Eating for Two: Your Guide to a Healthy Pregnancy

by Leah Frankel, MS, RD | frankel@myhousecallmd.com

You’re standing in the checkout aisle at the grocery store when you glance over at the newest entertainment magazine and see that yet another celebrity just lost all the weight she gained during her pregnancy in record time and looks even better than she did before the baby. You’re thinking to yourself, “Why can’t I lose my stubborn pregnancy weight?” One of the reasons many women have difficulty losing their post-pregnancy weight is because they don’t know how much weight they should be gaining during their pregnancy. While you are eating for two, you’re not eating for two adults!  We’ll discuss appropriate weight gain during pregnancy, what essential nutrients women need during pregnancy, some diseases that can develop during pregnancy and finally some tips to help lose weight after the big delivery.

Gaining the weight

With many women taking the notion of “eating for two” to the extreme, it’s become increasingly common for women to gain more weight than necessary during pregnancy.  These women are then stuck trying to lose the additional weight while caring for a newborn (i.e. sleepless nights and minimal personal time). Desired weight gain during pregnancy depends on the mother’s weight before pregnancy. The following chart describes appropriate weight gain based on Body Mass Index (BMI = weight (kg)/height (m)²:

The mother’s weight before pregnancy, as well as weight gain during pregnancy, correlate with the infant’s birth weight, which is important for the overall health of the newborn. For a normal weight mother, gaining the appropriate 3.5 lb in the first trimester equates to approximately one pound per month for the first three months. As most of us know, it’s not very difficult to gain one pound in a week, let alone a month (don’t worry we’ll discuss how to gain weight at a healthy rate as well as the other nutrients to look out for a little bit later). During the second and third trimesters, weight gain of 0.5-1 lb per week is appropriate. We’re sure you’ve wondered where all this weight is coming from (or where it’s going!) so here’s a breakdown based on a weight gain of 28-29 lb:

  • 7.5-8.5 lb fetus
  • 7.5 lb storing fat and protein
  • 4.0 lb blood
  • 2.7 lb tissue fluids
  • 2.0 lb uterus
  • 1.8 lb amniotic fluid
  • 1.5 lb placenta and umbilical cord
  • 1.0 lb breasts

After looking at these numbers, you can tell that a lot of the weight will be instantly lost while giving birth including the weight of the baby, amniotic fluid, the placenta and umbilical cord.

Getting all the right nutrients

In order to gain weight appropriately, there’s one key aspect of nutrition we need to focus on: calories! As we mentioned earlier, appropriate weight gain during the first trimester is only 3.5 lb; during the first trimester the DRI (Daily Reference Intake) does not recommend any increase in calories. However, during the second trimester an increase of 340-360 calories/day is recommended and, during the third trimester, calories should be increased an additional 112 calories/day for a total of 452 additional calories/day. Consuming an additional 350-450 calories could be as simple as adding a sandwich as a mid-day snack, or adding 100-150 calories to each meal with an extra few ounces of meat or an extra slice of bread. It’s important to remember that these additional calories are based on how many calories your body needed pre-pregnancy; most women decrease their exercise regimen during pregnancy so it is important to consider any change in calories burned due to a different exercise plan. While you should always consult your physician before beginning an exercise regimen while pregnant, there are many benefits to exercise during pregnancy including optimal rate of weight gain, prevention of gestational diabetes (which we’ll discuss a little later), reduced levels of stress and easier labor.

In addition to increasing calorie intake during pregnancy, there are a number of other key nutrients that you need to consume during pregnancy. Protein intake increases by 25 g/day during pregnancy in order to support the growth of maternal and fetal tissues. This requirement can be reached by consuming three 1 cup servings of milk/yogurt per day which will also provide additional calories and calcium. One of the most important vitamins to consume during pregnancy is folic acid. Folic acid intake is so important during the first month of pregnancy that intake requirements have increased for all women of childbearing age, since many women don’t realize they’re pregnant during the first 28 days of pregnancy (one of the most integral developmental periods). Adequate folic acid intake is important for preventing neural tube defects (the developing spinal cord of your baby).  Your body makes additional blood during pregnancy to carry nutrients to your developing baby.  To help make new blood cells, iron requirements also increase. Your doctor may recommend iron supplements which are generally absorbed better when consumed with foods high in vitamin C. In addition to folic acid and iron, your body will need slightly increased amounts of most vitamins and minerals during pregnancy which can be met through increased caloric intake or with a prenatal vitamin.

Complications during pregnancy

There are a number of complications that can occur during pregnancy, including morning sickness and heartburn. Many women are familiar with these uncomfortable changes but we want to discuss two noteworthy conditions that pregnant women can develop: gestational diabetes and pregnancy induced hypertension.

Gestational diabetes is diabetes that develops during pregnancy; this is not to be confused with diabetic women who become pregnant. Gestational diabetes usually develops after 20 weeks of gestation and most doctors will test for this disease between 24 and 28 weeks. Approximately 5 to 10% of all pregnant women will develop gestational diabetes. As with diabetes, women with gestational diabetes experience elevated levels of sugar in their blood, however usually not as high as with classic diabetes. Gestational diabetes is typically managed with a carbohydrate-controlled diet, moderate exercise and monitoring of blood sugar levels.  Insulin or other glucose-control medications are typically not needed. If gestational diabetes is not controlled, it increases the risk of premature delivery and fetal death.  It also increases the mother’s risk of developing type 2 diabetes later in life.


Hypertension (high blood pressure) can also develop during pregnancy.  This phenomenon is appropriately termed “pregnancy-induced hypertension” and comes in two forms: gestational hypertension and preeclampsia. Gestational hypertension is high blood pressure (140/90 mm Hg or higher) without protein in the urine that develops after the 12th week of gestation. On the other hand, preeclampsia is high blood pressure (140/90 mm Hg or higher) with protein in the urine which develops after the 12th week of gestation. Treatment for pregnancy-induced hypertension depends on the severity of the condition as well as how far along the mother is at the time. Treatment options can range from dietary changes (decreasing salt and fat intake and increasing water consumption) to providing blood pressure medication. If pregnancy-induced hypertension is left untreated, it can prevent the placenta from providing the developing fetus with adequate blood, thereby cutting off its oxygen and food supply.

Getting the weight back down

Now that we’ve discussed what to do to deliver a healthy baby, it’s time to discuss getting mom back into pre-pregnancy shape. After delivery, you can choose to either breastfeed your baby or use formula.  We strongly recommend breast-feeding for two reasons: 1) it can aid in weight loss and 2) it is healthy for your baby. Lactating leads to an increase in energy needs of approximately 450-500 calories a day (that’s equivalent to approximately an hour at the gym!) and the recommended calorie intake while breastfeeding is only 330 calories greater than a woman who is not lactating.  This means that the extra 100-150 calories your body needs to produce milk comes from your fat stores, helping you lose weight. Mothers are encouraged to begin exercising a few weeks after giving birth (although it is important to note that strenuous exercise can impair the mother’s abililty to make milk if she is breastfeeding). For women who choose not to breastfeed, remember that prior to delivery you were consuming an additional 450 calories in your last trimester.  If you continue to eat those extra calories, you’ll continue to gain weight.  While the images of celebrities and their rapid weight loss may be imprinted in your mind, remember that healthy weight loss occurs at a slow rate with a combination of exercise and well-balanced eating.

Questions? E-mail the Author: frankel@myhousecallmd.com

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07 2010

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