Being pregnant while fat
December 13, 2017 10:51 AM   Subscribe

In this, my second pregnancy, I am starting off about 40 pounds heavier than I was with my first. I have questions.

I am about 5'2 and 37 years old. I was about 135 pounds at the beginning of my first pregnancy, and subsequently gained 60 pounds. I was 30 then. I lost it all, and then some, in the 2 years following. Fast forward to today - I am now 12 weeks pregnant and started off at about 175 (not a normal weight for me, and something I hope to be a temporary thing). I don't know my weight now, and I don't *want* to know - it will just make me grumpy. But in any case, since I haven't been in this situation before, I have a few questions.

What can I do to NOT gain a lot of weight this time? Do I need to count calories? I know from a life's worth of experience as a woman that if I eat as I think a normal person does, I will gain weight. On the other hand, if I watch what I eat, I will err on the side of too little and lose weight. Arg.

I am already uncomfortable. My belly is stupidly big. A couple of hours of shopping and my feet hurt. How bad are things going to get, and what can I do about it?

What am I going to do about clothes? I didn't buy a lot of maternity stuff last time - I mainly wore normal clothes in an extra large size, but I am already currently at an XL or about size 14.

What else should I be thinking about?

You may think I'm overreacting - could be, but I'm not thrilled about this situation and since I can't do much to change it at the moment I'm probably ruminating about it instead. Also, I know I sound grumpy but truly, I am very, very happy about this pregnancy!
posted by kitcat to Health & Fitness (23 answers total) 5 users marked this as a favorite
A few things from my own research: typically you show more the second time around because your muscles are more stretched out from your prior pregnancy. It's easy to compare this time to your first time, but it's not fair to do that!

Your doctor should tell you about any risk factors for you at this time.

If I were you, (IANAD/IANAMP) I would aim to add a couple healthy snacks when I feel the most hungry (carrots with peanut butter, a mozzarella stick, a cup of apple sauce, a handful of nuts, whatever!) but otherwise not change much. You are only supposed to add 300 calories per day (less at the beginning and more at the end, but that's the average). Though I've also heard lots of people say that as long as your diet is balanced and you are eating well, you shouldn't worried about eating a lot more.

About clothes: do you have friends who had kids? If not, see if you have a local Buy Nothing in your area and post a request for maternity clothes. Otherwise, maternity places totally have clothing for people of all sizes, so I wouldn't panic!
posted by ancient star at 11:03 AM on December 13, 2017 [1 favorite]

Focus on the nutrition you need for your baby to grow- look at macronutrients instead of calories. Work on this with your midwife or OBGYN.

Know too that after one pregnancy, your stomach muscles are different, so almost everyone shows more, and is generally more uncomfortable their second time around. Also realize you are taking care of another child, and you just don't have the luxuries of rest and relaxation the second time around- this also contributes to the second pregnancy being harder.

In terms of clothes- Target has a great maternity line of clothing- it is cheap and doesn't scream maternity.
posted by momochan at 11:05 AM on December 13, 2017

Congratulations on on your pregnancy! Obviously what your doctor advises trumps anything this internet stranger has to say...

So the mayo clinic book on pregnancy advises not to diet during pregnancy. Having said that, I have a coworker who was overweight when she became pregnant with her third child and she was advised by her doctor to not gain weight during the pregnancy. Obviously this is not medical advice and N=1. So, I'm not sure about dieting when you're a few pounds over, versus counting calories to gain all little as possible when you are truly overweight.

My doctor told me that too much weight gain during pregnancy increases the likelihood of having a bigger baby which can be problematic for both mom and baby. But that may be different than being overweight to begin with.

She also told me not to add extra calories in the first trimester because it's not necessary. I have had good luck with with raw veggies to fill my stomach and curb hunger. I'm eating a lot of veggies in my first trimester because I always feel sick on an empty stomach. Eating veggies solves the nausea problem without adding calories.

Call your doctor and ask. If you feel they aren't supportive, find another.

Good luck and congrats again!
posted by onecircleaday at 11:13 AM on December 13, 2017 [1 favorite]

I was fatter than you during both my pregnancies--say 250, give or take--and, as a bonus, I had nausea and vomiting throughout so that I was very limited in my ability to control what or how much I was able to eat. In my experience of pregnancy, it is a magical time during which you can gain quite a chunk of weight despite not having been able to eat a normal meal in, say, five months.

