Whether you're planning a pregnancy, entering your second trimester with your first baby, or contemplating having a third baby, you've likely thought about the weight gain—and looming struggle to get it off afterwards—at least a few times. And, if you're starting out with even a few extra pounds on your frame from the last pregnancy, as many moms already are, the physical and emotional toll on your body can be a daunting one.
You've probably heard that too much weight gain during pregnancy can lead to an increased risk of developing gestational diabetes, but you're also more at risk for hypertensive disorders of pregnancy—which could be gestational hypertension or a preexisting condition called preeclampsia. In its most severe form hypertensive disorders of pregnancy can lead to earlier delivery, says Celeste Durnwald, MD, assistant professor of Obstetrics and Gynecology at the Hospital of the University of Pennsylvania.
Excessive weight gain during the pregnancy can ultimately lead to a bigger baby, whether that's a 'large for gestational age baby' (measuring over the 90% percentile) or fetal overgrowth, says Dr. Durnwald. "Oftentimes women don't feel a large baby (over 8.8 pounds) is a major problem, but if you have a large baby it could alter the mode of delivery...and put the baby at risk for other problems."
Dr. Durnwald says larger infants may have problems with low blood sugar or other metabolic abnormalities after delivery, and it can lead to a longer stay in the hospital. "Our pediatric colleagues say that babies who are born larger and have more fat mass are at an increased risk for childhood metabolic problems like type 2 diabetes and obesity."
So what's a reasonable rate to gain each week? Helain Landy, MD, professor and chair, Department of Obstetrics & Gynecology, and fellowship director, Division Director at MedStar Georgetown University Hospital in Washington, D.C., says she recommends the common sense approach. "For normal-weight patients, ideally they should gain 25-35 pounds, and for 40 weeks in a pregnancy, that's usually a pound or a half pound per week.
"Pregnancy is a time when women want to do the right thing for the developing baby. And when they are a mother they want to do the best thing," says Dr. Landy. It's a good time to hit home important components, like restricting alcohol, taking your vitamins, developing a balanced diet, and getting regular exercise if you're able to.
To help you have the healthiest pregnancy you can—for you and your baby—practice these tips from our experts:
Dr. Durnwald recommends 30 minutes of light exercise like walking or swimming three days a week for the physical health benefits. Unless you're experiencing a complication like placenta previa or bleeding, you should be able to continue your pre-pregnancy exercise routine. If you weren't active before you conceived, you can still start now. Stay motivated by making a walking date with another pregnant friend or your partner. Or, take the kids on a walk to go play at the park. "Even if you can sustain exercise for at least 10 minutes, you're getting a benefit," says Dr. Durnwald. "You can still see some benefits from the natural release of insulin with exercise after 15 minutes."
Both doctors recommended meeting with a nutritionist or taking a nutrition class so you have more tools for living a healthy lifestyle.
Those extra 300 calories might only look like a granola bar and piece of fruit. Remember, it's better for your baby if you're taking in healthier foods rather than a pint of ice cream.
Dr. Landy recommends you really take a look at what you're eating and drinking during the day. "Some patients might be having a glass of orange juice in the morning and a glass of apple juice at lunch. I tell them that the juice is full of sugar, and suggest they eat the orange or apple and drink the equivalent of water. It's better for you, has fewer calories and keeps up your fluid intake up."
If you've gained the highest recommended weight already and you're only at 28 weeks, you can still adjust your trajectory, says Dr. Durnwald. "You can at least control the amount of weight gain at this point. I'll tell patients, 'Let's only gain a pound a week, or a half a pound a week (for an obese woman)—that should be our focus now. We can't do anything about the first five months, but we can still do something.' It's important to build the mom up because she might feel frustrated or defeated. If you feel negatively about yourself it can impact your eating, exercise habits, and our motivation with everything else."
We know this is easier said than done but both experts stress the importance of beginning a pregnancy at a normal weight for a less-complicated pregnancy. Ideally, you should have a body mass index (BMI) of between 19.8 and 26 prior to conception.