Susan L. Grant MD and Margaret Klugman RPA
Obstetics and Gynecology Board Certified




8 East 83rd Street
New York, New York 10028
Phone: 212.769.0755
Fax: 212.769.4728
info@grantklugmanobgyn.com

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Pregnancy

What is healthy?

There's no one-size-fits-all approach to pregnancy weight gain. Here's help gaining the right amount of weight.

Like it or not, pregnancy weight gain is inevitable. Your baby's growth and development depend on it. But common sense still rules. Gaining the right amount of weight during pregnancy can support your baby's health - and make it easier to shed the extra pounds after delivery.

The guidelines

There's no one-size-fits-all approach to pregnancy weight gain. How much weight you need to gain depends on various factors, including your pre-pregnancy weight and body mass index (BMI). Your health and your baby's health also play a role.

Work with your health care provider to determine what's right for you. Consider these general guidelines for pregnancy weight gain from the American College of Obstetricians and Gynecologists:

Pre-pregnancy weight Recommended weight gain
Underweight 28 to 40 pounds
Normal weight 25 to 35 pounds
Overweight 15 to 25 pounds
Obese At least 15 pounds

If you're carrying twins or triplets, you'll need to gain more weight - often 35 to 45 pounds.

When you're overweight

Although excess weight carries risks - such as gestational diabetes and high blood pressure - pregnancy isn't the time to lose weight. Even women who are overweight should gain some weight during pregnancy.

Of course, it's important to keep an eye on the scale. If you gain more than the recommended amount during pregnancy and fail to lose the weight within six months after giving birth, you may have a higher risk of being obese later.

When you're underweight

If you're underweight, it's essential to gain a reasonable amount of weight while you're pregnant - especially during the second and third trimesters. Without the extra weight, your baby may be born earlier or smaller than expected.

Where does it go?

Let's say your baby weighs in at 7 or 8 pounds. That accounts for some of your pregnancy weight gain. But what about the rest? Here's a sample breakdown:

  • Baby: 7 to 8 pounds
  • Larger breasts: 1 to 3 pounds
  • Larger uterus: 2 pounds
  • Placenta: 1 1/2 pounds
  • Amniotic fluid: 2 pounds
  • Increased blood volume: 3 to 4 pounds
  • Increased fluid volume: 2 to 3 pounds
  • Fat stores: 6 to 8 pounds

Putting on the pounds

In the first trimester, most women don't need to gain much weight - which is good news if you're struggling with morning sickness.

If you start out at a healthy weight, you need to gain only a few pounds in the first few months of pregnancy. You can do this with an extra 150 to 200 calories a day, about the amount in 12 ounces of calcium-fortified orange juice or a serving of low-fat yogurt. A normal appetite will typically provide these calories.

Steady weight gain is more important in the second and third trimesters - especially if you start out at a healthy weight or you're underweight. This often means 3 to 4 pounds a month until delivery. An extra 300 calories a day might be enough to help you meet this goal. If you began your pregnancy underweight, your health care provider may suggest boosting your caloric intake more.

The menu

It would be easy to add calories to your diet with junk food, but this won't give your baby the nutrients he or she needs. It's more important to avoid overeating and make nutrient-rich choices. Consider these suggestions:

  • Trade white bread and pasta for the whole-grain variety.
  • Choose arugula, mustard greens or spinach rather than iceberg lettuce. Better yet, top your salad with soy nuts or black beans and drop the breadsticks or dinner roll.
  • Eat sliced fruit instead of a cookie.
  • Choose juices fortified with calcium and other nutrients.

Working with your health care provider

Your health care provider will keep a close eye on your weight. Do your part by eating healthy foods and keeping your prenatal appointments. To keep your pregnancy weight gain on target, your health care provider may offer suggestions for boosting caloric intake or scaling back as needed.

Exercise During Pregnancy

If you have been following a regular exercise program prior to your pregnancy, you should be able to maintain that program to some degree throughout your pregnancy. Exercise does not increase your risk for miscarriage.

  • If you are just starting an exercise program as a way of improving your health during your pregnancy, you should start very slowly and be careful not to over exert yourself.
  • Listen to your body. Your body will naturally give you signals that it is time to reduce the level of exercise you are performing.
  • Never exercise to the point of exhaustion or breathlessness. This is a sign that your baby and your body cannot get the oxygen supply they need.
  • Wear comfortable exercise footwear that gives strong ankle and arch support.
  • Take frequent breaks, and drink plenty of fluids during exercise.
  • Avoid exercise in extremely hot weather.
  • Avoid rocky terrain or unstable ground when running or cycling. Your joints are more lax in pregnancy, and ankle sprains and other injuries may occur.
  • Contact sports should be avoided during pregnancy.
  • Weight training should emphasize improving tone, especially in the upper body and abdominal area. Avoid lifting weights above your head and using weights that strain the lower back muscles.
  • During the second and third trimesters, avoid exercise that involves lying flat on your back as this decreases blood flow to your womb.
  • Include relaxation and stretching before and after your exercise program.
  • Eat a healthy diet that includes plenty of fruits, vegetables and complex carbohydrates.

