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Healthy Expectations: Achieve the Right Weight for a Healthy Pregnancy

Online Health Chat with Karen Cooper, DO

July 26, 2013


Description

If my baby at delivery will only weigh around eight pounds, why do I have an extra 23 lb. weight gain? When a woman is pregnant, weight gain is inevitable—and necessary—to support the growth and development of her fetus into a healthy baby. This extra weight is provided to growing breasts, a larger uterus, placenta, increased blood volume and fat.

The amount of weight gain expected during pregnancy is individual to the patient, and factors to consider include pre-pregnancy weight, BMI of the mother and expected size of the baby. Twins and other multiples require more weight gain by the mother.

Gaining weight the right way, with appropriate nutrition to your developing baby, is crucial. Weight control during pregnancy is very important, because unhealthy dieting tactics can affect your baby. Uncontrolled weight gain, however, can also affect both mother and baby. Being overweight before pregnancy can lead to medical complications including gestational diabetes, uncontrolled high blood pressure and pre-eclampsia (a combination of high blood pressure and protein in the urine). Conversely, underweight expecting mothers risk delivering their babies earlier than expected.


About the Speaker

Karen Cooper, DO, is the Director of the Healthy Expectations Program, and is part of the Women’s Health Institute. She is board certified in Family Medicine and sub-specializes in Obesity (Bariatric) Medicine. Dr. Cooper medically managed overweight and/or obese patients in the surgical setting for the past seven years, and has now shifted her focus to address overweight and/or obese women who are considering pregnancy, are pregnant now or who have delivered a baby. With a team of expert dieticians, Dr. Cooper will provide medical and dietary education and clinical management in individual and group appointments.

Dr. Cooper completed her residency in family medicine at University Hospitals of Cleveland, in Cleveland, and Georgetown University, in Washington, DC. She completed an internship at St. Barnabas Hospital, in Bronx, NY. Dr. Cooper graduated from New York College of Osteopathic Medicine.


Let’s Chat About Healthy Expectations: Achieve the Right Weight for a Healthy Pregnancy


Preconception Preparation

SimiCat: What should I do before I get pregnant to ensure a healthy pregnancy for me and my baby?

Karen_Cooper,_DO: Try to stay as healthy as possible. That means keeping your weight within normal limits, choosing healthy foods, keeping portion sizes small, drinking adequate low-calorie fluids and getting regular exercise. The most important thing you can do is stay within your normal weight for your height.

sdeberry753: Is there any advice you would recommend for eating prior to getting pregnant?

Karen_Cooper,_DO: If you are not yet pregnant, try to eat the amount of calories that would keep you within a normal healthy weight. Food choices that include fruits and vegetables, low-fat foods, baked or grilled fish, meat and low-fat dairy products will provide the correct amount of nutrition your body needs.


Appropriate Weight Gain

chloe: When should you start to gain weight during pregnancy?

Karen_Cooper,_DO: Weight gain will occur gradually once you become pregnant. The extra weight goes to the baby, the placenta, your breast tissue, your extra blood supply and your uterus, where the baby is growing. You should gain about two to four pounds in the first trimester, then approximately one pound per week in the second and third trimester. Depending on the weight you start with, your doctor will give you the range of weight you should gain, which can be between 11 and 35 lbs.

passport: What is the right amount of weight to gain during each stage of my pregnancy?

Karen_Cooper,_DO: Weight gain should be slow and gradual. If you were normal weight prior to pregnancy, then you should expect to gain 25 to 35 lbs. For overweight women, a range of 11 to 25 lbs. is ideal. However, it is very important to be under the supervision of an expert provider.

sdeberry753: What is the average amount of weight a woman can expect to gain during pregnancy? Also, should women partake in light-to-moderate exercise to help with weight gain?

Karen_Cooper,_DO: Your weight gain depends on how much you already weigh. According to the National Institutes of Health guidelines, if your body mass index (a measurement of your height and weight) is between 19 and 24.9, then your weight gain should be between 25 and 35 lbs. If it is between 25 and 29.9, then your weight gain should be between 15 and 25 lbs. If it is 30 or greater, then your weight gain should be between 11 and 20lbs. Your obstetrician-gynecologist physician will direct you to the range best suited for your current weight, based on those guidelines.

Exercise is very beneficial during your pregnancy but please check with your physician first, to be certain it is O.K. for you to exercise. Activity such as swimming, low-impact aerobics, walking or yoga can improve your posture, and help with backaches, constipation and fatigue.


Extra Caloric Intake During Pregnancy

Verde: How many extra calories should I really be eating, since I am ‘eating for two’?

Karen_Cooper,_DO: During pregnancy, the ‘myth’ is that you’re eating for two, when in fact your baby only needs approximately 300 extra calories per day to help meet his or her nutritional and caloric needs. I would emphasize healthy choices to include adequate amounts of protein, carbohydrates and fat. For example, yogurt with some nuts or a lean meat would be a great option.


Effects of Excess Weight on Pregnancy

madagascar: I am overweight and have heard rumors about the effects it can have on my baby. Is that true? If so, can you explain some of the risks?

