Weight Loss During Pregnancy

What to Do About Weight Loss During Pregnancy: Is It Safe?

During pregnancy, health and wellness take a front seat while your baby develops. It’s common to focus more on nutrition, exercise, and self-care while pregnant, to help ensure a safe and healthy pregnancy and delivery.

Weight may be a concern during pregnancy. Some people are worried about not gaining enough weight or gaining too much weight, while others may have started the pregnancy underweight or overweight, and are trying to manage it.

When coping with food aversions, cravings, nausea, and fluctuating hormone levels, weight does change during pregnancy. These ups and downs are noted at doctor visits and are part of the care plan after conception.

Unless you’re in early pregnancy, it’s not safe to lose weight while pregnant. Your body is working hard to support your growing baby, and if you’re losing weight or dieting while pregnant, you may miss out on important nutrients you need for a healthy pregnancy. If you’re overweight or obese and pregnant, do your best to eat well and exercise regularly – and talk to your provider about gaining weight within a healthy range.

Why Is It Generally Not Recommended to Lose Weight While Pregnant?

Women who contend with severe nausea or food aversions may unintentionally lose weight during the early months of pregnancy, and these conditions need to be shared with and managed by your health care provider. But purposely trying to lose weight by dieting while pregnant is not advised.

Eating enough during pregnancy ensures both mom and baby will get the nutrients required for overall health. Dieting, cutting calories, or restricting food groups can result in nutrient deficiencies that can affect the developing fetus.

A meta-analysis and systematic review were conducted to examine pregnancy outcomes in obese women with gestational weight loss.2 The study found that women who tried weight loss diets during pregnancy had had higher odds of delivering babies that were small for gestational age, and the researchers concluded that weight loss diets should not be recommended during pregnancy.

Dr. Julie Rhee is a reproductive endocrinologist and infertility specialist and Director of the Preimplantation Genetic Screening Program at Vios Fertility Institute in St. Louis. Rhee advises a healthy diet and exercise program once you get pregnant, and cautions against weight loss during pregnancy.

Considering Weight Pre-Pregnancy

If you are trying to conceive, your health care provider may talk to you about losing or gaining weight to promote fertility and reduce pregnancy complications.

While people of all different shapes and sizes can get pregnant, studies show that there is an increased risk of certain complications in people with obesity. These potential complications include a higher risk of preeclampsia, preterm birth, and macrosomia (where the fetus is larger than normal, which can cause injury during birth).

If you are hoping to get pregnant, talk to your health care provider about positive, sustainable lifestyle changes that can support a healthy weight and promote fertility.

Risks of Being Overweight During Pregnancy

According to the ACOG, obesity during pregnancy may put you at risk of several health problems, such as:

  • High blood pressure
  • Preeclampsia (a serious form of gestational high blood pressure)
  • Gestational diabetes
  • Obstructive sleep apnea (a condition where you stop breathing for short periods during sleep)

Your obstetrician will monitor your blood pressure and blood sugar levels during your pregnancy to watch for signs of high blood pressure or gestational diabetes. They may give you specific diet and exercise advice to mitigate these conditions and promote a healthy pregnancy and delivery.

What if I lose weight in early pregnancy?

It can be normal to lose weight in early pregnancy, due to:

  • Morning sickness. In the first trimester, it’s common to lose weight as the result of morning sickness. The nausea can diminish your appetite, and the vomiting can cause you to miss out on calories. Don’t worry, your baby will get all the necessary calories and nutrients they need at this point.
  • Fat reserves. Overweight women have an extra reserve of calories in stored fat, so as your baby grows, it’s not harmful to maintain or even lose a little weight at first.
  • Improved lifestyle. You might lose weight early on if you’ve started exercising or eating healthier foods when you became pregnant.

In most cases, this weight loss isn’t dangerous. If you’re losing a lot of weight, though, or if you think you may be suffering from hyperemesis gravidarum (severe morning sickness), tell your provider right away.

How much weight to gain if you’re pregnant and overweight or obese.

If you started off your pregnancy carrying too much weight for your height, you’re not alone. More than half of pregnant women are overweight or obese.

You’re considered overweight if your pre-pregnancy body mass index (BMI) is between 25 and 29.9. (Your BMI reflects the relationship between your height and weight, and is an estimate of body fat.) You’re considered obese if your BMI is 30 or greater.

Not sure what your BMI is? Try this BMI calculator.

