What is the recommended weight gain during pregnancy for a woman whose bmi is 23 before pregnancy?

In this video, a midwife discusses where the extra weight in pregnancy comes from.

By Lisa Rapaport, Reuters Health

(Reuters Health) - The majority of women gain too much or too little weight during pregnancy, putting both mothers and babies at an increased risk for complications, a review of past studies suggests.

Researchers examined data from 23 studies covering a total of more than 1.3 million pregnancies and found 47 percent of the time women gained more weight than recommended by the Institute of Medicine (IOM) - about 25 to 35 pounds for people who start out pregnancy at a normal weight. Another 23 percent of the time, women didn’t gain enough weight.

Too little pregnancy weight gain was associated with a higher risk of undersized and premature infants, while too much weight gain was linked to greater odds of oversized babies and cesarean section, or surgical, deliveries, researchers report in JAMA.

“Women are rarely aware of healthy weight gain targets in pregnancy and are not generally weighed or supported to reach them,” said senior study author Dr. Helena Teede of Monash University in Victoria, Australia.

“This clearly needs to change,” Teede said by email. “Based on the study results both mothers and babies are healthier with less complications like cesarean sections and less small or large babies if weight gain is within targets.”

Weight gain recommendations vary depending on women’s size when they become pregnant. Women who are underweight should gain 28 to 40 pounds, according to the IOM. For overweight women, a 15- to 25-pound gain is recommended and obese women should gain just 11 to 20 pounds.

To see how often women were below, within or above recommended weight ranges for pregnancy, researchers assessed weight gains across all of the pregnancies based on women’s pre-pregnancy body mass index (BMI), a measure of weight relative to height.

An adult who is 5 feet 9 inches tall and weighs from 125 to 168 pounds would have a BMI of 18.5 to 24.9 and be considered a healthy weight, according to the U.S. Centers for Disease Control and Prevention. An obese adult at that height would have a BMI of 30 or more and weigh at least 203 pounds.

Compared with women whose weight gain fell within a range recommended by the IOM, women who added too few pounds during pregnancy were 70 percent more likely to have premature deliveries and 53 percent more likely to have babies that were small for their gestational age, the study found.

Too little weight gain didn’t appear to influence their risk of a cesarean section, and it was linked to lower odds of having overweight babies or infants whose shoulders got stuck in the birth canal during delivery.

But compared with women who gained a recommended amount of weight, women who added too many pounds were 85 percent more likely to have babies that were large for their gestational age and 30 percent more likely to have cesarean deliveries.

The study wasn’t a controlled experiment designed to prove how the amount of pregnancy weight gain influences specific health outcomes for mothers or babies.

Another limitation is that the individual studies had inconsistent definitions for certain outcomes like underweight or overweight infants or preterm deliveries, the authors note. Researchers could not always distinguish, for example, between a scheduled or elective cesarean delivery and an emergency surgery, and they couldn’t tell when preterm births occurred naturally or were induced.

The analysis also included studies published both before and after the IOM weight gain guidelines came out in 2009, and weight gain targets may have differed across the studies, the authors point out.

Even so, the findings confirm and strengthen results from many smaller studies suggesting that many women gain more than the recommended amount of weight during pregnancy, said Dr. Aaron Caughey, chair of obstetrics and gynecology at Oregon Health and Science University in Portland and author of an accompanying editorial.

“Even in individuals who might normally eat reasonable amounts, the hormones of pregnancy often lead to greater food consumption,” Caughey said by email. “Because of this ready availability of high caloric foods, it is easy to gain too much weight, which is the most common outcome.”

SOURCE: bit.ly/2sPc0qS and bit.ly/2qXSpIR JAMA, online June 6, 2017.

Our Standards: The Thomson Reuters Trust Principles.

Healthy eating, controlled weight gain and regular physical activity during pregnancy can keep you and your baby healthy during pregnancy and birth and after birth too.

In fact, staying healthy in pregnancy is good for your child’s health much later in life. For example, it cuts the chance of your child having diabetes, obesity and heart disease during childhood and even adulthood.

