Caloric intake for plus-sized pregnancy?

April 24, 2007 3:29 PM

How many calories does a plus-sized woman need during pregnancy?

A good friend of mine is pregnant with her second child. She's looking for accurate information on caloric intake.

She weighed about 195 lbs before her pregnancy, having jumped up 10-15 lbs in the previous 3 months due to 2 suspected spontaneous abortions in the first month of each pregnancy.

BACKGROUND

*Previous Pregnancy History
With her first pregnancy, she had problems gaining weight and her doctor was concerned. She was referred to a dietitian, but didn't move up on the waitlist until month 9, by whicb time only breastfeeding nutrition could be given. The nutritionist only talked about # servings of each food group and wouldn't talk about calories. In the end, my friend did gain enough weight to satisfy the doctor.

*This Pregnancy
This time around, my friend is not gaining as much weight as her doctor seems to think is appropriate. This past week, she dropped about 2 lbs, which may just be a bad scale or a water fluctuation or the result of some nausea and vomiting. However, my friend would like to know what her caloric intake should be. Her doctor didn't know the answer, although she agreed that my friend probably needed more calories than a smaller woman. Her doctor also said that the dietitian wait list is now so long that she will not get in before the baby is born. (And she's only 3 or 4 months along!) My friend has been eating 2100-2300 calories a day, with an eye to following serving and food group suggestions.

*Caloric Intake Readings
She knows she needs about 300 more calories than before she became pregnant. However, she's not sure how many calories she needed before, especially since her weight had just jumped up 15 lbs. She typically ate about 2000 calories a day (having only just weaned her first child) and she thinks she has light activity. She has read that 1800-2000 calories is the recommendation for an average non-pregnant woman, but that to *maintain* weight a plus-sized woman would need to eat more. Bigger people burn more calories just by existing. She's not sure if that is true, since she was never a real over-eater before and she was still overweight. She tried using some of the caloric intake calculators out there, but apparently a few sites say that the calculations don't work on plus-sized people.

QUESTION
So, with all that in mind, how what's the total amount of calories a woman of her size needs during pregnancy? Note: her doctor suggested a weight gain of about 25 lbs, so no need to derail with discussions of weight gain. Thanks!

posted by acoutu to health & fitness (15 comments total)

Being bigger doesn't always equate to needing more calories. A large muscular athlete will need more calories than a small muscular athlete, but a large sedentary person (who overheats easily) may need fewer calories than a small sedentary person (who still needs to move around enough to keep themselves warm).

Also, often large people gain weight easily because their bodies are extremely efficient. Two people with differently efficient bodies might have identical caloric intakes but different weights.

"The nutritionist only talked about # servings of each food group and wouldn't talk about calories." If your friend's dietician was trying to take the focus away from calories, she probably had a good reason. No need to fret.

Your friend should eat well. If she is large to begin with, she doesn't necessarily need to eat more or gain any weight at all. Back in the eighties when I was in dietician school we calculated caloric requirements based on a person's ideal weight. Thus if at her ideal weight your friend would require 1800 calories, then during pregnancy she would need 2100. If she doesn't gain weight on 2100 calories then she doesn't need to. (Fashions may have changed since then, but that was perfectly good advice at the time and won't kill anyone today.)

Your friend probably shouldn't be counting calories. She should be developing good eating habits. Sticking a Canada Food Guide (or whatever you use where you are) poster up on her fridge, learning what a portion is and making sure she gets enough fruit, vegetables, dairy and meat/alternates. If she wasn't counting calories before there is absolutely no reason to count them now. If she isn't gaining weight and her doctor would like her to, then she can eat more portions of her well-balanced diet. If her weight gain is healthy, then all is fine.