In some ways, being so sick that I literally had no choice but to eat whatever I could eat--for a good stretch of my first pregnancy, this was mostly peppermint stick ice cream--was a gift, because I simply couldn't obsess about nutrition or count calories. I was thinking in terms of, "Is this even remotely palatable to me? Am I likely to be able to keep it down? How horrible will it be if it comes back up?" All the books said, "You must maintain excellent nutrition during pregnancy!" I could only laugh bitterly.

My best advice is to try not to worry too much about it. You say you're ruminating, and it may be more productive to try to fight that than to fret too much about calories or weight gain. And, as a woman who had two pregnancies while very fat, I would like to reassure you that if you're concerned that your increased weight will cause complications for you or the baby, this is very, very unlikely. Even for women as fat as me--something like 280 pounds when I delivered my second baby--the increased risks you hear about are minimal.

I bought maternity clothes during my first pregnancy, and went with the big-and-baggy option in my second because I was too cheap to buy new stuff. I found that I liked maternity t-shirts because they were shaped to fit through my shoulders, whereas buying up a size or two to fit my stomach left me with a lot of ill-fitting fabric up top. I also found maternity jeans very comfortable. You might find that buying some maternity clothes helps you feel more comfortable in this pregnancy. In addition, I always find that, as a fat woman, flattering and properly-fitting clothes always make me feel more comfortable in my body, and more confident and attractive. So investing in some maternity clothes may pay off for you this time around.

Congrats on baby #2.
posted by Orlop at 11:16 AM on December 13, 2017 [12 favorites]

Oh! I just reread your post and we are very close to having the same due date : ) I'm 11 weeks, 4 days.
posted by onecircleaday at 11:18 AM on December 13, 2017 [2 favorites]

I am pretty anti-diet myself, pro feeling good and looking good at any size, and definitely think being hungry is stupid, especially while you're pregnant! But I had to give up gluten and cut dairy way down recently for health reasons, and now I feel better and am somewhat slimmer (like probably a size 10/12 at 5'7 instead of a size 14/16.) I didn't do this for weight loss, so it was so rt of a nice surprise.

So this is nothing dramatic, and I was actually fine with my size before, but I really do feel better and like my metabolism and everything just runs a little smoother. I fit into my clothes better. I was not a believer in the whole paleo thing, but my body likes it. I still eat rice and corn in smaller amounts, so I'm not really paleo I guess, but I try to keep grain-based carbs in check, and fill up on things like potatoes, good fats, meats, nuts and seeds, lost of full fat coconut milk, grain free treats (there are so many I'v learned about). I'm not hungry much at all, and I splurge all the time on coconut milk ice cream, fries, tacos-- and then balance it out with tons of veggies. It was a hard transition, but now I'm on a roll and my weight is stable.

I also think you can totally just say eff it, wear some leggings with long tanks/tunics the rest of your pregnancy, and just don't worry about. I just wanted to share my experience.
posted by Rocket26 at 11:18 AM on December 13, 2017 [1 favorite]

I gained way too much weight during both my pregnancies, so I can't give advice there, but I can tell you all about fat maternity clothes. I pretty much lived in maternity leggings and dresses from month 2 on. I think I went through three sizes of shirts, but comfy, stretchy dresses lasted me the whole pregnancy. Old Navy usually has them a little cheaper than Target, but also a little worse quality. Kids consignment shops and sales are a great place to pick up used maternity clothes. Towards the end of my last pregnancy, I outgrew all the maternity clothes I bought and ended up using a rental service through Le Tote - it was a nice way to have fancy clothes and look presentable when I felt anything but.

Not to scare you, but being overweight puts you at a higher risk of developing gestational diabetes. There's really not much you can do to avoid it, and it's not as bad as it sounds, but I wish I had better prepared myself for the possibility.
posted by galvanized unicorn at 11:29 AM on December 13, 2017

I lost weight during pregnancy due to horrible sickness (I started out BMI 22 so it wasn't intentional). I had a healthy baby. Everyone I spoke to reassured me that baby would take what they needed and to just eat what I could. So I wouldn't worry too much about making sure you gain the right amount. That is really very flexible.
posted by kadia_a at 11:34 AM on December 13, 2017 [2 favorites]

Yeah, count calories and focus on nutrition. Weigh yourself everyday. It goes against the common wisdom but there is research that supports more awareness of the number on the scale helping to calibrate diet, and you can’t track the impact of your diet without weighing yourself. You’ll know if you’re losing too much or not.
posted by stoneandstar at 11:34 AM on December 13, 2017 [2 favorites]

I'll bet your health insurance will cover a nutritionist, and I recommend it. You're taking folate, right? Pregnancy can steal your calcium, so dark leafy greens and other calcium-rich foods. I lost all my pregnancy weight by nursing for over a year, so if that's a thing you can do, I recommend it. I lost slowly for @6 months, then lost weight fast. congratulations!
posted by theora55 at 11:37 AM on December 13, 2017 [2 favorites]

Hi. I'm fat and was pregnant while fat and had a healthy pregnancy and birth and baby. Congrats!