Karen_Cooper,_DO: Yes, it is true that being overweight or obese can be harmful to you and your baby. Your risk for developing diabetes during pregnancy is increased, which can cause your baby to become very large during development. The baby can become very difficult to deliver. Other complications which can affect your baby include being born too early (preterm), having a shoulder stuck during delivery, having birth defects and gaining too much weight.

Sabrina: I am newly pregnant and pretty heavy already. My BMI is almost 38 (I am five foot seven inches tall and 242 lbs.) Are there any health issues when obese and pregnant?

Karen_Cooper,_DO: With your body mass index, your weight gain should be between 11 and 20 lbs. Excess weight can have health effects on your baby and you. Your baby may be delivered too early. Your baby is at risk for growing too large if you develop diabetes, which can happen in pregnancy with excess weight. Your baby may become too large to deliver easily, making a cesarean section necessary. A limb of your baby (usually a shoulder) can get stuck during vaginal delivery because he or she is too large. Other effects on the baby include a risk for developing diabetes and being obese during childhood. You can minimize these effects now by exercising regularly (discuss this with your physician first) and keeping your weight gain within the guidelines given above (11 to 20 lbs).


Effects of Reduced Food Consumption

pammy: I was overweight when I got pregnant. Because of the baby’s position, I am never hungry and can only eat a little bit at a time. I have been losing weight. My doctor says the baby is growing fine. Is it O.K. to lose weight during pregnancy?

Karen_Cooper,_DO: I understand your concern with weight loss during pregnancy—it is not typically encouraged! However, your obstetrician-gynecologist is monitoring your baby's growth and your health status carefully. Since all is well at this time, then I would encourage you not to worry. Continue to choose healthy foods although your portion sizes are small, and continue to follow up with your doctor regularly.

Freezebot: I have had gastric bypass in the past for morbid obesity. I have lost about 100 pounds. Will I have problems getting pregnant? And if I do, how will nutrition affect my baby when I can only eat small amounts?

Karen_Cooper,_DO: Congratulations on your weight loss of 100 lbs. with gastric bypass surgery! Most women of reproductive age tend to be more fertile after surgery due to the hormonal shifts from the weight loss. So, unless there is other medical history that could prevent you from becoming pregnant, you should not have a problem.

If you do become pregnant, the small amounts of food you eat will be sufficient, but you should make sure that you eat a wide variety of foods. Your daily vitamin requirements need to include 1000 to 2000 mg of calcium citrate with vitamin D, 40 to 56 mg of ferrous iron, 350 mcg of vitamin B12, 4 mg of folic acid and 15 mg of zinc.


Vegetarian Diet During Pregnancy

Narelle: Is it possible to follow a vegetarian diet during pregnancy?

Karen_Cooper,_DO: Yes, it is possible, but you will need to take a B12 supplement, since that important vitamin is found primarily in meats.

However, if fish and diary are also a part of your vegetarian diet, you can find B12 in clams, cooked oysters, king crab, herring, salmon, tuna, blue cheese, camembert and gorgonzola cheeses. However, be careful of the mercury content in fish. During pregnancy, high levels of mercury have been associated with brain damage and developmental delay for your baby.


Foods to Avoid During Pregnancy

sdeberry753: Are there foods you should avoid eating during pregnancy and others that you would recommend to provide additional nutrients?

Karen_Cooper,_DO: Your diet should include nutrient-dense foods, such as lean meats, low-fat dairy, fruits, vegetables and whole grains. It is important to have adequate amounts of calcium, folic acid, iron, vitamin A and protein in your diet. Foods that are harmful during pregnancy include raw and seared fish, fish containing high levels of mercury, and soft cheeses that are not made with pasteurized milk.


Hydration During Pregnancy

amp2013: How much water should I be drinking during pregnancy? Is sparkling water acceptable?

Karen_Cooper,_DO: You should be drinking approximately 9 cups of water per day (8 oz each). You can also get some of your water from other beverages that you drink daily. Remember to limit your caffeine intake. If you drink coffee, just one cup daily will be enough. Sparkling water is O.K., but read the label to be sure there is no added sodium.


Exercise During Pregnancy

essie: Is it safe to work out while pregnant? How hard should I push my body to still be physically active, but not cause any harm to my baby?

Karen_Cooper,_DO: Physical activity during pregnancy is an excellent thing to do! It can help with flexibility and relieving lower back pain that can be caused by the extra weight in the midsection from the baby. However, it is very important to listen to your body and not push yourself too hard. You do not want to run a marathon or join a boot camp, for example. Something like walking or swimming is a great activity because they are low-impact exercises.


Medications During Pregnancy

v.neut: I take medication for hypertension (that is weight-related) that is considered class C and not recommended during pregnancy. Are there hypertension medications that are safe during pregnancy and while breast feeding?

Karen_Cooper,_DO: It is important to have this discussion with your obstetrics-gynecologist physician. There are medications that treat elevated blood pressure during pregnancy more safely than others, and your doctor will be able to determine which one is best for you at this time.


