Pregnant Women: Eating Well Means Eating Wisely

Taken from an article printed in Ob/Gyn News by Dr. E. ALBERT REECE, M.D., PH.D., M.B.A.
DR. REECE, who specializes in maternal-fetal medicine, is vice president for medical affairs at the University of Maryland, Baltimore, as well as the John Z. and Akiko K. Bowers Distinguished Professor and dean of its school of medicine. He said he had no relevant financial disclosures.

To help women control weight gain during pregnancy, I try to be both pragmatic and practical.

The latest Institute of Medicine guidelines on weight gain during pregnancy issued in 2009 recommend that women with a body mass index of 18.5-24.9 kg/m2, should gain between 25 and 35 pounds during pregnancy. Those who are underweight (with a BMI of less than 18.5 at the time they conceive) should gain more, between 28 and 40 pounds. However, for women who are already overweight at the beginning of pregnancy (with a BMI of 25–29.9), the weight gain recommendation is between 15 and 25 pounds.

Although I typically recommend that pregnant women gain somewhere in the 20-pound range, many women find gaining so little quite a challenge. This is natural. After all, pregnancy is a time when most women are hungrier than usual and want to eat more often than usual. These new mothers also hear all kinds of “good” advice from their friends and other women in their family such as “You’re eating for two now,” and “You’re growing a baby; this is no time to start on a diet.” It can be very hard for a woman’s physician to counteract such messages from family and friends.

The truth is, the baby is probably going to weigh around 7 pounds or so. Therefore, if a woman is gaining 30 or 40 pounds, such a gain in weight is way in excess of the weight of the baby, the placenta, and all the extra fluid combined. Gaining that much weight makes it that much harder to lose after giving birth.

The group that usually gets the most attention with regard to weight gain is the group of women with diabetes or gestational diabetes. They usually get nutritional counseling, assistance in choosing an appropriate diet, and information about glucose control. The American Diabetes Association recommends that women with gestational diabetes – and women who are just gaining more weight than you’d like – restrict carbohydrate intake to 30%–40% of their daily intake. By doing this they will at least slow the trajectory of weight gain. For those women who are diabetic, restricting carbohydrate intake also will allow them to see a lowering of their blood glucose.

Every pregnant woman needs to eat well. What they may not recognize, however, is that eating well doesn’t mean eating more – it means eating wisely. Furthermore, most women come into pregnancy without healthy eating habits. These habits are already part of their nature, so the best we can do is to try to moderate them.

On the other hand, pregnancy is a very good time to try to improve a woman’s eating habits. Indeed, there are very few other times in a woman’s life when she will be so motivated to change her health habits as when she’s pregnant. Even smokers will quit then – although they may start back up after the baby is born. But during pregnancy, not only the mother, but the entire family is invested in bringing this child into the world as healthy as possible.

When it comes to this issue, I try to be practical. You can’t expect people to change their entire lifestyle immediately. Also, I try to take a pragmatic approach that focuses on changing a few things at a time.

Food

Instead of telling women to “eliminate, eliminate, eliminate,” I encourage them to be thinking all the time about what they do eat. Decreasing carbohydrates in line with the national recommendations of no more than one-third of the daily calories is a good idea for everyone. Protein, on the other hand, is food the body can’t store. So I advise women to increase their protein intake because it has a filling effect and lowers carbohydrate intake as well.

At the same time, they can significantly increase their intake of vegetables and fruits, including salads, while watching the salad dressing. Pregnancy is also a time of slower gastrointestinal motility and constipation. Eating more vegetables – in particular raw vegetables – can cut down on intestinal transit time and help with constipation.

Liquids

Water is the best drink for a pregnant woman. They may tell you they’re consuming a lot of fruit juice. However, most of these juice drinks are full of carbohydrates in the form of sugar. Even though “naturally” unsweetened juices are a better choice, they still have a lot of calories and carbohydrates in them.

As for soft drinks – the more pregnant women avoid them, the better. They are full of sugar and are really unhealthy for anyone, especially women with diabetes.

Again, if you only counsel women to “eliminate, eliminate, eliminate,” they probably won’t do it. My pragmatic approach is to have women limit, instead of eliminate. So I say, “Try to drink more water, less soda, and unsweetened fruit juice only in moderation.”

Exercise

Exercise can be beneficial for anyone, and any woman who has been in the habit of exercising can continue. But exercise should not be a new sport you take up when you get pregnant. If pregnant women are new to exercise, it’s better to concentrate on the upper body rather than the lower, because these women don’t have an exercise-related established physiology of improved blood flow. Intense lower body exercise for these women can compromise blood flow to the fetus.

I would say that the average woman with moderate exercise habits can continue to exercise for a moderate duration at a moderate intensity and without excessive fatigue. As far as when to stop as the pregnancy advances, I use my clinical judgment. As long as the baby is growing well and there are no signs of premature labor, exercise can continue. There really is no a priori time that she must stop.

Women who have exercised vigorously much of their life – athletes and dancers, for instance – can usually continue to do so until the time of delivery. If the pregnancy is showing any signs of not progressing well, however, they should stop exercising immediately. On the other end of the spectrum are women who should not be exercising at all during pregnancy. These are the women who have a history of preterm labor or are showing signs of it, as well as those with some underlying disease.

Women with hypertension or some kind of vessel disease – like severe varicose veins or vasculitis – should not be exercising at all. With vessel disease, as the demands on the heart increase during exercise, blood will be shunted way from the fetus and could truly compromise the flow into the placenta. Sometimes these babies will experience decreased heart rates during exercise.

Some mothers have heard that certain exercises during pregnancy will make for an easier labor and delivery. There may be some truth to this, as women who are exercising before they get pregnant tend to have a lower incidence of large-for-gestational-age infants – and in that regard, they may have less difficult deliveries.

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