For clothing, I worked in an office so I needed some reasonably nice clothes. I got by with a handful of official maternity tops + regular plus-sized pants in material with some stretch. (I carried my baby high, and am pear-shaped to begin with. YMMV.) In off hours: leggings and extra-large non-maternity tops.

For weight: do not count calories or weigh yourself daily. I really focused on "eat when you're hungry" and "you're growing a human from scratch" and "your body is working perfectly right now, calling for what it needs" to get me through. Sometimes this meant eating a lot. Sometimes this meant eating very little. I actually felt as if this was the healthiest I'd ever eaten, because I was truly listening to my body. I ended up gaining about 22 pounds overall, and a week or two after giving birth I'd lost 15 of it.
posted by BlahLaLa at 11:44 AM on December 13, 2017 [10 favorites]

Ah, yes, this was me. I was already overweight with my first pregnancy, gained a shitload of weight (50+ lbs) and proceeded to barely lose any of it, and then got pregnant a second time. Both babies were born healthy and normally sized (7 lbs and change), and no GD or other complications for either them or me.

I too stressed about it a lot beforehand, like while we were TTC our second, but when the + sign finally showed up, I just decided that I simply could not let it dominate my headspace like it had with my first. I put the scale away for the duration, looked away when the nurses weighed me at my OB visits, ate whatever I could manage, and decided that whatever would be would be, and that I would just deal with it AFTER I delivered. And you know what, my second pregnancy ended up being VERY different from my first, so you're not doomed to have history repeat itself. With my first, I was constantly, horrifying nauseous unless I had something in my stomach at all times, so that's where the bulk of my weight gain came from -- that, and I fervently, desperately craved cards and sugar. With my second, I was less sick, but also sugar sounded terrible (!) so I subsisted mostly on string cheese and was just less hungry in general. I ended up only gaining about 20 lbs with my second, and now that he's five weeks old, I've lost it all plus an additional 10 lbs (thanks, baby who actually nurses).

I'm way bigger than you (245 lbs currently), so you will totally be able to find clothes. I wore mostly leggings (both maternity and regular) and non-maternity dresses and still managed to feel mostly cute and comfortable the whole time. (And I was soooo NOT a leggings person before, but shopping for plus-size maternity jeans sounded absolutely excruciating, I understand all the hype about leggings!) Empire waist was my friend. Torrid has a TON of cute dresses and I got a million compliments every time I wore one. Target has lots of decent maternity basics, too. My pregnancy wardrobe was tiny and not that exciting but I got good haircuts, added variety and flair with shoes and jewelry, that kind of thing.

Congratulations and best wishes!
posted by anderjen at 12:02 PM on December 13, 2017 [2 favorites]

You'll be fine. I know being fat is uncomfortable, but please be kind to yourself. While you're pregnant is not the time to be beating yourself up or trying to lose weight.

A lot of pregnancy weight gain is a function of hormones and quite beyond your control, in any case. The advice to weigh yourself constantly - presumably to discipline yourself for gaining - is deeply misguided here.

Your doctor will tell you if she wants you to do anything special nutrition-wise (for instance, mine asked me to not go to town on breakfast cereal, which was one of the things I really REALLY wanted to binge on) because she didn't want me eating a ton of sugar. Fair enough. Your doctor will have her own things she recommends.

If you're looking for reassuring anecdata, I started off my pregnancies at about the weight you are now, gained c 25 lbs with each, had no diabetes or other trouble, and had perfect, healthy, average-weight babies. (The weight eventually came off, too.)

For clothes, I found Target was all I needed. Plenty of maternity wear in big sizes, reasonable costs. They have nursing tank tops so comfortable I kept them for years afterwards. (I avoided fashionable shops like Pea in the Pod as they did not seem to accommodate plus-sizers.)

Good luck, and be nice to yourself. Your body is doing something very important and very hard right now. You won't have to deal with another person inside your skin forever.
posted by fingersandtoes at 12:27 PM on December 13, 2017

Dear lord, don't count calories or weigh yourself daily. What a recipe for stress and frustration and discomfort!

