Pregnancy brings dramatic changes to your body, not least the inevitable weight gain as your baby and its placenta take up residency in your womb, alongside a healthy stash of amniotic fluid. Then there's all that extra blood and fat your body starts hoarding for pregnancy and breastfeeding. It's understandable - and perfectly healthy - therefore, to put on a certain amount of weight during pregnancy. But just how much weight can you put on and still maintain a healthy pregnancy?
A sensitive subject
For many, pregnancy is a time to surrender your body to Mother Nature and embrace all the changes - weight gain included - even using pregnancy as an excuse to eat whatever you want for the first time in your adult life (midnight chocolate cravings, anyone?). And, with morning sickness and extreme fatigue playing havoc with your hormones, who can blame a gal for seeking comfort in cake?
But it's something of a sensitive subject, especially here in the UAE, where the melting pot of cultures gives rise to mixed messages about what is considered a 'normal' amount of weight gain in pregnancy. What's more, pregnancy can be stressful enough as it is without the added anxiety of constant weight monitoring. So much so that in the UK mandatory weigh-ins for pregnant women were abolished in the 1990s as it was believed that the stress and anxiety it heaped on mothers outweighed any benefit.
Until now, that is. The Royal College of Midwives has called for a return to this weight monitoring following new research. The report, published in 2018 in Diabetologia, the journal of the European Association for the Study of Diabetes, found a link between pregnancy weight gain and an increased risk of high blood pressure and poor blood sugar control. This echoes a new study by the Chinese University in Hong Kong, which found even a mild increase in glucose in pregnant women can give rise to a risk of diabetes and obesity in off-spring. In fact, Australian health authorities have gone a step further as a result of new findings. A recent recommendation in the Medical Journal of Australia advocates monitoring the weight of pregnant women even more closely, and discussing weight, diet and fitness at all antenatal appointments.
While there are currently no such set guidelines in place in the UAE, women here are generally weighed routinely at each appointment.
"On average women should gain around 10 to 12kg during pregnancy, this is considered healthy as per the World Health Organisation guidelines," explains Hazel Leonard, lead midwife at Babies and Beyond. "However, some clinicians may vary their recommendations depending on individual health assessments and the mother's health needs. She adds, "Weight is one way of assessing maternal wellbeing, so this is usually monitored at every appointment here in the UAE."
One eye on the scales
According to Dubai's Department of Health, obesity is one of the biggest health concerns facing women of childbearing age in the region. Coupled with the complications that can arise from unhealthy weight gain in pregnancy - preterm birth, gestational diabetes, increased risk of miscarriage, for example - it might seem prudent to keep one eye on the scales.
Cecile De Scally of Malaak Mama & Baby Care warns of some of the further complications that can arise from excessive weight gain in pregnancy: "High blood pressure as a result of weight gain can cause damage to other organs, most often the kidneys, while the increased pressure on the heart can lead to cardiac problems. Weight gain can also cause sleep apnea, and make vaginal birth more difficult - resulting in the need for a C-section. Recovering from the C-section can also take longer as there is an increased risk of wound infections, and mobility problems can result in chest infections and deep vein thrombosis."
What's more, being overweight in pregnancy can also have an adverse effect on your baby, continues Cecile. "Your baby could be larger than average (a condition called fetal macrosomia) and have more body fat than normal. This increases the risk of blood sugar concerns in the first few days, which can continue into a possible metabolic syndrome and childhood obesity," explains Cecile. She adds, "Any birth defects are also harder to detect with an ultrasound if the mother is overweight."
It's a scary picture, but addressing the issue head-on, as Australian authorities have, comes with the added consideration of the mother's mental health. After all, pregnancy is a stressful enough time without worrying whether that extra helping of chips is going to wreak havoc on you and your baby's health.
