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Answered By:


Nora Saul, MS, RD, LDN, CDE

Manager, Nutrition Services
Joslin Diabetes Center
Boston, MA

Q:

I've just entered my second trimester and my doctor is concerned that I've already gained too much weight. How can I eat well and give my baby all the nutrients it needs without adding on too much extra weight? And, please don't ask me to give up dessert!

A: 

In women who are normal weight before pregnancy a weight gain of 26 to 35 pounds during pregnancy is ideal. An increase of approximately 300 calories a day above usual calorie intake starting in the second trimester is recommended to meet the increased energy demands of pregnancy. Energy needs in the first trimester approximate those of non-pregnant females. Health care providers usually look for a weight gain of approximately 1 to 1.5 lbs per week starting in the second trimester. Excessive maternal weight gain is associated with pregnancy induced hypertension and gestational diabetes among other complications. If you have already gained excessive weight, your goal should be to slow the rate of weigh gain, but not to lose weight.

The best way to avoid excessive weight gain during pregnancy is to choose nutrient dense foods (those supplying many nutrients at reasonable calorie levels). A good way to look at food needs for pregnancy is to think in terms of food groups. An adequate diet for pregnancy would include 7 ounces from the protein group (meat and meat substitutes), 3 servings of milk products 7 servings of grain products, 5 servings of fruits and vegetables, and 3 servings of fat. Although getting adequate servings from all the food groups might sound challenging, most serving sizes are quite modest. A serving of fruit and vegetables is just ½ cup or 1 tennis ball size piece; ½ cup cooked grains or 1 slice of bread is a serving from the grain group, a teaspoon provides a serving of fat and 7 ounces of meat for the whole day is only the size of a chicken breast. It is the choices you make from each category that will determine whether you meet or exceed your calorie needs. For example, 8 oz. of skim milk is 90 calories, whereas 8 oz. of whole milk is 150 calories. Although there is no need to give up dessert, you may want to consider the type and frequency of the desserts you have. A slice of angel food cake with strawberries provides 160 calories, while a slice of chocolate cake is 340 calories.

Exercise can also play a helpful role in reducing excessive weight gain as well as facilitating labor (when it's time!), reducing the risk of gestational diabetes and relieving stress. Continuing a pre-pregnancy exercise program during pregnancy can help reduce fat and facilitate a quicker return to pre-pregnancy weight. If you are starting an exercise program for the first time during pregnancy it is best to discuss your plans with your healthcare provider before you begin. Exercises such as walking, swimming and bicycling are all good choices.

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