Eat what you feel like eating. Baby will take what baby needs, barring any medical issues that you should discuss with your doctor. Be kind to yourself. Pregnancy is hard, second pregnancies are harder. Not only is your body working overtime, you're taking care of a small child as well. Do not add micromanaging your weight to your list of chores.
posted by lydhre at 12:28 PM on December 13, 2017 [12 favorites]

IANYOBGYN... but I have studied perinatal nutrition and expectations when I wanted to get into maternal nursing. It used to be that a certain amount of weight gain was expected for all pregnancies, regardless of starting weight and health. That has been updated to reduce the necessary weight gain for those people who have started at a higher BMI, and already had some excess weight to lose.

That is to say, that you should not aim for weight loss by any means, but rather than a 50lb weight gain, you could aim instead to only gain 20... I'm wasn't sure what the recommended ranges actually were or are (but found them and put them in the link below), but I do recall that this was something. I have also heard of near morbidly obese women actually continuing to lose weight and not recognizing the pregancy until the baby arrived (thinking it was just indigestion), but that is NOT recommended in any way - and certainly doesn't sound like it fits your situation at all.

Aha! Here's a link to the Mayo Clinic's info which gives healthy guidelines. I knew that I could have possibly said to aim for 10-20 lbs, but I really don't know what your BMI actually is, and you can calculate that for yourself.

As for what others have stated, yes, definitely aim for micronutrients rather than calorie counting. I found this one-page site on pregancy nutrition, and I like that there is also an emphasis on exercising while pregnant.
posted by itsflyable at 12:38 PM on December 13, 2017 [1 favorite]

I was very heavy at my second pregnacy to the consternation of my perpetually slim and handsome doc. But after testing no diabetes. I worked all the way through, walking three miles a day at work. He weighed me expecting the worst. At delivery I lost the weight I put on. So worrying creates stress which can raise blood sugars. Just watch your gain vs the average gain, for a healthy pregnacy. Breathe, get some walking in, don't worry, align your cravings for carbs with high fiber carbs, and fruits low on the glycemic index, blueberries, strawberries, canteloupe, Mexican papaya. Drink plenty of plain, pure, water. Best to you and your new and old babies.
posted by Oyéah at 12:38 PM on December 13, 2017

I would talk to your doctor about your concerns -- if there really is a need for you to change what you're eating, they can hopefully direct you to a dietitian who can help you work out the best plan. I would highly doubt it includes lots of calorie counting and constant weighing -- you're already getting weighed at the doctor for every appointment, so they'll be able to let you know if things aren't looking right in terms of either weight or other health indicators (blood pressure, gestational diabetes, etc.).

Also, I just have to laugh at some of these "best things to eat when you're pregnant!" articles you find online. Everywhere seems to want me to eat eggs, which -- well into the third trimester now -- would probably make me projectile vomit over everyone in the surrounding area. I only recently became able to eat fish again without it turning my stomach, and even then only salmon and no other types. Sometimes you've just got to eat what your body will tolerate, which for many people is vastly changed during pregnancy, and that's okay. I freaked out about eating too many carbs and not enough protein during my first trimester (at that time, cold cereal was a main staple of my diet and I couldn't stand the sight of meat), but my doctor reassured me that you can't do that much about food aversions and the baby will honestly be okay even if you don't eat that perfect "pregnancy diet" that websites love to talk about (presumably written by men who have never been pregnant?? Or women who had magic pregnancies?). So, talk to your doctor -- I bet she will be reassuring, or if she does have specific advice, at least you will know what her recommendations are and can stop stressing over it!
posted by rainbowbrite at 1:27 PM on December 13, 2017 [2 favorites]

Talk to a dietitian! They'll definitely be able to help sort you out better in regards to all the worries you have right now regarding food/counting calories/nutrition while pregnant.
posted by astapasta24 at 2:24 PM on December 13, 2017

I’m fat and also currently pregnant. From all I’ve been told by doctors (and read) you should not be trying to lose weight while pregnant and the 10-20 lb gain is the recommended range for people who were overweight before. In Expecting Better the author actually points out that according to the data she reviewed, while having too small a baby or having too big of one for gestational age are both not ideal, there are worse complications for babies that are too small than too big and so erring on the side of slightly more gain is better than too little.

