By Caroline J. Cederquist
Winter 2005-06
Got a baby on board? If you're not careful, you could be carrying extra cargo long after you've delivered.
That old adage about "eating for two" has misled generations of women into overindulging during pregnancy. And in recent decades, as people have been getting heavier in general, the temporary gains of pregnancy have more often become permanent for women.
It's not at all uncommon to meet women who never had a weight problem until they became pregnant, even if their first baby wasn't until they were into their 30s. We hear it all the time from female patients: "I just never could get the weight off again after my baby."
And if the weight sticks after a pregnancy, that story often holds true through several babies, with more and more gains. Overweight women also have higher risks for pregnancy and delivery complications, including pre-eclampsia and gestational diabetes. And that's to say nothing of how the maternal body chemistry of an overweight mom - with elevated blood glucose and likely insulin resistance - might affect the developing fetus. Researchers are exploring whether those factors might eventually make the child more prone to weight problems.
Studies have already shown that there's a high correlation between being overweight before pregnancy and ending up with that long-term additional weight gain after a pregnancy. Because of this, overweight women in many European countries are advised to gain less weight during pregnancy than healthy-weight women.
But that's not really a good idea for the little person who needs high-quality nutrition for the hard work of growing and getting ready to be born. You're supposed to gain some weight during pregnancy; there's a whole other person in there!
But a long-term study out of Sweden showed that the best indicator of whether a woman would have long-term weight problems was not whether she was heavy or not before her pregnancy or even how much weight she had gained.
Rather, it was whether or not she'd lost her excess pregnancy weight within the first year after the baby's birth that had the strongest correlation with long-term excess weight. After that one-year window of opportunity, the chances of a woman ever returning to her pre-baby weight dropped off dramatically. The more a woman took off in her first year following pregnancy, the more likely she was to be of healthy weight years later.
I see many women who come in for guidance with weight loss within just weeks of the baby's birth, and I often marvel at their determination. Having had three babies, I remember being wiped out just by caring for the new baby and dealing with the sleep deprivation, let alone trying to take on a new diet and exercise regimen.
But many more mothers fall into unhealthy patterns of inactivity once there's a baby to be looked after. And having grown accustomed to eating a little more, some women don't cut back to an appropriate eating-for-one level after birth. The study shows that getting back into healthy habits as soon as possible is key to avoiding that lifelong burden started by a pregnancy gain.
Of course, weight is like most health problems in that prevention is easier than a cure. If you're overweight and contemplating getting pregnant, think about bringing your weight down beforehand. Because of the serious risks to the baby that are associated with maternal obesity or diabetes, it's best to be at a normal weight before you get pregnant.
At any weight, it's critical during pregnancy to eat particularly well, but that doesn't mean eating a whole lot more. Because while a pregnant woman literally is "eating for two," it's important to remember that one of those two is a really, really tiny one.
Get plenty of fresh vegetables and good, low-fat dairy. The extra 300 calories a day a pregnant mom should eat could easily be accounted for with a morning snack of yogurt and fruit or by adding three glasses of milk to the daily intake.
And as soon afterward as you've started to normalize your schedule and get some good sleep, start getting your exercise and get right to work getting rid of that baby weight. Chances are awfully high that if you still have it after a year, you'll still have it even 15 years later.
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Caroline J. Cederquist, M.D., is a board certified bariatric physician and a nationally recognized authority on weight management. She is author of "Helping Your Overweight Child: A Family Guide," available at www.DrCederquist.com, Amazon.com or by calling 1-800-431-1579.