So how much weight should fat women gain in pregnancy? That's the real question here, and one which has been hotly debated for many years.
Dr. Raul Artal, director of the "Bariatric Obstetrics" clinic in St. Louis, believes that fat women should gain very little if ANY weight and maybe even lose weight in pregnancy (with medical supervision). He's been putting out press release after press release in the last several years, pressuring the Institute of Medicine to lower the weight gain guidelines for everyone, but especially for fat women.
The Institute of Medicine's current guidelines for weight gain in pregnancy are:
- Underweight women: up to 40 lbs.
- Normal weight women: 25-35 lbs.
- Overweight women: 15-25 lbs.
- Obese women*: at least 15 lbs.
The first question is......how do they figure out how much weight a woman "should" gain in pregnancy, anyhow? Typically, they estimate how much weight the baby will weigh, how much the placenta and amniotic fluid weigh, how much increased blood volume there will be, etc., then add all those up. The total should be about what women "should" gain in pregnancy.
Most sources also factor in some "fat storage" as normal, to be used as energy reserves during the birth, immediately post-partum, and during breastfeeding. Other sources (like Dr. Artal) do not believe that there should be ANY fat storage at all.
So there is a major difference of opinion among experts whether pregnant women "should" put on any fat stores or not. Some believe it's part of nature's preparation for the demands of birth and breastfeeding, while others contend this was only for times of famine, so there is no need for additional fat storage. Of course, because fat women already have fat stores, they are viewed as not needing those reserves at all.
“We’re not bears,” Artal says. “Pregnancy is not a time of hibernation.”
Now you'd think all the sources would pretty much agree on the total weight of each of these components (minus the fat storage issue), but they don't. Each has slight differences, but we can compare some common guidelines.
MSNBC has a chart they use to describe "Where the Weight Goes in Pregnancy." It breaks down the weight gain as follows:
- Developing fetus 7 to 8 pounds
- Placenta 1.5 to 2 pounds
- Amniotic fluid 2 to 2.5 pounds
- Increased uterine size 2.5 to 3 pounds
- Breasts 2 to 3 pounds
- Increased blood volume 3 to 3.5 pounds
- Normal water retention 3 to 3.5 pounds
- Total 21 to 25.5 pounds
- baby: 7.5 pounds
- maternal energy stores (fat, protein, and other nutrients): 7 pounds
- fluid volume: 4 pounds
- breast enlargement: 2 pounds
- uterus: 2 pounds
- amniotic fluid: 2 pounds
- placenta: 1.5 pounds
- This gives an average total of about 26 pounds
Hmmmm. His math seems kind of fuzzy. Let's see, going with low-end estimates from above....7 lbs for the baby, 1.5 lbs for the placenta, 2 lbs for amniotic fluid, 3 lbs for blood volume, 2 lbs for breasts....I still come up with a minimum of 15.5 lbs*, and that doesn't include any allowance for uterine size increase. I don't know how Dr. Artal comes up with his 10-14 lbs figure.....and that's for average-sized women! Fat women aren't to be allowed any of that, under his guidelines.
So then, let's think this through. If they now are going to recommend less than the basic 15 lbs. weight gain for obese women, where should we be taking this away? The baby? The placenta? The blood volume increase? The amniotic fluid? Which of these is not needed or excessive?
Oops, sorry, fat chicks, you're only allowed a one-pound placenta, a pound of amniotic fluid, and half a pound of added blood volume. No increase in boobs is allowed; you have enough to start with and everyone knows fat women can't breastfeed anyhow, right? And a 7 lb. baby? Forget it. You have to have a 5 pounder instead, at most.
Oops, but even then, fat women would still be gaining some weight, tsk tsk tsk. They're not supposed to be gaining ANY. So by insisting on NO gain (or "very little"), doctors are, in effect, insisting that fat women lose weight while pregnant. Is that really safe? And how, really, are they supposed to do that? Drink Slim-Fast? Why would nutritional requirements be ANY different for a fat woman during pregnancy than any other woman?
Of course, any negative effects of such restrictions are completely shrugged off. And that's the problem....doctors assume that these restrictions are beneficial for baby and mother, but are they really?
More on that in future posts.
*That's how the 15 lb. IOM weight gain guideline for obese women was probably derived. They allowed for the weight of the baby, placenta, and related fluids etc. No allowance was likely made for fat reserves, and everything was based on the minimum possible weight gain.