If you’re overweight and want to get pregnant
Being in the healthy weight range can improve your chances of getting pregnant. One of the best things you can do is lose some weight before you start trying to get pregnant.

If it’s too hard for you to get to the recommended weight range, even a small weight loss can help a lot. If you can lose 5-10% of your body weight now (for example, 5-10 kg if you weigh 100 kg), you’ll reduce your chance of health problems and complications during pregnancy. For example, you’ll have lower blood pressure, which reduces your chance of pre-eclampsia .

It’s best to talk with your doctor about a healthy weight for your body and ask about the best weight management options for you.

If you’re overweight when you get pregnant
Paying attention to what you eat, how active you are, and how much weight you gain during pregnancy can help you and your baby stay healthier.

Women who are overweight can safely gain less weight in pregnancy. Talk to your doctor or midwife about healthy weight gain during pregnancy.

Practical tips for a healthy pregnancy

Focus on important foods
Rather than concentrating on what you shouldn’t be eating, focus on healthy foods.

Eat:

If you’re filling up on good foods, you’ll be less hungry and less likely to choose unhealthy foods.

Eat small meals regularly
This can help you with healthy weight gain and pregnancy issues like morning sickness and heartburn. Eating regularly also boosts your metabolism, helps to steady your blood sugar levels, and stops you from getting too hungry and overeating foods with too much sugar and fat.

Skipping meals won’t help you with healthy weight control.

Drink plenty of water
Water is the best drink for good health. Aim for at least 6-8 glasses a day. It can help to keep a bottle or glass of water handy.

Flavoured milks, soft drinks and juices can cause extra weight gain because of the high amounts of sugar they contain.

Avoid the cravings trap
It can be easy to start eating a lot of chocolate, chips, ice-cream, lollies, flavoured milks, biscuits or cakes in pregnancy and write them off as pregnancy cravings.

Keeping these foods out of your cupboard has health benefits for the whole family, not just you. It’s also a good way to set up healthy habits for your children.

Be organised
Planning and preparing meals and snacks in advance helps you make healthy food choices.

Writing a dinner menu for the week makes shopping and cooking easier. And when you stock your cupboard and fridge with grainy crackers, fruit, wholegrain bread and salad ingredients, you’ve always got a healthy snack or lunch handy.

Reward yourself with non-food treats
Pregnancy isn’t always easy, so it’s normal to want a few rewards. The trick is looking for treats that don’t involve food!

Instead, you could treat yourself to a movie, a phone call or catch-up with a friend, or a massage from your partner or another support person.

Be active
It’s recommended that pregnant women do at least 2½ hours of moderate exercise a week, unless your doctor or midwife tells you something different. To get this amount of exercise during pregnancy, try exercising for at least 30 minutes a day, 5 days a week.

If you weren’t exercising before your pregnancy, that’s OK. It isn’t too late to start if your midwife or doctor says it’s all right. You can start with light exercise and build up to moderate exercise.

Walking or swimming are both good choices. It doesn’t have to be 30 minutes all at once – you could break it up and do three 10-minute walks each day.

You can also add activity to your normal routine by:

• getting off the bus earlier, walking the long way around, or taking the stairs
• walking instead of driving
• including physical activity when you catch up with friends – for example, you can chat as you walk.

Set yourself goals
It’s best to be specific. For example, you could say, ‘I’ll eat vegies with lunch and dinner every day this week’. If you set a goal that you can measure, you’ll know whether you’re achieving it.

Get support
Many health services and maternity hospitals around Australia have dietitians and extra support for women who are overweight. Ask your doctor or midwife what’s available in your area.

Setting goals with others can make it easier for you to reach your goals. For example, you could try preparing healthy meals and exercising with family and friends.

Many women find tracking their progress can motivate them to make healthier choices about eating and exercise during pregnancy. Your doctor or midwife can recommend some online resources or smartphone apps.

What is overweight?

Body mass index (BMI) identifies healthy, overweight and obese weight ranges. Your BMI is based on your weight and height.

