Experts debate weight gain during pregnancy

In 1958, pregnant for the first time, Mimi Lowe lived in fear -- of her doctor.

Despite his stern admonitions against gaining an ounce more than 20 pounds, she couldn't hold back her body.

"Before my monthly checkups for two days I wouldn't eat or drink anything and I'd take my jewelry off, but the weight just kept going up and going up," said Lowe, 71, who has always been slim when she's not pregnant. By the end of her pregnancy, she'd put on 35 pounds.

In Lowe's day, and for much of the 20th century, doctors urged women to adhere to an austere 15-20 pound weight gain, a difficult task for many women. Anything more increased their odds of large babies, high blood pressure, dangerous Caesarean sections and other complications, experts believed.

But in recent decades, weight gain recommendations for pregnant women have climbed steadily. In 1970, concerned that weight gain restrictions were leading to low birth weight babies, experts raised the limit to 25 pounds. In 1990, the current recommendation of 25-35 pounds for normal weight women was set.

And women have kept pace. In 2003, the average pregnancy gain was 30.5 pounds, according to the National Center for Health Statistics. That's up from about 25 pounds in the mid-1960s. Some studies also suggest women retain an average of 10 pounds after every pregnancy.

Now, with so many women going into pregnancy already overweight or obese, experts are revisiting the issue, this time with an emphasis on the mother's long-term health.

Are strict weight gain restrictions once again on the horizon for pregnant women? Or is there another answer?

"The pendulum swings back and forth. I think it's a little trendy," said Barbara Abrams, professor of epidemiology at the University of California-Berkeley, and member of a committee assembled to review the latest research on pregnancy and weight gain.

It is a project organized by the Institute of Medicine, an independent scientific advisory agency to the federal government. The committee is expected to come out with a report summarizing its findings by the end of the year.

"Women can only control so much of it," Abrams said. "I think it would be a real shame if we went back to starving women during pregnancy."

Healthy babies have always been the primary aim of weight gain recommendations.

But with the obesity epidemic in full swing, experts are more attuned than ever to the danger zone pregnancy represents for mothers as well.

Close to half of all pregnant women in Washington in 2004, for example, began their pregnancies already either overweight or obese, putting them at greater risk for a host of health problems, including high blood pressure and gestational diabetes, according to the state Department of Health.

The risks for babies of an obese mother, including stillbirths, prematurity and childhood obesity, are also well known.

"The state of health is so poor at conception," said Dr. Maxine Hayes, state health officer and chair of the Institute of Medicine committee. "The parents of the boomers didn't have the burden of epidemic obesity that the current generations have."

At the time, some experts argued the 1990 guidelines raised the upper weight limit too high and would leave women struggling to shed excess pounds after pregnancy.

Those dire predictions haven't come true, at least for those who stick to the guidelines.

Instead, many now agree that women who gain within the parameters recommended for their pre-pregnancy size have the best chance of losing their pregnancy weight and having healthy babies.

But not all women adhere to the guidelines. About 36 percent of pregnant women gain more than they should, putting them at risk for a lifelong battle with extra pounds.

Winnowing their bodies back down to a healthy weight can be a long, frustrating battle.

Bonnie Raffo started her pregnancy about 10 pounds overweight and gained another 45 pounds.

Her son, Dixon, is now almost 3 years old.

"I would just look at my wedding photos and think I'm never going to be that size again," said Raffo, who hit a high of 214 pounds before Dixon was born.

She lost all of her pregnancy weight and then some, but it took a year.

"By the end of that pregnancy I was so uncomfortable," said Raffo, 32. She suffered severe back pain, a pinched nerve in her groin and a painful foot condition. "All that extra weight didn't help."

Now pregnant with her second child, despite a new commitment to working out and eating well, she's on target again to gain too much.

And her new doctor is more strict.

"This doctor has been getting on me about it," Raffo said.

Stacey Chesnut is also working to get her body back to its pre-baby measurements.

Eighteen months after her son, Jonah, was born, Chesnut still wants to lose 15 pounds of the 50 she gained during her pregnancy.

Chesnut, a former intensive care nurse, spent much of her free time while she was pregnant driving from Portland to Seattle to house hunt. She learned she was pregnant at the same time her husband found a new job in Seattle.

Fast food pit-stops and time in the car added up.

"Between my third and fourth months, I gained 10 pounds," said Chesnut, 34. "You still think 'OK, I'm on track,' forgetting that you gain most of the weight in the last few months."

Determined to lose the extra weight, Chesnut joined Stroller Strides, an exercise class for mothers and babies when Jonah was 5 months old.

"I came home and I kept waiting for that drastic drop on the scale and it never really happened," said Chesnut, who lives in Lake Forest Park.

During a recent class in a hangar at Magnuson Park, Jonah giggled at his mom while she ran in place and jumped beside his stroller. The mothers in the class sing "Row, Row, Row Your Boat," and "Twinkle Twinkle Little Star" to keep their little ones entertained while they burn calories.

"I definitely feel a lot more in shape," Chesnut said. "I do know if I go through this again, I'll really watch it."

Still, some experts insist a singular focus on weight gain is missing the mark (in Great Britain, the Royal College of Obstetricians and Gynaecologists recommends against weighing women during pregnancy). The range of healthy weight gain for pregnant women is likely more flexible than the official recommendations suggest, they say.

Lowe, the woman who fretted about her pregnancy weigh-ins, now laughs at her timid 24-year-old self. But at the time she never thought to question her doctor. "He was just a god," she said.

"After those exams, I would come home and just pig out."

Despite defying doctor's orders, she had a healthy 8-pound, 2-ounce baby boy. A week later, she left the hospital weighing less than when she arrived.

"I hopped back into my clothes," said Lowe, who now lives in Bellevue. "That was just nature's way of protecting the baby and me."

"We make these guidelines for the population," said Dr. Naomi Stotland, an obstetrician gynecologist at the University of California San Francisco Medical Center who studies pregnancy and weight. "For any individual person, we don't have any way of knowing what your healthy weight gain is."

The baseline weight gain for pregnancy is about 15 pounds, which includes the fetus, the placenta, amniotic fluid and extra fluid and tissue in the mother's body.

"If a woman doesn't gain that, she's actually losing weight," Stotland said.

Unless a woman is obese, she needs a few extra pounds of fat (in addition to the minimum 15) to prepare for the demands of breastfeeding. Overweight women should gain between 15 and 25 pounds, according to the 1990 guidelines; 15 pounds is the suggested weight gain for obese women.

While experts debate the finer points of pregnancy and weight gain, many women struggle with their own expectations, molded in part by images of celebrity moms with perfectly rounded bellies and pencil-thin appendages.

Nicolle Hill, now six months pregnant with her second baby, said she gained 28 pounds during her first pregnancy. That's well within the healthy range for her weight, but the reality of those extra pounds terrified her.

"I'd never seen numbers that big," said Hill, a lifelong exerciser who lives in North Seattle and ran marathons before becoming a mom.

During their pregnancies, Hill and her sister had long talks about whether their bodies were destined to be oversized after having babies.

Their mother gained 50 pounds with her first pregnancy and never had a chance to rebound before she got pregnant with Hill's sister just six weeks later.

"Her body literally didn't recover," said Hill, who teaches a Stroller Strides class in Seattle.

But if women are eating well and staying active, they shouldn't beat themselves up, even if they do stray outside the guidelines, Stotland said.

"I don't take the approach like one of my colleagues really trying to scare or threaten women," Stotland said. "This is something positive you can do -- not just for your pregnancy, (but) for yourself and for your baby."

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