Obviously we should all be striving for getting all those calories from healthy sources but I’m not giving myself a hard time about a slice of pizza or some cookies when I’m mostly eating ok. I didn’t have really bad nausea and there was still a time when about all I could stomach was crackers. I say try to fill up on the good stuff but don’t beat yourself up for going with the cravings on occasion.
posted by brilliantine at 3:29 PM on December 13, 2017

Talk to a dietitian! During the first trimester, no extra calories are needed to maintain a healthy pregnancy. During the second, an extra ~350 a day are needed and during the third trimester, and extra ~450. That's really not much at all. I would eat moderately and limit sugars and simple carbs so that you limit your risk of developing gestational diabetes.
posted by quince at 3:43 PM on December 13, 2017

Eat when you're hungry, steer toward things without refine sugars , fill up on high fiber/fruits and vegetables.

Talk to your OBGYN.

Pretty much just don't try to lose weight.
posted by pearshaped at 4:29 PM on December 13, 2017

I didn’t try to lose or minimize weight gain during pregnancy, but then I got GD and had to keep my blood sugar within a tolerable range for the rest of the pregnancy. For me that meant figuring out which foods raise my blood glucose too much (food log and glucose meter), which resulted in a fairly low carb diet and only occasional low-dose insulin injections. I didn’t track or restrict calories, ate whenever and how much I felt like but avoided the foods that I had identified as raising my blood glucose levels too much. I ended up only gaining one or two kilos. Now, obviously, this is just one data point and everyone’s bodies are different and I’m no medical professional and this is not medical advice.
posted by meijusa at 1:13 PM on December 14, 2017

IAMYOBGYN, but I am an OB/Gyn.

Your starting BMI is 32, which puts you in the IOM guideline range (as linked upstream on the Mayo website) in the "gain 11-20lb" range. What this translates to is about 1/2 pound per week in the second and third trimester. HOWEVER, there are data to suggest that weight stability at your weight is safe for the pregnancy, and even weight loss if done with a balanced diet. The 340-450 extra calories mentioned above apply to women starting with a lower BMI than you. You will likely need less than that, and it's sometimes helpful to keep in mind just how tiny those "100 calorie snack packs" are!

I want to be explicit in saying I am not trying to fat shame you here, but for data's sake, your BMI puts you at significantly increased risk of hypertensive disorders, gestational diabetes, shoulder dystocia at delivery (which is when baby's shoulder gets stuck under your pubic bone during labor and can cause catastrophic neurological impairment in your infant) as well as stillbirth.

I will quote UpToDate (which is like the doctor's google):
"Asphyxia and death — Risks for birth asphyxia, fetal death, stillbirth, perinatal death, neonatal death, and infant death are all increased in the setting of maternal obesity. A population-based cohort study from Sweden reported increased risks of perinatal asphyxia-related complications (Apgar 0 to 3 at five minutes, meconium aspiration, neonatal seizures) with increasing maternal BMI in singleton term infants [103]. A 2014 systematic review and meta-analysis of cohort studies found that even modest increases in maternal BMI increased the risk of fetal death, stillbirth, and infant death [104]. The 44 publications included >10,000 fetal deaths, >16,000 stillbirths, >4000 perinatal deaths, >11,000 neonatal deaths, and almost 5000 infant deaths. The major findings were:

●Relative risk per 5 unit increase in maternal BMI: fetal death 1.21 (95% CI 1.09-1.35, n = 7 studies), stillbirth 1.24 (95% CI 1.18-1.30, n = 18 studies), perinatal death 1.16 (95% CI 1.00-1.35, n = 11 studies), neonatal death 1.15 (95% CI 1.07-1.23, n = 12 studies), and infant death 1.18 (95% CI 1.09-1.28, n = 4 studies).

●Absolute risk per 10,000 pregnancies for women with BMI of 20, 25, and 30 were: fetal death 76, 82, and 102, respectively; stillbirth 40, 48, and 59, respectively; perinatal death 66, 73, and 86, respectively; neonatal death 20, 21, and 24, respectively; and infant death 33, 37, 43, respectively."

Now for the good news: you are early in your pregnancy and probably haven't gained too much at this point, so you still can still somewhat control your outcome. Because of the nature of absolute risk, none of the scary above risks will likely apply to YOU in particular. And as some people have pointed out, some pregnancy weight gain is genetic, so you may do everything right and still gain weight. The absolute most proactive best thing you can do right now is start an exercise plan.

And please try to not be too hard on your midwife or doctor if they address your weight--they are dealing with their own trauma from all the bad outcomes they've seen happen, and truly just are trying to help you avoid those bad outcomes even if they may not be tactful or are downright brusque about addressing it.
posted by eglenner at 10:33 PM on December 14, 2017 [4 favorites]

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