Supporting Healthy Pregnancy Weight Gain

Pregnancy Weight Gain

Gaining the right amount of weight is important for fetal development and health. Gaining either too much weight, or not enough, is associated with increased risk to both mother and baby, and unfortunately, most moms-to-be are falling into one of these categories. According to a recent study by the Center for Disease Control and Prevention (CDC), 47% of women gain more than the recommended amount of weight, while 21% do not gain enough. That means only one-third of women are getting it right.

Pregnancy weight gain can be a very tricky area for many fitness professionals to manage, given client personalities and relationships, scope of practice, and so many issues that fall outside your control.  However, there are some simple strategies that can make a big difference.  Let’s start with getting the facts straight first about what healthy weight gain means.

Healthy Weight Gain Guidelines

The official guidelines for weight gain during pregnancy are provided by the Institute of Medicine.  The most recent guidelines (from 2009) for a single and twins pregnancy are summarized in the tables below.

Because only about 6-8lbs of weight goes to the actual baby, you may be wondering where all of the additional weight goes. The extra pounds are distributed throughout the body between the breast tissue, growing uterus, placenta, increased blood supply, and accumulation of extra maternal fat stores.

Note that weight gain throughout pregnancy will not be evenly distributed, and that every woman is different. During the first trimester, a weight gain of 3-5lbs can be expected, due to the increase in fluid and blood volume. However, some women do not gain – or even lose — weight during the first trimester, due to morning sickness.  Others may gain well above that due to increased hunger and sub-optimal food choices. Many women gain the bulk of their weight during their second trimester.  Often women will plateau — or even begin losing weight — around week 36, as the stomach becomes compressed from the large uterus, which makes eating very difficult.  Weight gain of more than 3lbs in one week may be a sign of excessive fluid accumulation.  If a woman notices this, she should immediately contact her OB/GYN.

Caloric Increase Guidelines

The increased caloric intake needed to support a pregnancy actually begins in the second trimester.  During the first trimester, energy (caloric) needs actually remain the same — even for a twins pregnancy — so she does not need any additional calories. Beginning in the second trimester, the metabolic demands of pregnancy require approximately 300 additional calories per day (more if the woman is exercising).  During the third trimester, this increases to about 450 extra calories per day — that’s total, not in addition to the 300 (Academy of Nutrition and Dietetics, 2014).  This is not much, and is equivalent to 1-2 additional snacks per day, along with an addition of 1-2oz of protein at meals – nowhere near the old saying of “eating for two.”  For women pregnant with twins, they’ll need an extra 500-600 calories per day, beginning in the second trimester (ACOG).

Tips for supporting clients who are gaining too much

This can be a very tricky area, and one you really have to approach with care on a client-by-client basis.  If your client is falling above the healthy weight gain guidelines (or approaching it), the first thing to understand is if she is even bothered by this.  Many women only think of excess weight gain as being an issue for postpartum weight loss (and they can worry about that later).  In these cases, gentle and factual education about the additional side effects of excess weight gain may be necessary.  Below are the facts, but you will need to determine how to frame these in the best way for the individual you’re working with:

  • Increased risk of pain and injury: The physical changes of pregnancy pull the body out of neutral alignment (tipping the pelvis forward into an excessive anterior tilt, shifting the center of gravity up and out, and rounding the shoulders).  All these shifts place increased stress and tension on certain muscles, and the greater the weight gain, the greater the alignment shifts and resulting risk of injury.
  • Increased risk of core damage: Along the lines of the above, a growing belly places a great deal of excess stress on the abdominal and pelvic floor muscles.  The more weight a woman gains, the more pressure she places on her core muscles, and the more likely she is to develop diastasis recti and pelvic floor dysfunction.
  • Loose skin and stretch marks that won’t return: While weight can be lost, and muscle can be re-gained, skin takes much longer to heal.  If stretched too far, it will likely not return to its pre-pregnancy state.
  • Increased risk to baby: Moms who gain too much weight put their babies at risk for being born with macrosomia (birth weight over 8lbs 13oz), experiencing health problems like diabetes, and becoming overweight or obese later in life.

If your client is aware her weight gain is an issue, and motivated to correct it, then your job becomes a bit easier!  Here are some tips you can provide to support her in managing excess weight gain:

  • Listen to your body! Just as she should be doing this when exercising, the same goes for eating.  Many women think they have to “eat for two” in order to ensure the baby gets enough.  Perhaps she uses a clock to time her meals more than her own hunger cues.  Make sure she understands the caloric needs of pregnancy listed above, and that it’s really more like eating for 1.1 instead of 2.  If she listens to her body, and eats only when she’s hungry, this can help her get into a more appropriate range.
  • Eat more protein and higher fiber foods: Protein and fiber create a longer sense of fullness to help her avoid overeating.
  • Eat smaller meals, regularly spaced throughout the day: Because blood sugar is lower during pregnancy, it’s best to eat smaller meals, regularly spaced throughout the day to avoid large fluctuations in blood sugar levels, which can cause feelings of ravenous hunger, and lead to overeating.  Smaller meals also help to reduce indigestion and heartburn.
  • Water! Water! Water! Dehydration can induce feelings of hunger, and lead women to overeat, so simply staying hydrated can reduce hunger. Hydration also aids digestion and elimination, and boosts metabolism. While juice hydrates, it also adds unnecessary calories and sugars (natural sugars are still sugar!).
  • Get adequate sleep: Encourage her to do this now while she still can!  Also not getting enough sleep can lead your body to feel hungrier.
  • Limit sugar, processed foods, and other empty calories: Sugary snacks and beverages contribute calories, but lack nutrients that mom and baby need. In addition, many processed and packaged foods have addictive qualities, due to the combination of high-fat content + salty, savory, or sweet flavors, which could also lead to overeating.  Instead, encourage your clients to stick with nutrient-dense foods.  While she shouldn’t eat for two, challenge her to try to get “nutrition for two,” making smart choices with her additional calories.
  • Keep moving! Daily activity is critical for avoiding excess weight gain.  Remind your clients this does NOT mean they have to hit the gym every day, but they DO have to get in some type of activity.  Explain the concept of N.E.A.T to your clients, and discuss strategies for how they can incorporate more of this into their day.

Tips for supporting clients who are not gaining enough

Remember that 21% of women are not gaining enough weight, and adequate weight is needed to support optimal fetal development.  Many fitness professionals ask about how to manage situations in which their pregnant client does not want to gain weight, or at least wants to gain far less than the recommended, due to appearance concerns or societal pressures.  This, of course, can be an equally challenging situation.

The best advice we can give in these situations is to tell your client (in the most supportive and encouraging way) “welcome to your first great maternal responsibility.”  In other words, welcome to life no longer being solely about what you want.  Becoming a mother is an awesome responsibility.  It is one of life’s greatest thrills, and also one of it’s greatest challenges — filled with sacrifices big and small.  Pregnancy is a unique and powerful stage of motherhood because your actions have such a direct impact on your child.  Encourage your client to treat this time with love and pride — doing her part to nourish her baby (and her own body) — to give her little one the very best start at life.  It’s a gift only a mother can give, and that’s pretty cool.