How much to gain during pregnancy depends on your BMI:

  • If your BMI is 25 to 29.9: It’s recommended that you gain between 15 and 25 pounds by the end of your pregnancy, or approximately 2 to 3 pounds per month in your second and third trimesters.
  • If your BMI is 30 or higher: You’re advised to gain 11 to 20 pounds during pregnancy.

Though it’s not safe to lose weight during pregnancy, if you’re overweight or obese during pregnancy you may be able to safely gain less than the recommended amount – with your healthcare provider’s guidance and monitoring.

Pregnancy weight gain recommendations are provided by the Institutes of Medicine (IOM), and there’s been some controversy about the IOM amounts stated for obese women. One issue is that the IOM provided one recommendation for all obese women (those with a BMI of 30 or higher) rather than different numbers for different categories of obesity.

According to some researchers, if you’re overweight or obese, it may be safe (and advantageous) for you to gain less than IOM guidelines recommend. Some studies show that overweight or obese women who gain only 6 to 14 pounds had similar or better neonatal outcomes than women who gained the recommended 15 to 20 pounds, for example.

If you’re overweight or obese, talk with your provider about your target weight gain during pregnancy. If you gain less weight than recommended, they’ll want to monitor you and your baby to be sure your pregnancy is progressing well and your baby is growing appropriately.

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Tips for Diet and Exercise During Pregnancy

A balanced, nutritious diet and exercise plan are important during pregnancy, since you are caring for both yourself and your baby. Your healthcare team can provide you with the best personalized advice, but here are some tips to get started:

Tips for Healthy Eating

“It is important to eat a balanced diet while pregnant,” says Rhee, who adds that watching portion control can be a healthy practice to continue in pregnancy if your weight is a concern.

She also stresses that if you are on medications or supplements to aid weight loss, you should speak to your health care provider to make sure that they are safe during pregnancy.6

Lastly, Dr. Rhee advises that diets in which one eliminates certain food groups should be avoided.

Deborah Malkoff-Cohen, MS, RD, CDN, CDE says that “eating for two” is an outdated recommendation, especially during the first trimester when the baby is very small. She suggests these tips to create nutritious, balanced meals during pregnancy:

  • Do not skip meals. Eat regularly to make sure you are getting adequate nutrition.
  • Eat lean protein such as chicken and fish. Incorporate fresh meat and seafood into your diet and limit processed meats like bacon, sausage, and hot dogs.
  • Eat mostly whole grains instead of refined grains. Include whole-grain wheat, oats, brown rice, quinoa, or other whole grains into your diet. Limit white, refined grains.
  • Increase your vegetable intake. Fill half of your plate with vegetables at mealtime.
  • Watch your sugar intake. Choose natural sugar, such as fruit, over processed, sugary treats such as candy and ice cream. Pair fruit with a source of protein (such as apple and peanut butter) and try to choose high-fiber fruits such as berries, apples, or pears.
  • Meet with a registered dietitian. A dietitian can help guide you with trustworthy, evidence-based dietary guidance.

Pregnancy Exercise Tips

Physical activity during pregnancy is generally recommended. But what if you have been sedentary? Or what if your weight management program prior to pregnancy included strenuous activity?

Dr. Felice Gersh, M.D. is a board-certified OB/GYN who is also fellowship-trained in integrative medicine. Gersh says that even sedentary women can benefit from initiating an exercise program during pregnancy.7 “Walking is wonderful!” she says, adding that pregnancy yoga classes or prenatal fitness classes are available to keep women fit while expecting.

Dr. Rhee adds that light to moderate activity is beneficial to pregnant women. “Light jogging, walking, or aerobic exercise at least 30 minutes per day can be beneficial to both mom and baby and also potentially help with labor and postpartum recovery,” she says.

Dr. Gersh recommends that you continue the level of exercise you’re comfortable with but don’t push too hard or do high-impact activities.8 She stresses that you should focus on health—not weight loss—to stay healthy during pregnancy. Dr. Rhee agrees, noting that any exercise is better than none.

Bottom Line

Pregnancy is a time to practice self-care by eating well and being physically active. This can help ward off pregnancy complications such as gestational diabetes and high blood pressure and ensure you gain an appropriate amount of weight to support a healthy pregnancy.

It’s not a smart idea to try and lose weight while pregnant, since cutting back on food groups or calories can mean your body isn’t getting the nutrients that are required for a healthy pregnancy. Speak with a dietitian to plan nutritious meals and snacks during pregnancy.

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