Dou­bling down on food dur­ing preg­nancy is out, un­less it’s diet qual­ity we’re talk­ing about.

New Zealand Listener - - CONTENTS - By Ruth Ni­chol

Dou­bling down on food dur­ing preg­nancy is out, un­less it’s diet qual­ity we’re talk­ing about.

If you think preg­nancy is an ex­cuse to start chow­ing down on dough­nuts and chips – or sim­ply to start eat­ing larger quan­ti­ties of healthy food – think again. Al­though you may be “eat­ing for two”, that doesn’t mean you can eat twice as much; in­stead, you should be eat­ing twice as well. It’s a case of out with the chips and in with the kale. Min­istry of Health guide­lines say that a woman who be­gins preg­nancy at a healthy weight (with a body-mass in­dex [BMI] be­tween 18.4 and 24.9) doesn’t need to eat any ex­tra food dur­ing the first 12 weeks. Af­ter that, she only needs to in­crease her daily in­take by about 837kJ – the equiv­a­lent of a whole­grain peanut but­ter sand­wich and an ap­ple.

Weight gain is in­evitable dur­ing preg­nancy. As well as the baby, the pla­centa, am­ni­otic fluid, ex­tra blood and an in­crease in the size of the uterus and breasts all add ki­los. The body also stores fat to help it cope with preg­nancy and breast­feed­ing.

It’s this ex­tra fat that can cause prob­lems. Gain­ing too much of it is as­so­ci­ated with a range of com­pli­ca­tions. These in­clude high blo­od pres­sure, ges­ta­tional di­a­betes, pre-eclamp­sia, longer labours and higher cae­sarean rates.

There can be consequences for the baby, too. “If you gain more than the rec­om­mended amount, your child is more likely to end up with a high BMI,” says Dr He­len Pater­son, a se­nior lec­turer in women’s health at the Univer­sity of Otago.

Gain­ing too lit­tle weight can also cause prob­lems for moth­ers and ba­bies. These in­clude higher still­birth rates and – para­dox­i­cally – a higher like­li­hood that your child will be­come over­weight or obese later in life.

But women are much more likely to gain too much weight than too lit­tle dur­ing preg­nancy. A re­cent re­view of more than a mil­lion preg­nan­cies found that 47% of women put on too many ki­los and 23% added too few.

The in­creas­ing num­ber of women who en­ter preg­nancy al­ready over­weight or obese makes the weight-gain ten­dency even more of a prob­lem. That’s be­cause car­ry­ing

The rec­om­mended weight gain in preg­nancy for a healthy-weight woman is 11.5-16kg.

ex­tra weight on its own can cause preg­nancy com­pli­ca­tions. Gain­ing too much weight in­creases the risks.

Pater­son says there’s no point in ber­at­ing preg­nant women for be­ing over­weight – par­tic­u­larly as they can’t do any­thing about it while they are preg­nant. It’s more im­por­tant to find ways to help them to keep their weight gain within the rec­om­mended guide­lines.

“The mes­sage we need to be sell­ing is that women who gain the ap­pro­pri­ate amount of weight have bet­ter out­comes and their chil­dren have bet­ter out­comes.”

It used to be that all women – what­ever their ini­tial weight – were told to gain no more than 12kg dur­ing preg­nancy. That has now been re­cal­i­brated to re­flect a woman’s BMI when she first be­comes preg­nant. The rec­om­mended weight gain for a newly preg­nant woman with a BMI of 30 or more – which puts her in the obese cat­e­gory – is now 5-9kg. That com­pares with a rec­om­mended weight gain of 12.5-18kg for an un­der­weight woman with a BMI of less than 18.5. The rec­om­mended weight gain for a healthy-weight woman is 11.5-16kg.

Pater­son and her Otago col­league Dr Kirsten Cop­pell are ap­ply­ing for fund­ing to test a mid­wife-led weight­man­age­ment in­ter­ven­tion to help preg­nant women achieve op­ti­mal weight gain. This will in­clude us­ing a spe­cially de­vel­oped book­let on healthy food and life­style choices dur­ing preg­nancy.

“We’re look­ing at a re­ally prag­matic ap­proach and we’re work­ing with mid­wives be­cause they de­liver most ba­bies,” says Cop­pell. “It’s about pro­vid­ing a ser­vice to en­able a healthy preg­nancy.”

Jac­qui Anderson of Christchurch, an ad­viser with the Col­lege of Mid­wives, says mid­wives are al­ready aware of the im­por­tance of talk­ing to women about good nu­tri­tion and healthy weight gain.

She says they rou­tinely weigh and mea­sure women on their first visit to es­tab­lish their BMI, and are likely to take spe­cial care with a woman who is obese or mor­bidly obese. This may in­clude reg­u­lar weigh­ing and pos­si­bly a re­fer­ral to a di­eti­cian.

“We prob­a­bly wouldn’t reg­u­larly weigh a nor­mal-weight woman, but we would be hav­ing con­ver­sa­tions about nu­tri­tion and healthy eat­ing and the im­por­tance of not ‘eat­ing for two’.”

Dr He­len Pater­son: work­ing withmid­wives.

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