Why Pregnant Women Don't Need to Eat for Two

Why Pregnant Women Don't Need to Eat for Two

More than half of pregnant women in the United States gain more than the recommended amount of weight, and that extra weight can lead to large babies, difficult deliveries, birthing injuries, weight retention after pregnancy, and a higher risk of obesity for those babies later in life, according to recent research.

Kaiser Permanente physician and researcher Kim Vesco, MD, MPH, saw these complications in her own practice and vowed to do something about them. Dr. Vesco splits her time between delivering babies at Kaiser Sunnyside Medical Center in Portland, Oregon, and conducting research across town at the Kaiser Permanente Center for Health Research.

Her focus on excessive gestational weight gain led to the landmark Healthy Moms Study, which encouraged women who were obese to maintain their weight during pregnancy. Study results, published in 2014 in the journal Obesity, found that regular weigh-ins and group meetings helped women limit their weight gain and reduce their likelihood of having large-for-gestational-age babies.

But Dr. Vesco says it’s not just obese women who need to worry about extra weight gain during pregnancy. Women who start out with only a few extra pounds and those with a normal body mass index (BMI) also need to remain vigilant.

“That old adage about eating for two is just a myth,” says Dr. Vesco, who, in addition to maintaining a busy schedule as a physician and researcher, also has two young children. “You don’t need any extra calories during the first trimester of pregnancy, and during the second and third trimesters you only need 200 to 300 extra calories per day.”

Unfortunately, she says, many providers do not counsel their patients about appropriate weight gain, healthy eating and exercise. “It’s tough to get everything in during prenatal visits, but providers have a great deal of influence with patients, and we need to tell patients about the guidelines and review our patients’ weight gain with them at each prenatal visit.”

Until now, there has been no easy way to do that. Providers could plot a pregnant patient’s weight gain manually on paper, but that is cumbersome and time consuming. Now there is a new function in Kaiser Permanente’s electronic health record that makes tracking a patient’s weight gain much easier. These personal weight-gain graphs allow providers to show patients exactly how much weight they’ve gained since their last appointment, and to compare that to the recommended weight gain for their height based on pre-pregnancy weight.

Dr. Vesco is teaching providers how to use the new weight-gain graphs, and together with Kaiser Permanente dietitian Stasha Hornbeck, she has also created a toolkit for providers and patients. The kit includes this six-minute video with healthy weight gain, eating and exercise suggestions, as well as handouts on pregnancy diet myths and facts and tips to help manage weight gain.

Hornbeck, who is pregnant with her second child, says that rather than eating for two, pregnant women should think for two. “What you eat during your pregnancy affects your baby not just in the womb, but for the rest of his or her life,” she says.

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