If you’re among the roughly 75 percent who are overweight in this country or among the approximately 40 percent who are obese, the odds are in your favor of having a safe pregnancy and delivering a completely healthy baby.
Still, carrying more weight than is medically recommended while you’re expecting puts you at higher risk for certain pregnancy complications, including preterm birth, preeclampsia and hypertension.
But there’s good news: By working with your doctor, you can learn more about your unique situation and take steps to increase your chances of having a healthy pregnancy.
To help you on this journey, it’s important to understand what the number on the scale actually means for you, and from there you can craft a smart plan.
Understanding your BMI
Learning your body mass index (BMI) and how it’s calculated is a good first step to figuring out how much weight you should aim to gain during pregnancy along with your recommended caloric intake.Your BMI is an approximation of body fat based on height and weight.
The National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC) have BMI calculators that can quickly determine your number, but your doctor should do it at your first appointment, when he or she will also confirm which of the following categories you fit into:
- Underweight: a BMI that’s less than 18.5
- Normal: a BMI of 18.5 to 24.9
- Overweight: a BMI of 25 to 29.9
- Obese: a BMI that’s greater than 30
Once you know your BMI, you’ll have a better idea of how much weight you’ll need to gain to best reduce your risk of pregnancy complications and protect your own health.
Here are some weight gain guidelines from the Institute of Medicine (IOM) and World Health Organization (WHO) that are based on your pre-pregnancy BMI:
More About Pregnancy Weight Gain
- Overweight: Gain 15 to 25 pounds throughout pregnancy, with just over half a pound per week in the last trimester.
- Obese: Gain 11 to 20 pounds, with half a pound a week in the last trimester.
- Pregnant with twins: Gain 31 to 50 pounds if you’re overweight and 25 to 42 pounds if you’re obese.
What happens at your first appointment when pregnant
Wondering when to make your first doctor’s appointment? It’s a good idea to schedule it as soon as your pregnancy test comes back positive. The earlier you can get your first ultrasound, the better. This will help date your pregnancy and give you a sense of when your baby will be due.
Bear in mind that if you’re overweight, it may be tougher to date your pregnancy accurately for two reasons. First, ovulation is often more irregular in obese women. And second, it may be harder to measure your baby using an ultrasound, which is the traditional way practitioners estimate gestational age.
Your doctor may also test you for gestational diabetes (GD) early on because being overweight increases your risk. If you test positive, you’ll need to monitor your blood sugar at home. If not, your doctor will check your blood pressure and look for protein in your urine at every checkup — and you’ll likely receive a second test later in pregnancy.
At this point, it’s also smart to consider the relationship you have with your practitioner and his or her willingness to help you with your healthy living goals. If you think you’re experiencing weight bias, make a change. You deserve the best possible care — so get recommendations and note that if you switch OB/GYNs, do so in the first trimester if possible, since some doctors may not accept patients later on.
Risks and complications of being overweight and pregnant
It is possible to have a healthy pregnancy if you’re overweight or obese. However, you and your baby are at higher risk of some conditions and complications, including:
- Macrosomia. This condition results in a larger-than-normal baby at birth.
- C-section delivery. Cesareans are more common if you’re obese, and the surgery and recovery can be more complicated.
- Preterm birth. A baby born before 37 weeks of gestation is considered preterm.
- Gestational diabetes. Gestational diabetes is a type of diabetes that appears only in pregnancy. It affects up to 9 percent of expecting women.
- Hypertension. Hypertension is another name for high blood pressure. A systolic reading at or above 140 or a diastolic reading at or above 90 is considered high blood pressure during pregnancy.
- Preeclampsia. This condition is characterized by a sudden onset of high blood pressure, and it can be serious if left untreated.
- Obstructive sleep apnea. These abnormal pauses in breathing while you’re asleep can make you feel tired during the day and cause other complications.
- Birth defects. Fetal brain and heart defects are possible, including neural tube defects.
- Stillbirth. Sadly, the higher your BMI, the greater your risk of stillbirth.
While you’re pregnant, you may find that it’s difficult for your practitioner to measure the fetus’ size and position and harder for you to feel those first kicks. Pregnancy weight gain can also amplify symptoms like backache, varicose veins, swelling and heartburn.
Daunted? Don’t be. There’s plenty you and your practitioner can do to minimize the risks to you and your baby and ease discomfort. Eliminating all pregnancy risks that are within your control, such as drinking and smoking, is particularly important. Ask your doctor fortips too.
Is it okay to lose weight during pregnancy?
Pregnancy is not the time to lose weight even if you were already overweight or obese, according to the American College of Obstetricians and Gynecologists (ACOG). Instead, losing even a small amount of weight before you conceive can up your odds of a safer pregnancy.
Several studies have shown that overweight pregnant women who gain less than the recommended amount of weight do not experience any negative effects on fetal growth and development. They also had a lower risk of C-sections and macrosomia — plus they retained less weight postpartum.
Bottom line: If you’re overweight or obese, it’s a good idea to talk to your doctor about the best amount of weight gain for you, which might be less than the standard amount.
