Wondering how much weight you should gain during pregnancy?

The answer isn’t as straightforward as you may think. The optimal amount of weight to gain while expecting isn’t the same for everyone. It depends on the baseline body mass index (BMI) at which you start your pregnancy.

Adequate gestational weight gain (GWG) is one of the reliable indicators of fetal-maternal well-being. Too little or too much GWG can predispose both you and the developing fetus to various health risks and complications not only during but even after pregnancy.

As an obstetrician, I always guide expecting moms to keep a close eye on their GWG. This article will provide you with essential information to gauge your gestational weight and make the required changes to remain within a healthy weight range.

Gestational weight gain recommendations

The following are the recommendations for GWG by the Institute of Medicine (IOM) for singleton and twin pregnancy:

• If you are entering pregnancy with a low BMI (below 18.5), then you should go for GWG of 28-40 pounds (12.5-18 kg). If, however, you’re carrying twins, the ideal weight gain may be more than this.
• If you have a normal baseline BMI (18.5-24.9), you should put on around 25-35 pounds (11-16 kg) in case of singleton pregnancy and 37-54 pounds (16.5 to 24.5 kg) in case of twin gestation.
• If you are in the overweight category (BMI 25.0-29.9), you should aim for gaining 15-25 pounds (6.8-11 kg) when carrying one baby and 31 to 50 pounds (14 to 22.5 kg) in case of twins.
• If you are obese (BMI equal to or more than 30) should be more vigilant and should not gain more than 11-20 pounds (5-9 kg) during the entire pregnancy. For those carrying twins, the goal would be around 25-42 pounds (11-19 kg).

You must discuss your weight gain goals with your health care provider when carrying higher-order multiples, that is, being pregnant with 3 or more fetuses.

Average weight gain for each trimester

How much weight should you gain during your pregnancy? If you’re starting it with a healthy BMI, then you should put on about 1-5 pounds (0.5-2.2 kg) during the first 3 months and around 1 pound ( 0.5 kg) per week during the 2nd and 3rd trimesters.

According to a large survey conducted in 48 states of the U.S. in 2015, only about 32% of women gain the recommended amount of weight during pregnancy. The rest of them either gain too much (48%) or too little weight (21%).

You can track your GWG by using various tools, such as an online pregnancy weight gain calculator, or create a graph to watch your weight.

How is weight gain distributed in pregnancy?

If you feel that all your weight gain is only because of your growing belly, that’s not true. Actually, most of the GWG goes to the development of the tissues required for fetal growth and the preparation of your body for labor and breastfeeding.

Here’s the approximate distribution of your weight gain:

• Baby: 7.5-8 pounds (3-3.5 kg)
• Placenta: 1.5 pounds (0.7 kg)
• Amniotic fluid: 2 pounds (around 1 kg)
• Maternal blood volume: 3-4 pounds (1.3-1.8 kg)
• Fluid in maternal tissues: 3-4 pounds (1.3-1.8 kg)
• Enlarged breasts: 2 pounds (approximately 1 kg)
• Enlarged uterus: 2 pounds (approximately 1 kg)
• Fat stores: 6-8 pounds (2.5-3.5 kg)

Effects of gaining too much weight during pregnancy

The most common misconception among pregnant women is that they’re “eating for two,” which usually leads to excessive GWG.

In reality, you only need around 300 extra calories daily during the 2nd trimester and around 400 in the 3rd trimester. During the first 3 months of pregnancy, no calories over and above your normal daily pre-pregnancy diet are required.

Gaining too much weight while expecting can predispose you and your baby to potential health hazards.

• You place yourself at risk of gestational diabetes and preeclampsia.
• Your baby could be larger than normal, which may lead to birth injuries or a cesarean section.
• There may be problems in regulating your baby’s blood sugar levels after birth. Your baby may also be at greater risk of becoming obese and diabetic later in life.
• You may also face difficulties in getting rid of the extra pounds after pregnancy, which can result in long-term obesity.

Losing weight during pregnancy

Dieting or weight loss is not recommended during pregnancy except in very rare cases of morbidly obese women when doctors may advise them to shed some pounds under strict monitoring and guidance by professionals.

During the 1st trimester, some women may lose a few pounds because of excessive vomiting, nausea, and aversion to foods, and they may require extra health care. After that, however, they should gain an adequate amount of weight.

Consult your doctor If you’re experiencing weight loss during your pregnancy because in some cases, there may be some serious underlying cause that needs urgent medical attention.

What are the risks associated with too little weight gain? Too little GWG can lead to low birth weight and preterm birth. These low-weight babies are at greater risk of various health problems and might need pediatric care, resulting in a prolonged hospital stay after birth. They may also experience difficulty breastfeeding. Issues related to delayed developmental milestones are also more common in premature babies.

Tips for healthy weight gain during pregnancy

A healthy GWG mainly depends on three things:

• What do you eat?
• How much do you eat?
• How often do you exercise?

Following are some tips that might help you in gaining adequate weight during pregnancy.

• Keep yourself hydrated. Drink water rather than sweetened drinks or juices. Drinking enough water will help you feel satisfied between meals and also prevent constipation.
• Eat balanced and nutritious foods rich in protein, fiber, and healthy fats.
• Don’t skip meals and always start your day with a healthy breakfast (oatmeal with berries, nuts, seeds, and peanut butter or an omelet with whole-grain bread and avocado). Focus on small and frequent nutrition-dense meals and snacks.
• Go for complex carbohydrates (whole grain bread, brown rice, or quinoa) instead of refined carbs.
• Limit your sweets, saturated fats, and sodium intake.
• Eat fresh or frozen fruits and vegetables.
• Prepare your food at home. You may have occasional take outs, say, once a week.
• As you only need around 300 and 400 extra calories in the 2nd and 3rd trimester, respectively, you can get those by adding a healthy snack or 2 to your daily diet (apple with nut butter, fish or boiled egg with fresh salad, whole-grain crackers with cheese , fruit smoothie, or yogurt with granola).
• Exercise also plays a huge role. Ideally, you should aim for 150 minutes of moderate-intensity aerobic workout spread throughout the week (30 minutes daily, 5 days a week). It’s not necessary to complete your daily 30-minute workout in one go. You can break it down into 10-15-minute rounds.

Psychological issues related to gestational weight gain

Pregnancy is undoubtedly a beautiful journey, but it does come with many changes, both physical and emotional. It can be quite challenging at times for some women.

Some moms-to-be feel uncomfortable in their large bodies, and it’s difficult for them to accept their pregnant image in the mirror. Don’t get stressed because of your extra weight: gaining optimum weight is necessary for you and your baby and a healthy pregnancy outcome.

Some women may get depressed because of difficulty in gaining weight during pregnancy.

Reach out to your health care provider for proper advice, counseling, and help if you are anxious because of inadequate weight gain or are struggling with your body.