obesity suggests that GWG (gestational weight gain) above the recommendation may contribute to the obesity epidemic among children and adults.

The study is of particular importance as it states  ” the greatest GWG occurs among non-obese women. Thus, this effect seems to recruit subjects to the obese segment of the population from the non-obese segment in the preceding generation.”

Isn’t that absolutely amazing? This study showed that GWG alone, aside from genetics and mother’s weight before pregnancy, can contribute to the child’s obesity risk.

This has been shown in several other studies. For example, it has been shown that for every 1 kg weight gain during pregnancy there was a 3% higher chance of child being overweight at age 7. (Wrotniak, 2008)

GWG above the recommended guidelines is associated with LGA (Large for Gestational age) infants which is defined as infants above the 90th percentile. Infants that are LGA have been shown to be more likely to be obese or overweight in adolescents and adulthood (Maternal and Infant Risk Factors for Childhood Obesity). 

In addition, babies born LGA carry risks of their own such as shoulder dystocia and other forms of birth injury, as well as cesarean delivery.

 

2. gaining TOO MUCH weight during pregnancy Increases the risk of Gestational diabetes (GDM)

Gestational diabetes (GDM) is  defined as diabetes diagnosed during pregnancy that is not clearly overt diabetes. (Hederson et. al, 2010).

What does this mean for mom?

Women diagnosed with GDM usually face a higher risk for preterm delivery, cesarean delivery, gestational hypertension,  or delivering LGA(Large for gestational age). (Black, 2010) (Metzger, 2008)

Women with GDM also have several fold higher risk of developing type 2 diabetes in the future compared to women without GDM.(Damm, 2009)

What does this mean for baby?

“Babies with excess insulin (due to exposure from mother with gestational diabetes) become children who are at risk for obesity and adults who are at risk for type 2 diabetes.” – American Diabetes Association 

It has also been shown infants born to mother with gestational diabetes, are at risk of other diseases related to Metabolic Syndrome such as hypertension (high blood pressure) and dyslepedemia (abnormal cholesterol levels), which is a risk factor for coronary heart disease (Boney et. al,2005).

diabetes

Other risks are also mentioned by the ADA such as “Newborns may have very low blood glucose levels at birth and are also at higher risk for breathing problems”.

As I mentioned above, gestational diabetes increases the risk of gestational hypertension or  Preeclempsia. Preeclempsia  is a pregnancy associated high blood pressure. Preeclempsia  is very dangerous and can lead to either maternal or infant death if not both.

3.gaining TOO MUCH weight during pregnancy Increases the risk of preterm birth, defined as baby born before 37 weeks gestation

Increasing rates of preterm birth is a global health concern. According to WHO (World Health Organization), almost 1 million children die each year due to complications of preterm birth. Many survivors face a lifetime of disability, including learning disabilities and visual and hearing problems.

I just want to say something about my own personal experience in the middle east. We don’t tend to think preterm is a big deal. Before getting my degree in Nutrition, don’t make fun of me, but I thought it’s totally okay to be born preterm. Preterm babies are even “smarter” and turn out “stronger” than other babies. I’m not saying babies born preterm can not be smarter and stronger. They most definitely can. All I’m saying is, preterm birth is a dangerous birth complication and can have detrimental effects on the entire family and should not be regarded by “Okay”.

4.GAINING too much WEIGHT DURING PREGNANCY INCREASES the risk of Cesarean delivery.

You might be thinking “What’s the big deal, people are doing Cesarean deliveries these days?”

Brazil C section

C- sections are so common in Brazil that there’s a joke that says “only way you won’t get one in Rio de Janeiro, is if your doctor gets stuck in traffic.” The numbers are on the rise everywhere in the world including the U.K where women have been referred to as “too posh to push”

Now it’s on the rise in the Middle East, and it is referred to as “easier” and “better”. Actually, it’s really not. It carries  risks  for mother and infant. It is unnecessary unless a medical condition “requires it”. More awareness needs to be spread about risks vs. benefits of cesarean deliveries. The recovery period is quite difficult, and whoever tells you it’s the same thing for vaginal delivery, simply did not try cesarean delivery and would not know the difference.

Lactogenesis (common words “Milk coming in”) is also delayed in mothers with Cesarean deliveries. For this reason and more cesarean delivery seems to impact initiation and duration of breastfeeding (Nommsen-Rivers, 2010). Issues with failing to breastfeed can have a huge impact on the health of the mother, and infant in the short-term and in the long term as mentioned in Benefits of Breastfeeding for Mother and Benefits of Breastfeeding for Infant.

It also has consequences that are now “emerging” for the child such as increased risk of allergies and asthma (Renz, 2005)

5.GAINING too much WEIGHT DURING PREGNANCY INCREASES weight retention 3 months to 3 years after delivery

What’s the big deal? You’ll lose it anyway

The big deal is, first, it’s gonna depress you like no other, which is the last thing you need with a new crying baby. That’s not the medical reason though.

The medical reason is that you might not lose the weight by the next pregnancy, and if you are overweight by the next pregnancy, then that puts you at even a larger risk than the risks I mentioned already(IOM, 2009)

weight

We all have so much extra flab after delivery, the last thing we need is a bit more!

 6.GAINING too much WEIGHT DURING PREGNANCY DECREASes INITIATION OF BREASTFEEDING

I mentioned above how Cesarean delivery affects initiation of breastfeeding. However, I want to dedicate a whole point for this it has been shown that GWG interferes with breastfeeding.

“GWG was associated with a measure of failure to initiate and/or sustain BF in all categories of pre-pregnant BMI. Thus, in addition to conceiving at a healthy weight, gaining the recommended amount of weight during pregnancy is also important for successful BF.” (Hilson. et al, 2006).

Issues with failing to breastfeed can have a huge impact on the health of the mother, and infant in the short-term and in the long term as mentioned in Benefits of Breastfeeding for Mother and Benefits of Breastfeeding for Infant.

 

weight

One reason you don’t want to gain extra weight: You really really don’t want those stretchmarks. Photo credit: May 1st via photopin (license)

 

Conclusion

“Given the increased obesity prevalence, these findings have implications for perpetuating the cycle of obesity, insulin resistance, and their consequences in subsequent generations.” – Metabolic Syndrome in Childhood

To sum up, gaining extra weight during pregnancy is not a simple matter of wabbling while pregnant, or not being able to get back into shape after pregnancy. Nor is it just a matter of medical delivery risks. It is a “health issue” for your baby, as it sets the foundation for your baby’s risk for obesity, diabetes, and other diseases.

“Collectively, the available literature including the present study, suggests that the public health implications of excessive weight gain during pregnancy are potentially profound.” IOM, 2009

References

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