Before you begin exercising, remember that it is important to talk to your health care provider. If you are already exercising, you may be able to keep up with your routine and adapt it as you grow. Keep your heart rate under 140 beats per minute and avoid overheating, especially in your first trimester.

Recommended Exercises

Kegel Exercises

Pregnant women who perform Kegel exercises often find they have an easier birth. Strengthening these muscles during pregnancy can help you develop the ability to control your muscles during labor and delivery. Toning all of these muscles will also minimize two common problems during pregnancy: bladder leaks and hemorrhoids.

Kegel exercises are also recommended after pregnancy to promote perineal healing, regain bladder control, and strengthen pelvic floor muscles. The best thing about Kegel exercises is that they can be done anywhere, and no one knows you're doing them.

Swimming

Many health care providers and fitness professionals say swimming is the safest exercise for pregnant women. Swimming keeps your body toned without adding weight and stress to your joints. When swimming you are raising your heart rate and enjoying a safe cardiovascular exercise that is not likely to cause overheating. Avoid scuba diving or water skiing.

Walking

Walking is very beneficial because it is safe for your body. It is easier on your knees than running and can be easily worked into your schedule. Start slowly and be sure you stretch well before you begin. Set realistic goals and wear good shoes to decrease the risk of falling or pressure on your feet.

Running & Jogging

Usually if you are in a habit of running, you can continue running. However, if you did not run before pregnancy, you may want to speak to your health care provider before you begin a running program. If you run, make sure you're well hydrated, avoid over-heating , and wear good shoes.

Bicycling

The best thing about biking is that the bike supports your weight, so there is less stress on your body. A stationary bike is great exercise because you have less of a chance of falling. As you grow, your center of gravity is shifting so your are at an increased risk of falling. As your abdomen grows, it can put a lot of stress on your back. Start slowly and do not over-exert yourself.

Stair Climbing Machines

These machines pose a small risk of falling. However, side rails provide balance support. Stair climbing is an excellent way to raise your heart rate.

Yoga

Yoga has a long standing reputation for relieving stress and pressure on your body. Most forms of yoga will be safe for you and your baby, as long as they are not excessively rigorous. Some yoga instructors offer special classes for pregnant women. Avoid lying flat on your back for extended periods of time and try not to overstretch.

Aerobics

If you already participate in aerobics, you will most likely be able to continue; however, you should speak to your health care provider before beginning a new program. Keeping your balance can sometimes be difficult, so you'll want to be careful as you grow. Taking a class specially designed for pregnant women is a good idea. Most health clubs offer them. Do not exercise lying flat on your back for extended periods of time.

Dance

Dancing can be done in your home or at a gym that offers special classes for pregnant women. Avoid a lot of spinning, leaping, and jumping.

Exercises to Avoid

Skiing

Although cross-country skiing is a fairly safe sport for pregnant women, there is a risk of falling. Downhill skiing has a greater risk of falling and is not recommended while pregnant.

Water Skiing

Water skiing could result in abdominal trauma, especially in the second and third trimesters.

Horseback Riding

Riding a horse can involve a lot of jolts and quick movements, which can really hurt you and your baby. There is also a risk of falling.

When you Exercise

Don't wear tight clothes, but do wear a good sports bra that will give you good support. Wear shoes that have good support and are not slippery, so you won't fall. Breathe deeply, drink a lot of water, and remember to keep your heart rate under 140 beats per minute. Avoid jerking motions and lying on your back for extended periods of time.

Stop exercising if you have any vaginal bleeding, dizziness, faintness, shortness of breath, contractions, or nauseous feelings.

Pregnancy and Medicine

Is it safe to use medicine while I am pregnant?

There is no clear-cut answer to this question. Before you start or stop any medicine, it is always best to speak with the doctor who is caring for you while you are pregnant. Read on to learn about deciding to use medicine while pregnant.

How should I decide whether to use a medicine while I am pregnant?

When deciding whether or not to use a medicine in pregnancy, you and your doctor need to talk about the medicine's benefits and risks.

