Commentary: Obese women should gain less in pregnancy

On 01.07.10, In Pregnancy after WLS, By Andrea

An opinion piece.

From Medical News Today:

Commentary: Obese Pregnant Women Should Gain Less Weight Than Currently Recommended

Recent recommendations by the Institute of Medicine (IOM) call for women who are overweight or obese to gain more weight than they should, a Saint Louis University obstetrician wrote in a January commentary for Obstetrics & Gynecology.

Joined by several colleagues, Raul Artal, M.D., chair of the department of obstetrics, gynecology and women’s health at Saint Louis University who has conducted extensive research on weight gain during pregnancy, did not endorse the IOM’s May 2009 recommendation. The IOM, a non-governmental, independent, nonprofit organization, provides advice that is designed to improve health to national decision makers and the public.

“The recently published IOM recommendations for gestational weight gain are virtually identical to those published in 1990 with one exception: obese women are now recommended to gain 11 – 20 pounds compared to the previous recommendations of at least 15 pounds," Artal said.

“Recommending a single standard of weight gain for all obese classes is of concern since higher BMI levels are associated with more severe medical conditions and have long-term adverse health implications."

Artal recommended obese women eat a nutrient-rich diet of between 2,000 and 2,500 calories a day, which would cause them to cap their weight gain at 10 pounds, and in some cases, lose weight.

Under a doctor’s guidance, he said, obese pregnant women can safely engage in physical activities and modify their diets to successfully limit their weight gain with no harmful effects on the fetus.

When obese women reduce the amount of weight they gain, they also cut their risk of developing complications such as gestational diabetes and preeclampsia. By contrast, obese women who gain too much weight increase their risk of developing these conditions who affect both mother and fetus.

Artal called excessive weight gain during pregnancy a significant contributor to the obesity epidemic.

“Excessive gestational weight gain has been implicated in an intergenerational vicious cycle of obesity as overweight and obese mothers give birth to big daughters who are more likely to become obese themselves and deliver large infants," he said.

Pregnancy is an ideal time for women who are obese to exercise and watch what they eat, Artal added. These lifestyle changes are safe and carry benefits that last long after they have given birth, Artal added.

“Similar to smoking cessation programs, pregnancy provides a unique and ideal opportunity for behavior modifications given high motivation and enhanced access to medical supervision," he said.

“Limited weight gain in obese pregnant women has the added potential for setting the foundation for a healthier lifestyle over a woman’s lifespan."

Artal led the team of obstetricians who drafted the American College of Obstetricians and Gynecologists’ guidelines for exercise during pregnancy. He was joined in writing the commentary by Charles Lockwood, M.D., chair of the department of obstetrics, gynecology and reproductive sciences at Yale University School of Medicine and Haywood Brown, M.D., chair of obstetrics and gynecology at Duke University Medical Center.

Popularly known as “The Green Journal," Obstetrics & Gynecology is the official publication of the American College of Obstetricians and Gynecologists.

Established in 1836, Saint Louis University School of Medicine has the distinction of awarding the first medical degree west of the Mississippi River. The school educates physicians and biomedical scientists, conducts medical research, and provides health care on a local, national and international level. Research at the school seeks new cures and treatments in five key areas: cancer, infectious disease, liver disease, aging and brain disease and heart/lung disease.

Source: Saint Louis University Medical Center

http://www.plus-size-pregnancy.org/firstindex.html

http://www.drbrewerpregnancydiet.com/id68.html

It is perfectly safe for obese women to diet during pregnancy previded they have an adequate intake of protein and of all the essential elements of good nutrition. However, it is much more important for the obese woman to eat a good adequate diet than it is for her to lose weight during pregnancy. It is necessary for the physician and his patient to place the primary interest on good nutrition, since the obese woman may have poor dietary habits; weight reduction must be looked on as a secondary and less important goal.

Yeah, I ate about 1600 calories a day while pregnant and still put on almost 20 lbs. I can't imagine what i would have gained eating 2,500 calories a day!

I think our bodies change with the gut rerouting.

But I would have digusted him -- I gained 60 with both pregnancies.

I am eating 1500 calories a day....started monitoring the cals last week.....I have gained 2lbs!!!

Without monitoring....I gained 3lbs in the month of December.

Someone needs to inform my body to listen to these recommendations!

According to the Dr. Brewer info referred to earlier, if a pregnant woman gets as little as 1700 calories a day, she will burn 1/2 of her protein intake to replace the calories that she is not getting.  When this happens, she will get only 45 of her 90 grams of protein (if she's eating that much) to use for blood building (blood volume needs to increase by 60%), uterus building (uterus needs to add 1 lb 14 oz of new muscle tissue), and baby building.  Since the primary cause of pre-eclapmsia is low blood volume, restricting the calories in pregnancy could easily trigger the pre-eclampsia syndrome process.  And if the uterus does not get the opportunity to grow enough new muscle cells, this could lead to a uterine dysfunction during labor, creating a need for pitocin or other interventions that otherwise might have been avoided with a more adequate calorie intake.
I hope that this helps.
Joy