The flip side
Nadia Brooker, counselling psychologist at The Priory Wellbeing Centre, Dubai warns against meticulously monitoring pregnancy weight gain, and says diet tools like food diaries should be off limits when you are with child. "These behaviours are not appropriate for any woman during pregnancy (apart from standard testing by a doctor/midwife to ensure the baby is growing). Any obsessional weighing or even food diaries is of concern and could be a sign of a pre-existing eating disorder, thus it is important that expectant mothers seek professional support. Moreover, this can be a stressful time for people who have a diagnosed history of an eating disorder, as weight gain and body changes can trigger 'old' eating disorder cognitions, thus ongoing support and monitoring is highly recommended."
Women who have struggled with body image pre-pregnancy should be extra vigilant not to fall into a weight-watching trap, adds Nadia. "Should there have been a confirmed eating disorder or significant body image concerns pre-pregnancy, these mums need to be extra mindful and continue to access support during and post-pregnancy. There are also risks concerned with the baby - dieting during pregnancy is dangerous for the growing child. If the mum has a history of an eating disorder, she may need postnatal support if body image remains an issue. The health of the mother post-birth needs close monitoring to ensure she can adequately care for the needs of the newborn child."
Striking a balance
The key, says Hazel, is in an open and trusting relationship with your midwife or doctor. "Some mothers may find regular weigh-ins stressful, which is why it is important to build a positive and trusting relationship with your healthcare provider. By doing so, appropriate education and information can be shared freely, helping to reduce stress for mothers. Should mothers find that the monitoring of weight is leading to high levels of stress, this should be discussed so that a referral to appropriate healthcare providers can be made, such as a dietician, counsellor or maternal support group."
Cecile also advocates a moderate approach. "Stress in a mother directly impacts the foetus, which can affect the baby's growth as well as cause a preterm birth. When we weigh too often this can be equally bad as not monitoring weight when needed. There needs to be a balance where the woman is observed and guided appropriately. If a pregnant mother has concerns about her weight, whether over or underweight, she requires proper guidance on nutrition and safe levels of exercise."
Read more: What should I eat more of when I'm pregnant?
It's worth remembering that every pregnancy is different, and how your body responds to pregnancy will vary from woman to woman. "Some women will retain water, so their weight gain will not necessarily be diet-related. It's important to guide a mother through any health concerns, keeping her mental state in mind," says Cecile. "It's worth noting that the concern a mother will have for her baby can be overwhelming and affect how she gives birth."
Above all, self-care is paramount. Nadia says this includes: "Good nutrition, ample rest/sleep, moderate to gentle exercise (depending on pre-pregnancy levels) and keeping stress levels to a minimum, generally. If you have other children to care for, ask relatives for help around childcare tasks, cooking, shopping etc. in the latter stages of pregnancy to allow more time for rest and relaxation. It can also be very helpful to talk about your worries or concerns - chances are you aren't alone and it's very helpful to feel validated and heard. Spend time doing things that you enjoy, but first and foremost look after yourself and take any health concerns seriously, no matter how minor you may think they are."
How much should you be eating in pregnancy?
1. Use your hands for portion control one fist for carbohydrates; two hands together for veggies; the tip of your thumb for fats and the thickness and size of your palm for proteins.
2. Include plenty of colour on your plate think a rainbow of orange, yellow, green and red fruit and vegetables and limit white processed food where possible.
3. Don't 'eat for two' instead of eating twice as much, try to eat twice as healthily. As a general rule, women don't need to eat any extra food during the first 12 weeks of pregnancy, and just 340 calories a day extra in the second trimester and 450 in the third - roughly the equivalent of a wholegrain tuna sandwich.
If you're carrying one baby, the recommended weight gain for women who were previously of a healthy weight is 11.5kg to 16kg.* If you are carrying multiples then the recommendation is a little more.
First trimester: 1-4.5 pounds (500g-2.5kg)
Second trimester: 1-2 pounds per week (500g- 1kg)
Third trimester: 1-2 pounds per week (500g - 1kg)
*Stats from NHS