Weight gain in pregnancy, is it baby's cravings?
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By Lee Hye-jun
My best friend used to complain how her mother-in-law forced her to eat more when she was pregnant. Her mother-in-law would say “The baby needs good nutrition to grow. Have some more.” On the other hand, her own mother was worried the baby would get so large that her daughter might experience a difficult childbirth.
There is no doubt under eating is harmful for both mothers and babies. Smaller and thinner babies are born to nutritionally deprived women and likely to get more hypertension, diabetes, dyslipidemia, and coronary artery disease when they grow up.
The recommended ranges of weight gain during a single pregnancy by the Institute of Medicine (1990) are as follows; between 12.5 and 18 kilograms for thin women (body mass index, or BMI, < 19.8), 11.5 to 16 kilograms for normal women (BMI 19.8-26), 7 to 11.5 kilograms for overweight women (BMI 26-29), and less than 7 kilograms for obese women (BMI>29).
When this guideline was written, concern was more focused on under-nutrition. Currently, obesity, whether pregnant or not, is in the center of attention in the developed countries. It was reported that 46 percent of women had weight gains above the guidelines. Now even lower weight gain than the guideline is advocated by some scientists.
The daily calorie requirements for an average woman are around 1,800 to 2,000 kcal. When pregnant, she needs an additional 100 to 300 kcal per day, which equals to one apple (100 kcal) or a small cheese burger (300 kcal). The required amount of nutrition in pregnancy is somewhat overstated.
Obese mothers are at higher risk of gestational hypertension, preeclampsia, and gestational diabetes. Oversized babies (usually weighing more than 4.5 kilograms at birth) born to these obese mothers are difficult to deliver. Their shoulders often get stuck in the way down the birth canal, nerve injury occurs, and also cesarean delivery rate increases.
Women all dream of the day they finally get out of the huge “bodysuit.” In reality, they will have to endure teasing for quite a long time. In fact, they lose most of the weight at delivery — about 5.5 kilograms by evacuating the baby and placenta and blood loss. An additional 4 kilograms are lost during the first two weeks by diuresis. In six months after delivery, women approach their own bodyweight with an average surplus of 1.4 kilograms. After that they get to decide whether to keep the surplus or not.
Does that mean you are likely to get bigger and bigger after every childbirth? Fortunately, the weight gain over time is not necessarily related to the number of childbirths, but is mostly from the natural tendency to gain weight as you grow older. One more encouraging factor is that whether they were overweight before or during pregnancy does not affect how much weight they retain after childbirth. In other words, no matter how many children they have and how overweight they were, they have the same chance to get back in shape after childbirth.
Breast feeding is one of the best ways to lose weight as 500 to 750 kcal a day is required to produce milk. There are two pitfalls. First, obese mothers are less likely to breast feed than normal women. Second, women happen to eat more than they need to produce milk. I have witnessed many cases with a combination of both.
Remember one apple or a small cheese burger. That is all your baby needs.
The writer is a doctor at Maria Fertility Hospital in Seoul. For further questions, send an email to the writer at hyejunlee@mariababy.com, or call the hospital’s English-speaking coordinator at 82 (Korea country code) 2 (Seoul area code) 2250-5577, or visit the hospital’s website, https://eng.mariababy.com/.