Weight Loss After Delivery

Heather: Do you have any tips for losing the weight after having my baby?

Karen_Cooper,_DO: Aside from the great nutritional effect that breast-feeding has on your baby, it promotes faster weight loss after birth. Breastfeeding burns about 500 extra calories per day to build and maintain a milk supply. If you choose not to breastfeed or need to lose more weight than breastfeeding will allow, then your diet and exercise should be evaluated by expert providers to help you achieve your goal weight. Depending on the medical evaluation, options can include a very low calorie diet, use of weight loss medications, meal replacements and intense exercise.

Pippi: I am unable to breastfeed and know that would help my weight loss efforts after pregnancy. What else can I do?

Karen_Cooper,_DO: If you are unable to breastfeed because your baby will not latch on or because it is very painful for you, then I would recommend that you pump your breast milk and feed it to your baby. This will help with the additional 500 calories you burn during breastfeeding and, very importantly, transfer your protective antibodies to your baby.

If the above is not an option for you, then I would recommend that your monitor your portion sizes carefully and increase your exercise. Keeping a food diary can make you more aware of how many calories you are taking in, and allow you to make adjustments where needed. I would also recommend the assistance of a dietician to help with your daily calorie requirements. If you have a smartphone, MyFitnessPal™ is an ‘app’ which many people use for that purpose.


Dieting During Breastfeeding

jtr333: After giving birth, and while breastfeeding, can you still diet? Will the baby get adequate nutrition?

Karen_Cooper,_DO: Breastfeeding will help with some weight loss, so I would not recommend that you go on a diet. I would advise that you choose healthy, low-fat and low-calorie foods. Keep your portion sizes small and avoid second helpings. That, combined with at least 30 to 60 minutes of exercise at an intensity suitable for your fitness level on most days of the week should be adequate until you wean your baby off of breastfeeding. Once that period is over, you can consider going on a diet to lose more weight if needed.


Weight Gain and Postpartum Depression

Mollie: Is there any correlation between weight gain during pregnancy and postpartum depression?

Karen_Cooper,_DO: Some people experience postpartum depression for a number of reasons, mainly due to the large hormonal imbalance which occurs. If it is difficult to lose the excess weight after pregnancy, it is possible that some depression can occur.


Closing

Moderator: I'm sorry to say that our time is now over. Thank you again, Dr. Cooper, for taking the time to answer our questions today about healthy weight and pregnancy.

Karen_Cooper,_DO: Thank you everyone for joining me on the webinar today! I received really good questions, which I was glad to answer! Staying as fit and healthy as you possibly can be, before and during your pregnancy, will help reduce the health risks that can impact you and your baby. Be sure to continue with these positive lifestyle changes after you deliver your bundle of joy, so that you can return to a normal weight—to stay as healthy as possible for you and your family!


For Appointments

To schedule a shared medical appointment before, during or after pregnancy with Karen Cooper, DO, please call 216.444.6601 and ask for the Healthy Expectations program or visit clevelandclinic.org/healthyexpectations for more information.


For More Information

On Cleveland Clinic

In the Ob/Gyn & Women’s Health Institute at Cleveland Clinic, the Healthy Expectations program takes a proactive role in maternal and—ultimately—childhood obesity. Cleveland Clinic’s Healthy Expectations program will give you the information you need to optimize your weight and health before and during pregnancy, and after delivery.

Karen Cooper, DO and Jeffrey Chapa, MD, Head of Maternal-Fetal Medicine developed the program with registered dieticians, to ensure you, the mother, has the tools to:

  • Reach a healthy weight before pregnancy
  • Gain the right amount of weight during pregnancy
  • Shed the weight you gained during pregnancy after delivery of your baby

This program is offered at Independence Family Health Center, Westlake Medical Campus, and Stephanie Tubbs Jones Health Center.

Cleveland Clinic gynecology is rated best in Ohio and third in the nation by U.S.News & World Report.

On Your Health

MyChart®: Your Personal Health Connection, is a secure, online health management tool that connects Cleveland Clinic patients with their personalized health information. All you need is access to a computer. For more information about MyChart®, call toll-free at 866.915.3383 or send an email to: mychartsupport@ccf.org.

A remote second opinion may also be requested from Cleveland Clinic through the secure Cleveland Clinic MyConsult® website. To request a remote second opinion, visit eclevelandclinic.org/myConsult.


Contact Information

If you need more information, click here to contact us, chat online or call the Center for Consumer Health Information at 216.444.3771 or toll-free at 800.223.2272 ext. 43771 to speak with a Health Educator. We would be happy to help you. Let us know if you want us to let you know about future web chat events!

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This information is provided by Cleveland Clinic as a convenience service only and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. Please remember that this information, in the absence of a visit with a health care professional, must be considered as an educational service only and is not designed to replace a physician's independent judgment about the appropriateness or risks of a procedure for a given patient. The views and opinions expressed by an individual in this forum are not necessarily the views of the Cleveland Clinic institution or other Cleveland Clinic physicians. ©Copyright 1995-2013. The Cleveland Clinic Foundation. All rights reserved.

Reviewed: 07/13