Maintaining a healthy diet
The foods you eat are also what your baby needs to develop, so maintaining a wholesome diet is one of the most important ways to have a healthy pregnancy. You’ll need foods that are good sources of vitamins, minerals and protein.
These tips can help get you on the healthiest eating path possible:
- Check out MyPlate.gov. This site from the U.S. Department of Agriculture (USDA) offers a customized personal fitness and nutrition program based solely on your needs and can complement your doctor’s recommendations.
- Talk to a registered dietitian. A nutritional professional can help you create a meal plan each week and give suggestions on which foods you should prioritize. By seeing someone regularly, you’ll likely feel more accountable for your food choices. Most dietitians ask that you log what you eat!
- Drink plenty of water. Research has shown that 1 in 4 Americans consumes at least 200 calories daily from sugary drinks. Simply replacing soda and other sugary beverages like juice with water is a great place to start.
- Fill up on fiber. Fiber-rich foods — including yellow and green veggies, fruit and whole grains like brown rice and whole wheat bread — will make you feel full. Bonus: They ease many pregnancy complaints including constipation, hemorrhoids and bloating.
- Go low-glycemic. Eat plenty of lean meat and poultry, vegetables and fruits (especially the dark green, red or orange kinds), along with healthy fats (like salmon and avocados) — all of which are low-glycemic. Unlike higher-glycemic foods like white bread, rice and potatoes, low-glycemic foods don’t spike your blood sugar levels as much.
- Stock your kitchen. Fill your pantry and fridge with plenty of nutrient-dense pregnancy foods. This makes opting for the right meals a lot easier.
- Make smart substitutions. Look for more places to add veggies, fruits and other good-for-you foods to your meals — like piling berries on your morning yogurt, ordering your sandwich with extra spinach or dipping baby carrots into hummus for your afternoon snack.
- Keep a food diary. Recording your breakfast, lunch, dinner and snacks every day may help you stay on track, especially since you might have to eat more frequent but smaller meals. Six mini-meals a day are often recommended for pregnant women instead of three large meals.
- Take your prenatal vitamin. It can be challenging to get all the nutrients you need, but a prenatal vitamin provides some extra insurance. This vital pill contains vitamin D and folic acid, two critical nutrients for healthy fetal development.
- Avoid appetite suppressants. Pills and beverages that claim to suppress your appetite can be dangerous during pregnancy, so keep them off the menu. Even after you deliver, always check with your practitioner before taking any OTC or prescription appetite suppressants.
- Don’t beat yourself up. No single food or meal can ruin your eating plan, so go easy on yourself. There will be more opportunities to make healthy choices.
Getting or staying active
If you weren’t active before, pregnancy is excellent motivation to get moving — and there are multiple benefits to be gained. Exercising during these nine months:
- Decreases constipation and swelling
- Helps ease back pain
- Increases your energy
- Makes you feel more positive (thanks to endorphins released during physical activity)
- Promotes better sleep
- Prepares your body for labor by increasing your muscle tone, strengthening your core and boosting your endurance (all of which will come in handy when you’re pushing!)
Start with five minutes of exercise every day, and add five minutes every week until you build up to the recommended 30 minutes per day (unless your doctor recommends otherwise).
Good exercise options include:
- Brisk walking
- Swimming, which is easy on the joints
- Prenatal yoga
Even little bursts of extra movement throughout the day can help you hit your goal. A few ideas:
- Take the stairs instead of the elevator.
- Get off the bus or subway one stop early and walk the rest of the way.
- Park at the farthest spot from the grocery store.
- Spend half your lunch hour eating and the other half walking around the neighborhood.
- Find a quiet spot during the day for a few prenatal yoga poses.
Sleeping better
A good night’s sleep helps your body stay healthy and may reduce your risk of certain pregnancy complications.
If you think you might have obstructive sleep apnea, be sure to tell your doctor, since the condition may also increase your risk of developing conditions like gestational diabetes, preeclampsia and hypertension. Your practitioner may recommend:
- Using pillows to prop yourself up into a more upright position
- A mouthpiece to keep your airways open while you sleep
- Continuous positive airway pressure or CPAP, which is a face mask hooked up to a small machine that blows air continuously at a set pressure
Staying motivated during an overweight pregnancy
It can be difficult to stay motivated, especially when you’re just getting started with a new diet and fitness plan when you’re pregnant. Fortunately, there are lots of little steps that can make your new lifestyle easier:
- Join a support group. Some groups are geared specifically toward overweight pregnant women. Your local hospital or OB/GYN may offer groups where you can make friends with other women and get support.
- Involve your family. Your partner, family and friends can not only provide extra motivation, but involving them in your goals helps everyone stay healthier.
- Work out with a friend. Taking a walk or a class together offers extra incentive to get out the door — plus it makes any activity more fun.
- Take a prenatal class. In workout classes such as prenatal yoga, you’re around other women who share your same goal (a healthy baby!), which can be inspiring.
- Give yourself an extra incentive. Save your favorite music, TV shows or podcasts and indulge during your workout sessions.
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