Baby fat: Why you shouldn't eat for 2 during pregnancy

Oh, baby!

In America, more than half of all pregnant women are overweight or obese.

As much as many of us would like to pretend we don't see the extra large belly bump or protruding backside, being too heavy during pregnancy goes way beyond squeezing into those pre-pregnancy jeans after delivery.

Carrying extra pounds in those expectant nine months can have profound consequences for the mother-to-be and the developing child, doctors say.

Being too heavy boosts the likelihood that a woman will develop such pregnancy complications as gestational diabetes, high blood pressure and preeclampsia. It also tends to make labor harder, and increases the risks of delivery by Caesarean section, said Dr. Michelle Moniz, an obstetrician-gynecologist and Robert Wood Johnson Foundation clinical scholar at the University of Michigan.

"I talk with every obstetric patient about this problem because all women are at risk for unhealthy weight gain in pregnancy, and most women during their pregnancy gain more weight than we recommend, regardless of whether they start pregnancy at a healthy weight or obese," Moniz said.

Many ob-gyns are setting goals for women about how much or how little to gain during pregnancy. Many recommend losing excess weight before becoming pregnant and encourage exercise, saying it's vital that mothers-to-be get the message that they're not really eating for two.

"Some people have used pregnancy as a time to splurge and eat whatever they want, and eat for two," said Dr. Amanda Alvelo-Malina, an obstetrician-gynecologist at Henry Ford West Bloomfield Hospital. "Some of my friends have. But you're not eating for two. The baby is much smaller than you are. It doesn't need that many calories."

Melissa Demorest LeDuc, a 34-year-old business lawyer from Royal Oak, is due in September with her first baby, a girl. She is working hard to make sure she doesn't gain more than the 25-35 pounds recommended for her.

"I'm trying to maintain my fitness and limit how much weight I gain," Demorest LeDuc said. "Not that I'm not expecting to gain weight, but I want to try not to go overboard."

She takes a 45-minute boot camp class three days a week through Real Detroit Muscle in Troy, modifying some of the exercises as recommended in pregnancy. She does prenatal yoga. And in a few weeks, she'll start a prenatal swim class as well.

So far, LeDuc has gained 8 pounds, which, she says "is normal. It's supposed to be a pound a week the rest of the way, but we'll see. I'm on track.

"From what I've heard, it does make things easier in terms of labor and everything if you stay active."

Big mothers, big babies

Weight gain can be an uncomfortable topic for many doctors to broach with patients, as they worry about upsetting women who are already aware of their growing girth.

"It's very sensitive," said Alvelo-Malina.

"It's tricky sometimes for me, too, because I'm thin. I gained the recommended amount in both of my pregnancies. I never had an issue with weight gain," Alvelo-Malina said. "I think you know, they look at me and they think how can you relate? But there are people in my family who have weight problems and obesity. I mean, it's all around us. I think just being sensitive to the fact that they probably are uncomfortable with the topic, and try to bring it up gently, bring it up as it's health-related — not so much as this is what you should weigh."

The issue is compounded, she said, when women fail to lose all the baby weight, and go into the next pregnancy even heavier.

"With each pregnancy, women tend to retain 10 pounds; so that's carryover weight," she said. "They don't lose the weight, and then they end up pregnant again."

A woman who might have been within a normal weight range with her first baby might fall into the overweight category in her second pregnancy and obese in her third.

And big mothers tend to have big babies.

"Mom being overweight or obese increases the risk that the baby grows to be too large and then will not fit through the birth canal or the pelvis," Moniz said. "It increases the risk of a long and challenging labor and the need for a C-section."

"Babies who grow to be too large … are at risk for being overweight or obese in childhood, adolescence and even into their adulthood," Moniz said.

"Huge programming effects are happening during pregnancy. Women who start pregnancy overweight or obese are also at risk of having babies with fetal anomalies, including spina bifida. And when mom is obese, it decreases the ability of an ultrasound to detect those abnormalities.

"That's why clinicians try to counsel patients to try to lose their extra weight before conception. We talk about consulting with a weight-reduction specialist between pregnancies because this so powerfully impacts outcome in a pregnancy."

Tara McDonald, a 38-year-old teacher from Farmington Hills, had gestational diabetes when she delivered her baby boy, William McDonald, four weeks early in December.

She gained 37 pounds during her pregnancy, and said diabetes doesn't run in her family.

"As I went through the diabetes, it did get worse as I got closer to delivery. The first few weeks, I could manage it with my diet." But as she approached the end of her pregnancy, she needed medication, though she noted: "I never needed to use insulin."

When baby William was born, he weighed 6 pounds, 7 ounces. "He was on the smaller side, she said, but if I'd gone full-term, he would have been a big baby."

He was healthy, and McDonald's diabetes disappeared after delivery.

Through watching her diet, breast-feeding and taking William on long walks, McDonald is now within 10 pounds of her pre-pregnancy weight.

"I don't snack much," she said. "I don't eat many desserts. I just don't overindulge. ... It's probably going to take me until I'm done breast-feeding to lose all the weight."

Move more, eat better

Moniz said

she tries to bust the myths about exercise and diet in pregnancy.

"First of all, eating for two is a myth," she said. "Pregnancy is a critical time to eat foods that are twice as healthy, not twice as much. Secondly, the foods you crave might not always be the best foods to eat. ... Similarly, babies don't control hunger. Moms do."

