Approximately one in every four or five women gains an inadequate amount of weight during pregnancy, according to Dr. Toya Ellis, MD, fellow of the American College of Obstetricians and Gynecologists and OB-GYN at Kaiser Permanente Colorado Region. Some of this is tied to socioeconomic status—women who begin pregnancy without good nutrition, smoke, or lack financial or nutritional resources—but many others are women who purposefully control their weight or just can’t gain weight.
“Women in general are certainly spooked about putting on a lot of weight, especially when they hear from media and friends that it completely changes your body or won’t come off easily,” says Melinda Johnson, a registered dietitian and spokesperson for the American Dietetic Association.
The ABCs of Weight Gain
How much you should gain during pregnancy depends on how much you weighed before conception. The Centers for Disease Control and Prevention (CDC) outline the following formula for calculating your own BMI (use your pre-pregnancy weight):
- Multiply your weight in pounds by 703
- Divide the answer by your height in inches
- Divide this number by your height in inches again. This is your BMI.
Once you know your BMI, the CDC suggests that you use the following parameters to estimate the best target weight gain for your pregnancy:
- Underweight pre-pregnancy: BMI of under 19.8: gain 28 to 40 pounds
- Normal weight pre-pregnancy: BMI of 19.8 to 26: gain 25 to 35 pounds
- Overweight pre-pregnancy: BMI of over 26.1: gain 15 to 25 pounds
The Skinny on Staying Skinny
There is a common misperception that all or most of the weight gain in a healthy pregnancy should go straight to the belly. In fact, the experts say that women who gain weight only in the stomach (creating those cute basketball tummies) are the exception and should not be looked to as ideals.
“When women gain only in the abdominal area, it usually means that they have not gained enough weight,” says Dr. Ellis. Most women gain weight everywhere during pregnancy, and there is no way to control where those pounds will go. The goal is not only to gain enough weight to grow a baby, but also to allow your body to build up fat stores so that you can successfully breastfeed.
Dr. Ellis adds, “Failure to gain enough weight creates a 50-percent risk of having a baby who is low birth weight.” Low birth weight babies have higher risks for infant mortality, admission to intensive care, cerebral palsy, sight and hearing problems, and learning difficulties. Women who do not gain enough weight in pregnancy face elevated risks of anemia, preterm labor, and osteoporosis later in life. According to Dr. Ellis, “The more underweight you are, the more risk there is.”
Slim and Pregnant
For many women, body image and a lifelong focus on being thin are powerful attributes which are difficult to move past. Molly Kimball, RD, sports and lifestyle nutritionist at the Ochsner Clinic Foundation Elmwood Fitness Center in Louisiana says, “I find there are societal pressures across the board to be thin. It’s a huge compliment to many women that they are tiny except for their belly.”
Karen Stealey of Long Island, New York, was determined not to gain a lot of weight in her pregnancy. “I watched all my friends gain 35, 45, and even 65 pounds. I did not want that to happen to me.” Stealey has always been tiny—a size two or four. When she got pregnant, she went to a nutritionist, followed a food plan, and kept a food diary. She also continued to do yoga and a cardio class. Her net gain was 19 pounds, and her healthy baby weighed eight pounds, five ounces. Stealey is pleased that she now has no stretch marks or roll of fat or skin around her middle. “I think my experience is proof that if you don’t just say, ‘Oh, I’m pregnant, I’m going crazy;’ you don’t have to gain a lot of weight.”
Striving for Gain
It can be difficult to gain weight during pregnancy, even if you want to. Although some weight gain is recommended in the first trimester, failure to gain is not a deal-breaker. Weight loss in the first trimester due to nausea, food aversions, or fatigue is not uncommon, explains Dr. Ellis. If you don’t gain in the first trimester, talk to your healthcare provider, but don’t panic. “Babies are very capable at extracting nutrients from our stored resources in the first trimester,” she says. She cautions however, that failure to gain in the second trimester is a more serious problem.
Elizabeth Johnson of Lansing, Michigan, didn’t gain a single pound during her third pregnancy, despite her efforts. Four and one-half months of morning sickness put a huge dent in her appetite. When she did eat, she was careful to choose very nutrient-dense foods in multiple food groups and did not count calories. “Everything was measuring OK, so my doctor wasn’t concerned, but about my sixth month he started ordering more ultrasounds.” Her baby weighed in at a healthy eight pounds, eight ounces. “At my postpartum check up, I was 25 pounds under my pre-pregnancy weight,” she recalls.
Nausea isn’t the only culprit. Dr. Ellis says, “Women who are thin often have to work harder to gain the weight. Sometimes they exercise and need to eat for both the exercise and the pregnancy. At times they just have higher metabolic rates.”
Melanie Nicsinger of Overland Park, Kansas, has always been a size three. “It’s hard for me to gain weight even if I try, and pregnancy was no exception,” she says. By her twentieth week of pregnancy, she had gained nothing, although her doctor wanted her to gain at least 28 pounds and possibly as much as 35. “I definitely think it is possible that women who are naturally thin can experience trouble putting on pounds.” Johnson concurs with this thinking. “Sometimes it is simply in the woman’s genes not to gain much weight during pregnancy.”
Eight million people in the US experience eating disorders, so many women come to pregnancy having either overcome an eating disorder or while they are still struggling with one. Dr. Ellis recommends being open with your healthcare providers about eating disorders. “I very frankly discuss with [women] at the first visit that we will be focusing on her weight at each visit.” She recommends that women who have had eating disorders see a registered dietitian and a mental health provider if they think they will feel the urge to diet or purge during pregnancy.
If your healthcare provider is not worried about your lack of weight gain, you shouldn’t be either. When you know you’re doing everything you can to have a healthy baby, it doesn’t matter what others think or say. Nicsinger remembers hearing a lot of comments about how she was too thin and speculation about how great it would be to see her bigger. “People think they can make comments about how you look when you’re thin. I just wish people would realize that no one wants to hear that they’re ‘too’ anything, especially when you’re pregnant.”
Dr. Ellis agrees with this point of view. “Women need to be encouraged to embrace their pregnant and post-pregnancy bodies and give themselves the gift of love, care, and forgiveness. Society needs to support women during pregnancy and not hold women to impossible, unreachable weight standards.”
How You Can Tip the Scale
Are you having troubles gaining pregnancy weight? A good first step is to add 300 calories to your diet per day and aim for a daily total of 2,000 calories, says Kimball. Focus on nutrient-dense foods that give you the most bang for your buck and eat when your appetite is at its peak.
You can add 300 calories a day by incorporating the following into your diet:
- Three tablespoons of olive oil added to breads or vegetables
- One scoop of ice cream
- A peanut butter sandwich
- A large bowl of cereal with low-fat milk
- Three handfuls of nuts
- One bar of dark chocolate
- A serving of fruit cobbler
- Substitute three cups of juice for three cups of water
- Three slices of cheese
- One slice of quiche
- A cup of chili and beans
- Eight ounces of chocolate milk
- One avocado
Try to eat every two to three hours. “Keeping it small is helpful for those who get nauseated easily,” suggests Kimball. Another easy way to add calories is to substitute higher-calorie beverages. If you tend to fill up quickly, eat carbs and proteins first, then have salad or vegetables. Replace light, diet, or low-fat foods with the regular equivalents (such as salad dressing, bread, mayo, sour cream, milk, cheese, yogurt, sweeteners, and soda).