  • Benefits: what are the good things the medicine can do for me and my growing baby (fetus)?
  • Risks: what are the ways the medicine might harm me or my growing baby (fetus)?

There may be times during pregnancy when using medicine is a choice. Some of the medicine choices you and your doctor make while you are pregnant may differ from the choices you make when you are not pregnant. For example, if you get a cold, you may decide to "live with" your stuffy nose instead of using the "stuffy nose" medicine you use when you are not pregnant.

Other times, using medicine is not a choice-it is needed. Some women need to use medicines while they are pregnant. Sometimes, women need medicine for a few days or a couple of weeks to treat a problem like a bladder infection or strep throat. Other women need to use medicine every day to control long-term health problems like asthma, diabetes, depression, or seizures. Also, some women have a pregnancy problem that needs medicine treatment. These problems include severe nausea and vomiting, earlier pregnancy losses, or preterm labor.

What if I'm thinking about getting pregnant?

If you are not pregnant yet, you can help your chances for having a healthy baby by planning ahead. Schedule a pre-pregnancy checkup. At this visit, you can talk to your doctor about the medicines, vitamins, and herbs you use. It is very important that you keep treating your health problems while you are pregnant. Your doctor can tell you if you need to switch your medicine. Ask about vitamins for women who are trying to get pregnant. All women who can get pregnant should take a daily vitamin with folic acid (a B vitamin) to prevent birth defects of the brain and spinal cord. You should begin taking these vitamins before you become pregnant or if you could become pregnant. It is also a good idea to discuss caffeine, alcohol, and smoking with your doctor at this time.

Is it safe to use medicine while I am trying to become pregnant?

It is hard to know exactly when you will get pregnant. Once you do get pregnant, you may not know you are pregnant for 10 to 14 days or longer. Before you start trying to get pregnant, it is wise to schedule a meeting with your doctor to discuss medicines that you use daily or every now and then. Sometimes, medicines should be changed, and sometimes they can be stopped before a woman gets pregnant. Each woman is different. So you should discuss your medicines with your doctor rather than making medicine changes on your own.

What if I get sick and need to use medicine while I am pregnant?

Whether or not you should use medicine during pregnancy is a serious question to discuss with your doctor. Some health problems need treatment. Not using a medicine that you need could harm you and your baby. For example, a urinary tract infection (UTI) that is not treated may become a kidney infection. Kidney infections can cause preterm labor and low birth weight. An antibiotic is needed to get rid of a UTI. Ask your doctor whether the benefits of taking a certain medicine outweigh the risks for you and your baby.

I have a health problem. Should I stop using my medicine while I am pregnant?

If you are pregnant or thinking about becoming pregnant, you should talk to your doctor about your medicines. Do not stop or change them on your own. This includes medicines for depression, asthma, diabetes, seizures (epilepsy), and other health problems. Not using medicine that you need may be more harmful to you and your baby than using the medicine.

For women living with HIV, the Centers for Disease Control and Prevention (CDC) recommends using zidovudine (AZT) during pregnancy. Studies show that HIV positive women who use AZT during pregnancy greatly lower the risk of passing HIV to their babies. If a diabetic woman does not use her medicine during pregnancy, she raises her risk for miscarriage, stillbirth, and some birth defects. If asthma and high blood pressure are not controlled during pregnancy, problems with the fetus may result.

Are vitamins safe for me while I am pregnant?

Regular multivitamins and prenatal vitamins are safe to take during pregnancy and can be helpful. Women who are pregnant or trying to get pregnant should take a daily multivitamin or prenatal vitamin that contains at least 1000 micrograms (g) of folic acid. It is best to start taking these vitamins before you become pregnant or if you could become pregnant. Folic acid reduces the chance of a baby having a neural tube defect, like spina bifida, where the spine or brain does not form the right way. See our information on Folic Acid. Iron can help prevent a low blood count (anemia). It's important to take the vitamin dose prescribed by your doctor. Too many vitamins can harm your baby. For example, very high levels of vitamin A have been linked with severe birth defects.

Are herbal remedies, "natural" products, or dietary supplements safe for me while I am pregnant?

Except for some vitamins, little is known about using dietary supplements while pregnant. Some herbal remedy labels claim they will help with pregnancy. But, most often there are no good studies to show if these claims are true or if the herb can cause harm to or your baby. Talk with your doctor before using any herbal product or dietary supplement. These products may contain things that could harm you or your growing baby during your pregnancy.

sources:
http://www.womenshealth.gov/
http://www.americanpregnancy.org/
http://www.mayaclinic.com
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