Guidelines for gaining, losing baby weight different for all moms

GRAND FORKS, N.D. -- Celebrities who drew criticism recently for the pounds they packed on during pregnancy -- Kim Kardashian and Jessica Simpson -- also focused attention on the question of how much weight gain is healthy for expectant moms.

The answer "varies according to a woman's starting weight and BMI," said Dr. Tana Setness Hoefs, obstetrician-gynecologist at Altru Health System in Grand Forks. BMI, or body mass index, is a calculation of fat in the body based on height and weight.

Years ago, doctors recommended that women gain 30 to 35 pounds during pregnancy, she said. "We've really moved away from that."

Research in this area has led doctors to advise women to put on fewer pounds while waiting for baby.

"It's OK to gain less weight during pregnancy than was previously thought," she said. "We now see a 15- to 20-pound weight gain as being very reasonable."

When women who are overweight get pregnant, they may not put on that much weight and still have a healthy pregnancy, she said.

Setness Hoefs emphasized that because each patient is unique, "you may receive a different recommendation from your physician." Recommendations are made on a case-by-case basis, she said, and individual concerns should be discussed with your doctor.

More weight, more risk

The amount of weight gain during pregnancy can affect the immediate health of the woman, baby and the future health of both, the American College of Obstetrics and Gynecology has reported.

Excessive weight gain places women at risk for developing high blood pressure and diabetes during pregnancy -- even women who didn't have those problems before becoming pregnant, she said. It also increases the risk of delivery by caesarean section.

For women with high blood pressure or diabetes before pregnancy, gaining excessive weight while they're expecting makes those conditions worse.

Excessively high blood pressure in pregnant women can result in poor placental blood flow to the baby and high risks of hemorrhage. It is a significant cause of infant and maternal mortality.

According to the Centers for Disease Control and Prevention, 7 to 18 percent of pregnancies are affected by gestational diabetes, and mothers will have as much as a 60 percent chance of developing diabetes within 20 years after pregnancy.

Obesity with pregnancy may lead to heavier babies who, later, may be at risk for childhood obesity, which could pose a higher risk for heart disease and diabetes in adulthood.

Some pregnant women keep gaining weight, which they don't fully shed after delivery, and they continue to gain with each pregnancy, Setness Hoefs said.

"Some say, 'I'm eating for two, so my caloric intake can double.' This is by no means true."

During pregnancy, a daily increase of 300 to 400 calories is recommended, she said.

That is the equivalent of an 8-ounce low-fat blueberry smoothie a day.

Dropping 'baby' weight

Losing weight after giving birth is difficult for some women, while others "don't seem to have a problem with it," she said.

"Be mindful of the weight you're going to put on during pregnancy, and that it's not going to just fall off after the birth."

As a mother of four, Setness Hoefs can empathize with new moms who struggle to lose weight. "It's a hard thing to do. In my own case, it was a combination of watching my diet and exercise."

Women may feel they're neglecting their responsibility if they leave their babies with a sitter to work out at a gym. "It's not easy finding time to exercise," she said. Mothers who work outside the home may be especially prone to feelings of guilt.

"They think, 'I've been away all day, I should be with my baby' and not take the time to exercise."

Sleep disturbances -- because of middle-of-the-night feedings -- have a way of undermining weight-loss efforts.

"You're waking up to the feed the baby, so then you eat something yourself," she said.

Fatigue makes it more difficult to make that trip to the grocery store to buy fresh vegetables and fruit, prompting moms to gravitate to less healthy food options or to eat out.

Beginning exercise?

The question of when is it safe to begin exercising after delivery also is an "it depends" situation.

If the baby was delivered vaginally or the pregnancy was uncomplicated, "there's no reason that (new mothers) can't resume normal activity six weeks after giving birth," Setness Hoefs said.

But if there were complications at birth, or other circumstances dictate, more vigorous exercise should be delayed eight weeks.

"That doesn't mean that before then, you can't exercise," she said. She recommends walking "when the patient feels up to it."

Above all, during this time, the new mother should do no strenuous, heavy lifting or pushing down against the abdominal wall and vagina.

Recommendations concerning exercise may depend on the mother's physical condition before and during pregnancy.

"We hear about women who run a marathon and go into labor," she said. "Would I recommend to a patient, who hasn't run, to begin training for a marathon when she's pregnant? Absolutely not."

But for those whose bodies are used to that kind of activity, they "will tolerate it better and can get back into it a whole lot quicker" after delivery.

In the first six weeks after delivery, Setness Hoefs suggests lower impact activities such as biking, Pilates, water exercise and yoga, she said, "anything that puts less impact on the joints and requires less bearing down."

Pilates strengthens the core while correcting the muscular imbalances developed from pregnancy.

During pregnancy and birth, the abdominal and rectal muscles have been stretched, she said. The body needs time "to allow those muscles to return to normal anatomical position."

"If it was a vaginal birth, things are not going to be as tight as they were before." Even in C-section cases, many women will have gone through some labor before delivery, she said, so the same kind of tissue damage has occurred.

During C-section surgery, "the muscles have been separated," she said. "We use artificial sutures, and we don't want any bearing down against that incision line."

Appropriate post-partum exercise is good for one's physical and mental wellness, said Stephanie Hoffman, coordinator of fitness at the University of North Dakota's Wellness Center.

"Exercise is an absolute perfect way to stay healthy in general," she said. It has been shown to have a positive effect on mental health that extends to pregnancy.

"Anyone who is prone to post-partum depression will benefit."

'Exercise is good for recovery'

Carrying a baby for nine months and bringing baby into the world take a major toll on the body.

Exercise is a key to getting back into pre-baby shape, Hoffman said.

If your pregnancy was uncomplicated, you feel up to it and your doctor clears you to begin exercising, she said, new moms can start with easy activity, such as walking and swimming, as early as a day or two after giving birth.

"Exercise is good for recovery," Hoffman said.

New moms should begin slowly though, she said, with 30 minutes of exercise a day, five days a week -- or 150 minutes a week -- as recommended by the CDC.

"You can break that up," she said. "Take three 10-minute walks," for example. But whatever you do, be sure to "stop before you get tired."

Depending on how good you're feeling, you can progressively increase the time and intensity of exercise, she said.

Exercises that tone the abdominal muscles are most helpful post-partum, she said. "Crunches would be good."

For new moms, "it's all about getting that core back into shape."

Also "planks and back extensions would help build that area up," she said. Such exercises strengthen posture.

If you're walking or swimming -- and if you're feeling good with those exercises -- you can also start doing crunches, planks and back extensions after a few days, she said.

Avoid any exercises that involve "jumping or jerky, bouncing movements, such as running," Hoffman said. "After six to eight weeks (after childbirth), you can start working those in."

Also, don't do "full sit-ups, double leg-lifts or anything that brings the knees to the chest," she cautioned. "Because of trauma to the pelvic region (during childbirth), that type of exercise puts those muscles into compromise."

Copyright 2013, Grand Forks Herald.