You are not eating for 2…

pastaOne of the most common phrases I hear amongst patients and in the media is “I’m eating for two,” when referring to pregnancy as an excuse for excessive food portions. This is just not true ladies. As I tell my patients, you are not, in fact, eating for two, but you are eating for yourself and a tiny baby. So that sandwich you are eating as an appetizer to your actual dinner? Completely unnecessary. I hate to break it to you ladies, but you only need about 200-300 extra calories A DAY. Unfortunately, excessive weight gain and/or obesity during pregnancy is a big deal. First, you run the risk of gestational diabetes, which turns your normal low-risk pregnancy into a high risk pregnancy, complete with food journals, blood sugar logs, and occasionally medications, frequent visits to the doctor, ect. We won’t even go into all that “fun stuff” in this post. Additionally, even without diabetes, we worry about the baby also gaining too much weight. cesarean incision with staples, can lead to difficult, prolonged labors, complications during the delivery, and God forbid if you do need a c-section, don’t hold it against your doctor if she can’t make a very aesthetically pleasing incision/scar due to the inches of excessive fat tissue. In these situations, wound healing is at risk for dehiscence (opening of the incision), and risk of infection when the belly hangs low over the wound and creates a breeding ground for bacteria. Aside from the serious risks associated with excessive weight gain in pregnancy, your doctors also have to listen to your complaints about feeling tired, bloated, swollen, aches, stretch marks, “feeling like a whale,” and the list goes on and on. Don’t get me wrong, many of these complaints are inevitable parts of pregnancy, but can also be prevented or lessened in severity by simply watching what you eat.

So how do we prevent these unfortunate circumstances? First off, starting at a healthy prepregnancy weight and BMI is crucial to your overall health and well-being, whether you are planning pregnancy or not. Let’s not kid ourselves, we all love fast food, pizza, beer, and everything that might make you look pregnant when you arn’t.I for one have had an intimate love/hate relationship with pizza, pasta, and McDonalds forever. Recently, we have decided to go our separate ways, and now we are just friends. Trust me, I know your pain over eating right, exercising, and maintaining a healthy weight. weightgain pregBut seriously, its important. If you should find yourself trading that “food baby” belly for a real baby bump belly, a healthy lifestyle is not just crucial for you, but for the health of your baby also.

Every woman and pregnancy is different. That being said, some women may have a little more leeway in how much weight is appropriate during pregnancy. For example, a woman that is already starting out with a high BMI or is overweight has a much smaller window for weight gain than another woman who is underweight. Its not that we are picking on the heavy girls, I promise, we all know you just have more to love. weight-distribution-during-preg-picBut you are already starting out at a riskier weight, and therefore the weight that you do gain, should more or less only be attributed directly to the pregnancy (growing baby, placenta, uterus, blood volume, etc.). So first off, determine your BMI (we all know you’ve seen that app in your phone), and based on your BMI, look at the chart to determine the recommended weight gain for the total pregnancy. 7508_ideal_weight_gain_during_pregnancyLet me reiterate, this is how much weight you should be gaining by the END of your pregnancy, and the majority of that said weight should be happening towards the third trimester. If you find you have almost reached your total weight gain amount halfway through your second trimester, its time for an intervention. It’s not that we’re calling you out on your weight problems. OK maybe we are, but its because we care about you! There are times when excessive weight gain might have pathologic causes, and you might need some lab work and a little more investigation to figure out what’s going on. jessica-simpson-pregnancy-weight-gain-300x300But if it’s because your pregnancy cravings sent you to Olive Garden for bottomless pasta bowls, then we have a problem. But please, I ask that no woman takes offense if that touchy weight gain subject comes up at one of your prenatal appointments. I promise, there is no pregnant woman mold, and we know how everyone has their own shape and size. But it is important to not be careless with eating and overeating during pregnancy. Please, stay away from fatty foods, and foods high in sugar and salts. Go for high fiber foods, veggies, whole grains, proteins, etc. We want a controlled, healthy weight gain that can keep your baby safe, and hopefully help make the pregnancy as enjoyable as possible.


Caesarean Deliveries and the Development of Childhood Allergies and Respiratory Issues

As medical advancements make more and more contributions to the way patients receive treatment, there seems to be an all time high in the rate of Caesarean sections amongst normal births. Reasons for this include the desire for quick, uncomplicated labor, and fears and lack in confidence regarding natural childbirth (Childbirth Connection, 2007). As a result of this increased incidences of C-sections, there has been more research exploring long-term effects of this method of birth on the children. The most significant findings have been increased rates of asthma, allergies, and chronic bronchitis amongst children delivered by c-section versus those delivered vaginally. In a retrospective cohort study, children that had been recently diagnosed in the past decade with any respiratory disorders, including allergies and dermatitis were investigated on their birth statistics, including birth weight, delivery method, gestational age, and maternal behaviors (Renz-Polster, 2005).  This investigation found a significant correlation between delivery by c-section and incidence of respiratory problems and allergies later in life. The pathologic process is thought to be due to the lack of microorganism exposure during the birthing process (Renz-Polster, 2005). The thought rises from the idea that decreased exposure to environmental organisms in the first few days of life leads to increased rates of allergy development; the normal intestinal flora of the newborn is generally acquired as it is exposed to organisms in the vaginal tract during the birthing process. This phenomenon is thought to be one of the most important factors contributing to this study, because it is associated with the necessary introduction to environmental organisms that leads to the development of immune system tolerance outside the sterile fetal environment (Renz-Polster, 2005). When the infant is removed by c-section, there is no contact with the maternal vaginal flora, and microbiotic exposure is experienced differently through skin contact over the next few days, with introduction of a different type and quantity of microorganisms (Renz-Polster, 2005). Furthermore, natural mechanical processes of a vaginal birth allow the expulsion of amniotic fluid from the lungs of the infant as its chest is compressed through the birth canal. In this manner, the infant’s lungs are better primed for the first breath, as opposed to during c-sections, where there is no mechanical compression of the chest, and fluid removal is often extracted by suction mechanisms, often leaving the infant with fluid still in the lungs, making it harder for it to begin breathing on its own.

With these findings, it is imperative that as health care providers we stress the importance of avoiding birth by Caesarean if at all possible. We need to provide out patients with the education necessary over what to expect during the birthing process, and how to appropriately manage delivery without surgical interventions. This is probably the most critical factor to implement, to explore delivery options before maternal stress and exhaustion from labor is experienced. This will lead to better informed consent, and will likely reduce the incidence of delivery by c-section. Furthermore, it is also important to inform our patients that subsequent deliveries after a c-section are often routinely performed as c-sections, further increasing the amount of risk for developing allergies and respiratory problems in the family later in life.


Childbirth Connection (2007). Choices in childbirth. The New York guide to a healthy birth.

Renz-Polster, H. (2005). Caesarean section delivery and the risk of allergic disorders in childhood. Clinical & experimental allergy, 35: 1466–1472. doi: 10.1111/j.1365-2222.2005.02356.x