Moniz encourages a diet high in fruit, vegetables, fiber, lean protein and good carbohydrates. She suggests avoiding sugar, especially from sweetened drinks, and upping the intake of water.

Jean McGrail, 30, of Northville was very careful about what she ate and her portion sizes during her most recent pregnancy.

By the time she delivered Declan McGrail on Dec. 9, she'd gained just 23 pounds.

"I've always been pretty active and healthy," she said. "I always told myself that during my pregnancy I'm not going to do the whole eating for two thing or have foods I don't normally eat just because I'm pregnant.

"I ate lots of fruits and veggies, and pretty much just kept my normal, healthy eating habits."

Moniz said another tool that helps pregnant women keep their weight down is exercise.

"For most pregnant women, exercise for at least 30 minutes that is moderate to rigorous on most or all days, is recommended," Moniz said. "The caveat is this might not be true for women with certain medical conditions," such as those with seizure disorders, poorly controlled diabetes or high blood pressure, lung disease or pregnancy complications that put them at-risk for preterm delivery.

Jen Dunbar, owner of Real Detroit Muscle, a boutique gym in Troy, said she has worked with many pregnant women in her 18 years as a trainer.

"One woman gave birth three days after class; for another woman, it was like nine days after her last class," she said. Her boot camp classes often include lifting weights, dumbbells, kettlebells, body-weight type movements, jumping rope and sprinting.

For her pregnant clients, Dunbar said: "We definitely have to make modifications, depending on how far along they are in their pregnancy. I watch them without making a big scene about it. I monitor them to see how they're doing. If I know ahead of time that this exercise isn't going to work for you, we modify it ahead of time.

"The majority of them had fairly easy labors," Dunbar said. "They've all been happy that they've worked out through it because it makes it easier to come back to it, too."

Tanya Petcoff, 35, a child therapist from Birmingham, has worked out with Dunbar two days a week throughout her pregnancy.

"In doing the boot camp class, I wanted to make sure that I was keeping the baby healthy, but that it also was good for me," said Petcoff, who is now 31 weeks pregnant.

"The doctor recommended that I continue because I'd been so active prior to getting pregnant; she encouraged me to keep doing it for as long as I felt good. I just decreased my weight limit. I'm definitely not pushing it to the same limits I did before I was pregnant. I find that the days I do work out, I tend to have a better night's sleep, and I just feel better in general.

"I've also been trying to do a lot of walking, and ... I'm right at the weight target every time I go to the doctor. I'm pretty disciplined, though, too. I try to make sure I'm eating really well, have a balanced diet, get lots of sleep and drink lots of water."

And that's exactly what doctors hope to hear from more women going forward.

"Pregnancy is a teachable moment when many people are particularly activated for change," Moniz said. "This is a critical time to adopt healthy habits that lay the foundation for a healthy family. These healthy habits are one of the first and most important things a woman can do to keep her baby safe and healthy."

Contact Kristen Jordan Shamus: 313-222-5997 or kshamus@freepress.com. Follow her on Twitter @kristenshamus.

How much should you gain?

Dr. Michelle Moniz, an obstetrician-gynecologist at the University of Michigan says there is no one-size-fits-all guideline for the right amount of weight for all women to gain during pregnancy.

"We broadly make recommendations based on a woman's pre-pregnancy BMI (body-mass index), but we suggest every woman talk to her obstetric provider and set a weight-gain goal that's just right for her and her baby."

The guidelines for weight gain in pregnancy were revised in 2009, and are issued by the Institute of Medicine. Here's what it recommends:

■ For women who start off underweight, with a BMI of less than 18.5, it suggests gaining 25-40 pounds.

■ For women who start off in the normal range, with a BMI of 18.5-24.9, it suggests gaining 25-35 pounds.

■ For women who start off overweight, with a BMI of 25-29.9, it suggests gaining 15-25 pounds.

■ For women who start off obese, with a BMI over 30, it suggests gaining 11-20 pounds.

To check your BMI, go to 1.usa.gov/1dSzT3p.

Big babies could mean big problems

Most parents love the pudgy thighs, round cheeks and double chins some newborns sport, but there are long-term implications for infants who are too heavy at birth, said Dr. Michelle Moniz, an obstetrician-gynecologist and Robert Wood Johnson Foundation Clinical Scholar at the University of Michigan.

A too-big baby, known medically as fetal macrosomia, weighs 4,000-4,500 grams at birth — or 8 pounds, 13 ounces-9 pounds, 4 ounces — according to the American College of Obstetricians and Gynecologists.

Women who deliver babies of that size and larger often struggle during labor. They are more likely to be unable to move the baby through the birth canal. Some macrosomic babies are injured during delivery — breaking their collarbones or getting nerve damage from squeezing large shoulders through a too-small pelvis; others must be delivered by C-section, Moniz said.

And for women whose babies grow too large because they were diabetic during pregnancy often are born with the potential for even more problems.

"The diabetic babies, they have higher risk of seizures, and blood-sugar problems, sometimes they have to go to a specialty-care nursery for transition," said Dr. Amanda Alvelo-Malina, an obstetrician-gynecologist at Henry Ford West Bloomfield Hospital. "Those are just some of the problems we're seeing. Long-term, babies who are exposed to gestational diabetes — those that are macrosomic — go on to have problems with childhood obesity. That's where we're thinking obesity starts."