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Posted June 16, 2009 | Copyright © The Northern Virginia Daily
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New guidelines say pregnancy weight gain should depend on your health

Rhoda Bennett regularly eats apples
Rhoda Bennett, of Strasburg, regularly eats apples and drinks plenty of water during her pregnancy to stay healthy for her baby. Rich Cooley/Daily

Bennett and her son, Tice, walk
Bennett and her son, Tice, 11, walk along Strasburg's scenic walking path behind the town park to get regular exercise during pregnancy. Rich Cooley/Daily

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By Josette Keelor -- jkeelor@nvdaily.com

Eating for two these days? Pregnancy can be a hectic time, a whirlwind of out-of-control cravings for frozen cheesecake and pickles mixed with moments of no appetite at all.

In light of a report released on May 28 by the Institute of Medicine of the National Academies, it is more important than ever for women to pay attention to the weight they gain during pregnancy, for their own health as well as the health of their children.

The report, "Weight Gain During Pregnancy: Reexamining the Guidelines," which was the first update the Institute of Medicine had made since 1990, details recommendations on the number of pounds a woman ought to gain during pregnancy depending on the weight she is at the beginning of the nine months, according to the institute's Web site, www.iom.edu/pregnancyweightgain.

"American women are now a more diverse group; they are having more twin and triplet pregnancies, and they tend to be older when they become pregnant. Women today are also heavier; a greater percentage of them are entering pregnancy overweight or obese, and many are gaining too much weight during pregnancy. Many of these changes carry the added burden of chronic disease, which can put the mother and her baby's health at risk," according to the report brief.

How much weight gain do doctors recommend?

"It's about 25-35 pounds depending on the patient's weight," says Dr. Mark Haeberle, a physician with Shenandoah Women's Care in Woodstock. Underweight women will want to gain more than overweight women will, says Haeberle.

"There is a major misconception that people need to eat for two," he says. He advises women to pay attention to how much they consume during pregnancy and focus on gaining a healthy amount of weight.

The ideal scenario would be for a woman to achieve a healthy weight prior to becoming pregnant, he says, but if that is not possible, he assesses each patient's case accordingly.

Those who begin pregnancy underweight need to first achieve a healthy average weight, then Haeberle will reassess how much the patient should gain from that point. Those who are overweight at the beginning of the nine months should act as though they have already gained some pregnancy weight, he says.

The more a woman weighs before or during pregnancy, the more problems she can have, he says.

"It can make larger babies, if it's not controlled," he says. "It's not dangerous ... it's not life threatening ... but it's a management problem [for the baby and for the pediatrician,]" he says.

"The obese woman runs a higher risk of having a cesarean section," he says. On the flip side, babies whose mothers do not gain enough weight during pregnancy can be born underweight, he says.

"The baby might be 5 to 6 pounds instead of the 7.3 average," he says. "[It's] just a matter of management and encouragement."

Still, the process isn't as cut and dry as gaining a specific number of pounds steadily over the course of nine months, he says. Other factors come into play, such as lack of hunger, gestational diabetes, and the fact that women tend to gain most of their pregnancy weight in the second half of pregnancy, gaining on average only about 10 pounds in the first 4 1/2 months.

Another problem is not knowing what to eat.

"Nutrition is something that people just don't know about," Haeberle says, and many of his patients need guidance depending on their health needs. "You really have to concentrate on what you're choosing," he says. "You have to make better choices."

Women who experience a loss of appetite during pregnancy will tend to stop eating, but Haeberle says that is a bad idea. Even if they are not hungry, they should eat frequent, short meals of healthy foods like vegetables, fruit and protein, based on their dietary requirements.

"I'm diabetic," says Rhoda Bennett, 41, of Strasburg, who is 22 weeks into her second pregnancy. She has gestational diabetes, which occurs only during pregnancy, so she has to be cautious of what she eats in addition to injecting herself with a shot of insulin each day.

"[I] stay away from sugars," she says. "I eat a lot of wheat, bran ... I do eat apples a lot, I crave apples -- and water." She also eats a variety of vegetables, fish, poultry and eggs.

"I try to stay away from drinking a lot of soda, and if I do it has to be diet, of course," she says.

Bennett received a list of recommended sources of iron from her nutritionist at Shenandoah Women's Care and finds it to be helpful. Bennett explains that women need more iron when they are pregnant. The list includes items like beet greens, chicken, dates, eggs, raisins, shrimp, turkey and wheat germ.

The toughest thing for her right now is just making herself eat.

"I haven't been having a very big appetite," she says, but she knows how much of a weight gain she should aim for, from speaking with her doctor, Dr. Margaret Loewith. "She said don't go over 20, that's the idea."

Once Haeberle informs his patients of their personal rules for healthy weight gain, the next step he gives them is to just "move." They cannot just diet, he says; they have to combine eating healthy with exercising. He recommends buying a pedometer and aiming for at least 6,000 steps a day.

"It's the idea of making better choices," he says. "Proper nutrition and exercise ... trying to be healthy; that's our job, trying to be healthy and teach health."

Bennett had been walking until recently when she found that walking aggravates her already swollen ankles.

"The more I walk, the worse it gets," she says, but she hopes to begin exercising again soon, preferring to use the new walking trail in Strasburg.

Her advice to other women?

"Just don't get pregnant when you're old, that's the main thing," she says, chuckling. "It's hard, it's really hard."

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