If the reason she is so focussed on calories is that she feels awful and can't eat, and is looking for some kind of signal that will give her permission to stop eating, she can use food portions the same way. The night before, she can lay out the food portions she will need to choke down the next day. Then try to get through them. No calorie counting required.
posted by kika at 4:09 PM on April 24, 2007

Oh, and back in the eighties when we were studying nutritional requirements during pregnancy - yes, the 25 lb figure was exactly what we used. A woman at her ideal weight would need to gain 25 pounds, but a little more would be ok too. An underweight woman would need to gain more: she would need to gain enough weight to reach her ideal weight, then gain 25 pounds on top of that. An overweight woman would not need to gain more than 25 pounds, and less might not be anything to worry about. A very overweight woman has no need to gain anything at all.

(Here I am using the non-PC terms of under- and over-weight because I am comparing to the "ideal weight" that is used for calculating requirements. This isn't about judging anyone, just about how to figure out what people need.)
posted by kika at 4:16 PM on April 24, 2007

as her doctor seems to think is appropriate

A second opinion from a midwife might be reassuring. Mine has no interest in what I (normal weight) weigh. The absence of that particular pregnancy worry is a great pleasure.

"Critics have argued that the (pregnancy weight gain) recommendations are unlikely to improve perinatal outcomes and may actually increase the risk of negative consequences to both infants and mothers."

From this abstract.

(I hope that's not too much of a derail.)
posted by kmennie at 4:49 PM on April 24, 2007

Thanks, kmennie. The article itself supports the recommendations, but yes, there is enough discussion to dissuade the pregnant from getting too hung up on their weight.

One point the article made was that women who are poor, who smoke, who are physically abused and/or who eat badly are more likely to gain less than 25 lbs and also more likely to have poor outcomes.

Chicken and egg, anyone?
posted by kika at 5:17 PM on April 24, 2007

Thanks. She says she is well versed in portions and (as I saw in her kitchen) she does have a Canada Food Guide on the fridge. She seems to eat very healthily, since she is adament about following the Food Guide for her first child. However, she said she'd like to know what trade-offs she's making, since some things have more calories than others. She doesn't want to increase her risk of gestational diabetes by eating more than suggested. She said something about her first pregnancy having an intrauterine growth restriction scare (I hope I got that right) and that the dietitian in the last month told her she wasn't eating enough.

I'm not sure why she wants to know calories more than servings. Maybe you're right about the permission aspect.
posted by acoutu at 5:22 PM on April 24, 2007

Ok, so she's panicking that if she doesn't eat enough the baby will be too small and that if she eats too much she'll develop gestational diabetes. She doesn't know how to steer a middle course. Gotcha.

No need to panic. If she weighs herself she can reassure herself that she's on the right track. It's not so much a question of eating too much or too little, it's gaining too much or little weight. Hence the bathroom scale.

If her particular difficulty is trying to gain enough weight, then she can put aside the fear of gestational diabetes for now. If she isn't gaining enough weight, then she is definitely not gaining too much weight.

These concerns are exactly what she needs to bring up with her doctor, who should be able to reassure her.
posted by kika at 6:21 PM on April 24, 2007

I talked to her some more. She agrees that she is having trouble finding a middle ground. She says she told her doctor this and the doctor said that she'd need to talk to a nutritionist, but that the waitlist is too long. Despite initially telling me she was okay with the weight gain thing, she now says that she keeps reading media reports that say she should only gain 15 lbs even though her doctor said 25. She says she trusts her doctor, though, but she doesn't want to gain more than necessary. She says that everything she reads online suggests she has gained enough weight so far, but that her doctor seemed to think she should have gained more. Perhaps she just needs to figure out what the source of her doctor's concern is.

Thanks for all the info, Kika. I will tell her to eat more!
posted by acoutu at 8:25 PM on April 24, 2007

This link confirms what I remember reading in several places: in general, you only need to increase your caloric intake by around 300 calories. To reassure herself, maybe she can count calories from an average day before her pregnancy to get an idea of where she is at right now.

