Pregnancy, Exercise, and Eating

Photo: Takis Markopoulos

You may be tempted to decrease or stop exercising while pregnant. Or you may be tempted to eat whatever you crave--no matter how unhealthy. But doctors recommend you continue to exercise throughout any normal pregnancy. And, of course, eating right is more important now than ever, both for your health and your baby's.

Pregnancy and Exercise:
If you normally exercise at very high intensity, you will need to decrease to moderate intensity during pregnancy. Your guideline is to keep your heart rate below 140 beats per minute. So if you usually run at 6.5 or 7.0 miles per hour, you will likely decrease your pace to 4-5 miles per hour now. This is difficult for women like me who like hard and sweat-pouring workouts. But you can still do most of your usual workout activities as long as you slow them down or modify them.

Exercise Appropriate During Pregnancy:
Treadmill or walking/light jogging
Elliptical machine
Stair Climber
Stationary bike
Swimming
Yoga/Pilates
Weight training

Exercise Not Recommended During Pregnancy:
Fast Jogging/Running
High Intensity Cardio
Plyometrics
High Impact Aerobics

Pregnancy and Eating:
In the past 9 years I have been pregnant five times, so I understand cravings of all sorts: potato chips, chicken soup, fudge, popcorn, chocolate frosties, and even cheese grits. Most foods can be eaten in moderation during pregnancy. But here is a brief list of unsafe foods: fish high in mercury (including tuna), cold cuts, caffeine, alcohol, unpasteurized cheese, raw sprouts, raw sushi, smoked fish, raw or rare meat, foods prepared with raw eggs. Some of these are allowed in small amounts, such a serving of tuna per week. The book referenced below is very comprehensive about all types of foods and the recommended amounts during pregnancy. Generally, try to eat a wide variety of nutritious foods. Find foods full of iron and folic acid. Eat a lot of fruits and veggies! Drink a ton of water! All of these are great habits to start now and should continue when you are breastfeeding.

References: Murkoff, Heidi and Mazel, Sharon. Eating Well When You're Expecting. Chapter 7: "Eating Safely When You're Expecting."

Recommended Weight Gain During Pregnancy

Table 1. Institute of Medicine Weight Gain Recommendations for Pregnancy
Prepregnancy Weight Category	Body Mass Index*	Recommended Range of Total Weight (lb)	Recommended Rates of Weight Gain† in the Second and Third Trimesters (lb) (Mean Range [lb/wk])
Underweight	Less than 18.5	28–40	1 (1–1.3)
Normal Weight	18.5–24.9	25–35	1 (0.8–1)
Overweight	25–29.9	15–25	0.6 (0.5–0.7)
Obese (includes all classes)	30 and greater	11–20	0.5 (0.4–0.6)
*Body mass index is calculated as weight in kilograms divided by height in meters squared or as weight in pounds multiplied by 703 divided by height in inches. †Calculations assume a 1.1–4.4 lb weight gain in the first trimester. Modified from Institute of Medicine (US). Weight gain during pregnancy: reexamining the guidelines. Washington, DC. National Academies Press; 2009. ©2009 National Academy of Sciences.

Source: The American College of Obstetricians and Gynecologists. "Committee Opinion: Weight Gain During Pregnancy." Number 548. January 2013.

Normal Weight: It is clear that there is a range of recommended pregnancy weight gain based on your pre-pregnancy weight. Pregnant women always hear the general statement that 25-35 pounds of weight gain is the recommended amount, but based on the above chart, that is only the case for women who were "normal weight" prior to pregnancy.

Underweight: Underweight women are recommended to gain more, even up to 40 pounds. This may be harder for you than your "normal" and "overweight" counterparts because likely you do not overeat nor do you gain weight easily. Also, it may be hard for you to gain enough weight because you may be concerned about losing the weight after Baby is born. You need to be more inintentional about how to increase calories in order to gain sufficient weight during these 40 weeks. Try not to worry too much about "getting fat" because pregnancy is the one time in your life it is actually good to gain weight!

Overweight: The recommended range for you to gain is lower than the "normal" and "underweight" categories, so work with your OB to form a strategy for proper weight gain. Otherwise, you may gain too much and risk having difficulty losing that weight postpartum. This may be difficult if you generally enjoy overeating and are indulging yourself even more now that you are pregnant. Or if you generally diet to lose weight, do not be afraid to gain the recommended 15-25 pounds now that you are pregnant.

Obese: Unfortunately, you have the lowest recommended amount to gain compared to the other groups of women. The only way to successfully gain under 20 pounds is to have a plan. Be sure that your plan includes accountability in order to ensure you are following through on your OB's guidelines. Gaining excessive pregnancy weight would only contribute further to your obesity and make your long term weight goals harder to achieve. Be sure to get specific advice from your doctor about how to keep your weight gain in the recommended range of 11-20 pounds.

Postpartum Weight Loss: How To Lose Baby Weight Quickly

Photo: Cornell University Library

2 ways to ensure postpartum weight loss and to return to pre-pregnancy weight are:

1. Do not gain excessive amounts of weight during pregnancy.

2. Breastfeed for at least 6 months, and ideally for 12+ months.

According to a research article in The American Journal of Clinical Nutrition, among a Danish population, postpartum weight loss was associated with breastfeeding. That population was selected because Danish women tend to breastfeed more and for a longer period of time than in other countries. The two major factors they considered were pregnancy weight gain and breastfeeding.

Is pregnancy weight gain correlated with postpartum weight retention? Researchers found that more weight gain during pregnancy was associated with more postpartum weight retention. In other words, the more weight they gained, the more weight they retained afterwards. This was true after 6 and 18 months postpartum.

Is breastfeeding correlated with postpartum weight retention? Researchers found that breastfeeding was associated with more postpartum weight loss for all groups of women except the heaviest.

There are obviously many strategies for postpartum weight loss, including healthy diet, exercise, belly binding, etc, but breastfeeding alone may be the single most effective way to lose your baby weight! Personally, I have found this to be true three times in the past four years. Each pregnancy, I gained ~35 pounds, and within 6-9 months (while breastfeeding) I returned to pre-pregnancy weight.

The women I know who have lost their baby weight in less than 6 months all gained much less weight than I did. For example, a friend who gained 15 pounds during pregnancy lost it within 1-2 months. A friend who gained 20-25 pounds lost it within a few months. Some women even lose it immediately, within days or weeks.

Do not fret if you gained a lot during pregnancy because breastfeeding can help you lose that weight. You just may have to work harder to lose the weight or it may take longer for you. Clearly, there are times when your OB may recommend you gain more or less weight during pregnancy, based on many clinical factors. Remember that your baby's health is more important than your size, so be sure to follow doctor's orders.

Tune in tomorrow for a discussion about how much weight you should gain during pregnancy based on your pre-pregnancy size.


Reference:  Baker JL, Gamborg M, Heitmann BL, Lissner L, Sorensen TIA, Rasmussen KM. "Breastfeeding Reduces Postpartum Weight Retention." American Journal of Clinical Nutrition. Dec 2008. Vol 88. No 6. 1543-1551.