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Pregnancy Weight Gain - When Should My OB Be Concerned?

by Dianna Graveman
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Most pregnant women will agree that one of their least favorite parts during pregnancy checkups is stepping on that scale. Are you gaining enough? Too much? Too little? Why and when should your doctor become concerned, and when should you?

Women who gain too many pounds during pregnancy may have a larger baby that is difficult to deliver, increasing the possibility of a necessary C-section. Serious complications for the mother can occur, like gestational diabetes, hypertension, and varicose veins. Sometimes, the birth must be induced before the due date to avoid risks to mother and baby.

Your doctor may even be concerned that you will develop health issues that will continue after your pregnancy ends. Research has shown that mothers who don't lose most of their pregnancy weight during the first six months will likely still carry that extra weight a decade later. Obesity can lead to lifelong health issues like heart disease, high blood pressure, hemorrhoids, joint pain, diabetes--and even depression.

Even if you are able to lose the weight after giving birth, you are much more likely to have a positive birth experience if you begin the process at a healthy weight. And while you're pregnant, too much weight can cause back pains, joint pain, excessive heartburn, and exhaustion, all of which can contribute to an unhappy and unhealthy pregnancy--something nobody wants.

Gaining too few pounds carries hazards, too. Women who watch their weight a little carefully carry a greater chance of delivering a premature baby or a baby with low birth weight. The baby could even be born malnourished. However, your health care provider will probably not be too concerned if you don't gain weight during the first trimester--or even if you lose a little bit due to morning sickness. Your baby does not need as many calories and nutrients as she will later in the pregnancy, and this very early lack of weight gain will probably effect her development.

So when should your doctor be concerned? How much is too much or too little?

According to WebMD, a woman should plan to gain about 2 to 4 pounds during the first trimester and about one pound a week for the rest of the pregnancy. That calculates for a woman of average weight to about 25 to 35 pounds. Mothers of twins should expect to gain 35 to 45 pounds, or an average of 1 1/2 pounds each week after the first trimester.

The American Pregnancy Association suggests you ask your health care provider to help you determine your body mass index (BMI), which is based on both height and weight. If you are of average weight with a BMI of 18.5 to 24.9 before pregnancy, you should gain 25 to 35 pounds. Underweight women, with a BMI of less than 18.5, should gain about 28 to 40 pounds, according to the association, and overweight women, with a BMI of 25 to 29.9, should only gain about 15 to 25 pounds. If you are obese before you become pregnant, with a BMI of over 30, your health care provider will probably suggest you gain no more than 11 to 20 pounds. These guidelines may differ from woman to woman, depending on individual health concerns.

What accounts for all that weight, if your baby weighs only about eight pounds? For an average-size woman, the placenta, amniotic fluid, and added breast tissue account for about 2 or 3 pounds each, your added blood supply weighs about 4 pounds, extra fat stores (to prepare for delivery and breastfeeding) account for 5 to 9 pounds, and the increased weight of the uterus is 2 to 5 pounds.

Ideally, your weight gain will be consistent throughout the pregnancy so that your baby has a steady nutritional supply, although fluctuations will occur from week to week and month to month. Your doctor or midwife will likely become concerned only if you have a sudden drop in weight or a sudden weight gain, especially toward the end of the pregnancy.


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