Pregnancy: No Weight Gain for Obese Women?
Study Suggests No Pregnancy Weight
Gain for Obese Women Who Get Nutritional Guidance
By Miranda Hitti
WebMD Health News
Reviewed by Louise Chang, MD
June 2, 2009 -- Women who are obese when they become
pregnant may not need to
gain weight during
pregnancy, as long as they and their doctors focus on healthy
eating, a new study shows.
"The take-home message is that you can eat well during your pregnancy without
overeating, and pregnancy should not be a license to overeat, and pregnancy
should not be a contributing factor to the epidemic of obesity in
this country," researcher Yvonne S. Thornton, MD, MPH, tells WebMD.
Thornton's findings, published in the June edition of the Journal of the
National Medical Association, go
further than the Institute of Medicine (IOM)
did in its new guidelines for pregnancy weight.
The IOM recommends that obese women gain 11-20 pounds during pregnancy.
Thornton's team argues that obese women may have healthy pregnancies maintaining
their weight, provided they have professional nutritional guidance -- and
accountability about what they eat.
Pregnancy "is not a time to eat twice as much, but twice as well," Thornton
says.
Pregnancy Weight Study
Thornton's study included 232 New York state women who
were obese when they got pregnant. The women's BMI (body mass index) ranged from 30 to 69, averaging
in the upper 30s.
All of the women got information about nutrition during pregnancy. Half of
the women also got a personalized healthy eating program and kept food diaries,
which were reviewed at each prenatal checkup. For comparison, the other half of
the group didn't get eating plans and didn't keep food diaries.
Thornton says she deliberately didn't use the word " diet" because she
considers it "an emotionally charged word" and because the study wasn't about
losing weight during pregnancy.
"We're not saying that pregnant women should lose weight. We're not
advocating that," Thornton says. "We're saying, 'Forget about the pounds,
already ... Let's talk about eating well and whatever happens, happens.'"
Thornton likens the food diary reviews to monitoring drivers' speed.
"If it says 55 miles an hour, you know most of us don't go 55 miles an hour.
But if there's a police officer there, we're going 55 miles an hour. And that's
the same thing with my study."
For instance, Thornton says a patient told her that she was craving chocolate
cake but decided to get fruit instead because she knew she would have to write
it down.
Thornton has been in her patients' shoes. Read about her own pregnancy weight
experiences, which inspired this study, in WebMD's news blog.
Obesity and Pregnancy: Study's Results
Overall, women who gained less than 15 pounds during the
pregnancy were more likely to be in the group that kept the food diaries than in
the comparison group, and they were less likely to develop gestational diabetes,
preeclampsia, undergo cesarean section, or have labor induced
The women who got personalized nutritional advice and who were asked to keep
food diaries gained an average of 11 pounds during their pregnancies. Women in
the comparison group gained an average of 31 pounds.
Most of the pregnant women who got personalized nutritional advice and who
kept food diaries -- 90 out of 116 women -- followed the study's ground rules.
They gained even less weight -- an average of 5 pounds during their pregnancies.
In contrast, women who didn't stick to their personalized eating programs and
didn't turn in their food diaries gained more weight -- 31 pounds, on average,
which is as much as women in the comparison group.
No side effects were reported during the study, and the babies were born
healthy and at a normal weight. "They were not little peanuts," Thornton says.
Obesity and Pregnancy: Don't Obsess
Thornton's study was "very interesting and timely work
... an admirable research effort," Bill Barth Jr., MD, tells WebMD. Barth is an
associate professor at Harvard Medical School and chief of the division of maternal-fetal
medicine at Massachusetts General Hospital.
"The study, if it's confirmed by larger studies, suggests that women who have
a body mass index over 30 may not need to gain weight at all if in a supervised
program," Barth says. "Ideally, this would be covered by a clinical nutritionist
or a nurse or a physician with special training and experience in dietary
counseling."
Michelle Owens, MD, assistant professor of maternal-fetal medicine at the
University of Mississippi Medical Center in Jackson, Miss., has had many obese
patients who've gotten pregnant.
Praising Thornton's study, Owens says people tend to "obsess" about how much
weight they should gain during pregnancy.
"But in actuality, those numbers are firmly rooted in basic behavioral and
nutritional habits," Owens says. "I think that that needs to be cornerstone,
rather than obsessing over the number, because you can still make a significant
impact without necessarily meeting a numeric goal."
Pregnancy can be an ideal time to move toward healthier eating, Owens notes.
"I think a lot of times with pregnant ladies, you can motivate someone to do
things for themselves during pregnancy that you ordinarily might not be able to
motivate them to do, because it's not just about them but it's also about the
outcomes for their babies, as well."
SOURCES:
Thornton, Y. Journal of the National Medical Association, June 2009.
WebMD Health News: "Pregnancy Weight Gain: New Guidelines."
Yvonne S. Thornton, MD, MPH, clinical professor of
obstetrics and gynecology,
New York Medical College, Valhalla, N.Y.
Bill Barth Jr., MD, associate professor of medicine, Harvard Medical School,
chief, division of maternal-fetal medicine, Massachusetts General Hospital.
Michelle Owens, MD, assistant professor of maternal-fetal medicine, University
of Mississippi Medical Center, Jackson, Miss.
© 2009 WebMD, LLC. All rights reserved.
Pregnancy RSS