You can use a simple BMI calculator to find out which weight category you fall into. It’s best to use your pre-pregnancy weight.

Healthy weight gain during pregnancy
Your recommended weight gain range for pregnancy will depend on what your BMI was before you became pregnant.

The Australian Dietary Guidelines recommend that:

• healthy-weight women (BMI 18.5-24.9) gain 11.5-16 kg
• overweight women (BMI 25-29.9) gain 7-11.5 kg
• very overweight or obese women (BMI over 30) gain 5-9 kg.

For women whose BMI is very high (over 40), many doctors say they should gain less than 5 kg in pregnancy.

Some overweight and obese women will lose weight in pregnancy too. This can be safe, as long as you’re eating well and being closely checked by your doctor or midwife at your antenatal appointments.

Checking your weight during pregnancy
If you start pregnancy above a healthy weight range, your weight should be checked at each antenatal appointment. If it isn’t, it’s a good idea to ask to be weighed or create a simple chart to track it yourself.

At your appointments, you can also ask about:

• why you’ve gained a certain amount of weight
• how to reduce weight gain in pregnancy
• what you can do to stick to your recommended weight gain – for example, healthy food alternatives
• how other things in your life might be affecting your weight.

Risks of overweight or obesity during pregnancy

Many overweight women have healthy pregnancies and babies. But there are health risks linked with being overweight or obese in pregnancy.

These risks increase if you gain too much weight while you’re pregnant. The higher your pre-pregnancy BMI and/or the more weight you gain, the higher your risk of health problems or complications.

These are some of the risks linked with being overweight or obese and/or gaining too much weight during pregnancy:

• Gestational diabetes: this is raised blood sugar levels in pregnancy, which can affect your short-term and long-term health and your baby’s. Most women are offered a test for gestational diabetes at 24-28 weeks of pregnancy or earlier. If you have a family history of diabetes or a BMI over 30, you have a higher risk of getting gestational diabetes.
• Labour and birth complications: women who are overweight or obese are more likely to have induction of labour and longer labours. They have a higher chance of needing birth interventions, including caesareans , and a higher chance of birth complications like shoulder dystocia.
• Medical complications: these complications include problems with managing pain during and after the birth – for example, it can be harder to get women’s bodies and medical equipment into the right position, and harder to keep pain relief going. There’s also an increased risk of bleeding straight after the birth, pre-eclampsia, sleep apnoea, longer wound healing time after caesarean, and postnatal depression.

If you do what you can to stay healthy and stick to the recommended weight gain guidelines for pregnancy, you’re less likely to have these health complications.

Staying healthy after birth

It’s important to keep eating well and doing moderate physical activity after the birth. This will give you more energy to care for your new baby.

There are a couple of other ways to get to a healthy weight.

Breastfeed
Breastfeeding combined with a healthy diet can help with weight loss after birth because it burns extra calories. Breastmilk is all your baby needs up until around six months.

Plan for weight loss
It’s a good idea to plan for losing weight once you’ve recovered from birth.

In the early weeks after birth, you can begin by just walking with your baby in a pram, baby carrier or sling. You could also join a community-run or private weight loss group or use a gym that offers child care. Many early childhood centres run free walking or exercise groups for new mothers.

Your GP, dietitian or child and family health nurse could help with ideas and contacts, or you could look online for weight loss or exercise groups near you.

Weight control: other things to consider

Weight control is a complex issue.

Your mood and emotions can affect your ability to eat healthy food and be active. If you’re not getting enough sleep, it can be harder to eat well too. Physical symptoms like back pain can also get in the way of exercise.

Talking to your doctor or midwife about these issues and getting support can help you work out what’s affecting your eating habits and lifestyle. They might raise some of these issues in your antenatal appointments. But if the issues don’t come up, it’s a good idea for you to ask.

Your body image might also change in pregnancy. You can talk to your doctor or midwife about changes in your body and how you feel about these changes.

Where to get help with weight management

You can get help with and motivation for healthy living and weight loss from: