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Weighing the Risks (part 1) - Pregnancy Weight Gain, Weight Woes

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1. Pregnancy Weight Gain

The health and weight of your baby at birth depend greatly on how much weight you gain over the course of your pregnancy. The weight of your baby factors into your weight gain, but your body also gains weight through its increase in blood volume—about 50 percent—as well as muscle, fluid, and tissue. Your body weight increases at a different rate depending on your stage of pregnancy. During the first trimester, weight gain is slow, about 2 to 4 pounds. During the last six months, weight gain should increase to about ½ to 1 pound per week, depending on your total target weight gain. Even though all women differ slightly, it is best to gain weight at a steady pace.

Trimester       Weight Gain
First trimester (1–3 months) 2 to 4 pounds
Second trimester (4–6 months) 12 to 14 pounds
Third trimester (7–9 months) 8 to 10 pounds

Your body weight before pregnancy will help to determine a healthy weight gain for you during pregnancy. The American College of Obstetricians and Gynecologists recommends the following target weight gains for healthy women. Keep in mind that these are only guidelines and that every woman is unique.

Pre-Pregnancy Weight*        Suggested Weight Gain
Normal weight (BMI of 19.8 to 26) 25 to 35 pounds
Overweight (BMI 26 to 29) 15 to 25 pounds
Obese (BMI greater than 29) At least 15 pounds
Underweight (BMI of less than 19.8) 28 to 40 pounds

*BMI, or body mass index, according to National Academy of Sciences classification.

Because all women are different, suggested weight gains are expressed in ranges. Shoot for your target weight gain, and if you are not sure where your pre-pregnancy weight falls, speak to your doctor or calculate your pre-pregnancy BMI in Appendix B.

Women who are African-American or in their teenage years (younger than eighteen) are advised to gain toward the upper limit of the weight range to help decrease the risk for delivering a low birth-weight baby. Taller women should shoot for the higher end of the weight gain ranges, and shorter women (62 inches or under) should shoot for the lower end of the range for weight gain.

More Than One?

Multiple babies obviously means more weight gain. But remember, there is a vital need for the extra weight you need to gain! You are supporting more than one baby. Infants of multiple births have a much greater chance of being born premature or at a low birth weight. Women carrying twins are expected to gain about 35 to 45 pounds. Although women carrying triplets usually don’t go full-term, if they did, they would need to gain somewhere around 50 to 60 pounds. Most women carrying twins have a higher-than-average weight gain in the first trimester. Experts stress the importance of early weight gain for women pregnant with twins because weight gain in the first two trimesters has been found to have the greatest impact on the birth weight of the babies.

Breaking Down Your Weight Gain

Your body is expanding. You know that not all of this extra weight can be coming from your baby alone, so where is it coming from? Many different parts of your body are used to support a healthy pregnancy, such as the storage of extra body fat to sustain the baby’s rapid growth and provide needed energy during labor, delivery, and breastfeeding. It may ease your mind a bit to know exactly what is contributing to your weight gain and the importance of each component. The following chart will give you an approximate breakdown of a normal 25- to 35-pound weight gain. Of course, the picture differs somewhat from woman to woman.

Baby       7 to 8 pounds
Placenta 1 to 2 pounds
Amniotic fluid 2 pounds
Uterus 2 pounds
Breasts 1 to 2 pounds
Increase in blood volume 3 pounds
Body fat 5 or more pounds
Increase in muscle tissue and fluid 4 to 7 pounds

2. Weight Woes

Ideally, you will be at a healthy weight before you become pregnant and then gain the advised amount of weight during pregnancy. Unfortunately, this does not always happen. There can be consequences to gaining too much or too little weight over the course of your pregnancy. The baby’s birth weight and/ or size at birth depends on your weight gain during pregnancy. Appropriate weight gain ensures a healthier outcome for both you and your baby.

Steady Now

Your goal should be to maintain a steady weight gain throughout your pregnancy. Your baby requires a daily supply of essential nutrients during your entire pregnancy, and that comes from what you eat every day. Expect your weight gain to fluctuate a bit from week to week and to gain more or less depending on the stage of your pregnancy. However, if your weight fluctuates too much or changes suddenly, that could be a warning sign. Be aware of some of the following red flags:

• Gaining more than 3 pounds in any one week during your second trimester

• Gaining more than 2 pounds in any one week during your third trimester

• Not gaining any weight for more than two weeks in a row at any time during the fourth through the eighth months

• Gaining more weight than you anticipated (given that you are diligent about sticking to a well-balanced, healthy meal plan daily)

If you experience any of these or other warning signs, you should contact your doctor.

Don’t be obsessive about weighing yourself every day. Your weight can fluctuate too much from day to day to pinpoint possible problems this way. Instead, make regular doctor’s visits, and weigh yourself at home every week or two to make sure you are on the right track.

If you experience any sudden weight changes, including either a gain or loss, you should contact your doctor immediately. Sudden weight changes can indicate other problems that may exist.

Size at Birth Counts

An infant’s weight and size at birth can be related to the risk of immediate health problems as well as to the risk of chronic diseases in childhood and adulthood. Although many factors can contribute to a baby’s birth weight, the amount of weight a mother gains during pregnancy can definitely have a direct impact on an infant’s size at birth. A baby who weighs too much or too little at birth can experience a number of problems.

Babies born weighing less than 2,500 grams, or about 5 pounds 8 ounces, are considered low birth-weight babies. Infants weighing less than 2,500 grams at birth may be premature (born before the thirty-seventh week of pregnancy) or full-term but “small for gestational age” (SGA) or “growth restricted.” Babies can be premature but weigh more than 2,500 grams at birth. Some infants can be both premature and SGA. These infants are at even higher risk for problems linked to low birth weight. Technically, a baby is considered “larger than gestational age” (LGA) at more than 4,500 grams, or about 9.9 pounds, at birth.

Low birth-weight (or SGA) babies run the risk of developing more serious health problems as newborns, such as breathing and heart problems. They also have a higher risk for delayed developmental problems and learning disabilities later in life. Babies born at a low birth weight are more likely to experience asthma, respiratory tract infections, and ear infections. They are more likely to score lower on intelligence tests and to experience developmental delays. Those born weighing less than 2.2 pounds are at greater risk for cerebral palsy.

Infants born at an average weight and size run the least risk of problems as newborns and have the least risk of problems related to their size later in life. High birth-weight (or LGA) babies put both the mother and baby at risk for a more difficult labor and delivery. These babies can also have problems with low blood sugar and high blood counts at birth. LGA babies have a greater risk for carrying excess body fat during childhood and throughout adulthood.

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