Medline lists some risk factors for gestational diabetes. I don't know that caloric intake in itself is an actual risk factor, but if her concern is for her baby, moderate amounts of complex carbohydrates balanced with protein at each meal/snack, plus lots of veggies, is an excellent way to keep her blood sugar levels balanced. I was a little weirded out when I was diagnosed, and couldn't stop thinking of all those smoothies and pints of ice cream I'd been eating.
posted by moira at 8:27 PM on April 24, 2007

It sounds like your friend is anxious about her weight and about the baby. I don't think gestational diabetes is caused by eating too much--or even by eating too much sugar, or I'd have had it for sure in my first pregnancy, during which I was able to eat almost nothing but ice cream for long stretches because of nausea and vomiting. And she's not likely to keep her baby from growing if she eats like normal, either.

I started both my pregnancies at just under 250 pounds. In the first one, I had nausea and vomiting throughout and was actually losing weight until into the 7th month because I couldn't keep anything down. Baby was perfectly healthy and just the perfect size for his gestational age (he was born at 37 weeks). I worried a lot about him not getting any nutrients because I was hardly getting any. I just tried to make sure that everything I did manage to eat had at least some food value in it.

In my second pregnancy, I gained about 30 pounds, gave birth to a 6 1/2 pound baby, and yet somehow was within 5 pounds of my starting weight immediately after the birth.

Food does matter, but pregnancy is one of those areas where we can be encouraged by the media, by books like What to Expect When You're Expecting, and by well-meaning friends to worry way too much about it. Your friend sounds conscientious and as knowledgeable as she probably needs to be. She'll be fine.
posted by not that girl at 9:29 PM on April 24, 2007

She has stepped up with a little more info. She was one point below on the GD test last time. And then she had a 9 lb+ baby. Her first preg was marked by lots of nausea and some weight loss in the early/middle pregnancy, so I guess they've told her to watch out for gestational diabetes. She says she eats protein & complex carbs every four hours, exercises and the like. I am no expert, other than from my own pregnancies, but it sounds like she should feel okay with what she's doing, by the sounds of what you all have said.
posted by acoutu at 9:41 PM on April 24, 2007

Hi, just wanted to jump in and clarify that I didn't mean to imply that eating lots of sugars is causative. I just personally hated the thought that I'd been pounding my little girl with massive sugar spikes before I was diagnosed. (Not that it could have been much different, since I was in the same boat as not that girl.)
posted by moira at 9:49 PM on April 24, 2007

There was a previous thread on gestational diabetes recently (and I don't have time to look for it). Basically, the research is supporting eating well, not focussing on sugar/carbs, not on weight gain, not on counting calories.

In my opinion, 'what to expect while you're expecting' [the next thing I might need to panic over]. Avoid it like the plague (literally). I recommend highly 'Ina May's Guide to Childbirth' by Ina May Gaskin, or anything by Sheila Kitzinger for good reading.

Eating well, not being hungry, not overly stressed out, comfortable exercising is what will make for a healthy pregnancy, a healthy baby and a healthy labour/delivery.
posted by kch at 10:14 PM on April 24, 2007

I think that's this gestational diabetes thread.
posted by acoutu at 10:27 PM on April 24, 2007

I was obese during my pregnancy. In my country, pregnant woman are not routinely put on a scale, since apperantly there is no strict correlation between weight gain and baby health (they did feel my belly to feel if the uterus grew, of course). I gained about 10 pounds total, most of it in the last weeks. The first few months I actually lost some weight. Everybody said that that was normal. I had a very healthy nine pound baby, born at her due date.

The advice I got was just to eat healthy and not worry about extra calories.
posted by davar at 2:41 AM on April 25, 2007

Thanks. My friend says that the answers in this thread have put her mind at ease. She had a 4-day labour with her first 9+ lbs baby and she was worried about under- and over-eating, given the risks on either side.
posted by acoutu at 3:22 PM on April 25, 2007