Dr. Paykel is a board-certified obstetrician and gynecologist. She completed the fellowship for Integrative Medicine at the Arizona Center for Integrative Medicine under the direction of Dr. Andrew Weil in 2008. Dr. Paykel completed medical school and residency at the University of Wisconsin. She served as a physician in the United States Navy for five years prior to private practice. She is the founder of MaternaCare, a new company that provides affordable, natural skin care products for pregnant women.
For a pregnant woman to be rushed suddenly to the hospital with high blood pressure (i.e. preeclampsia) can be terrifying - both she and her unborn child could be at serious risk. To help hospitals plan procedures for making the experience as comforting and supportive as possible, health psychologist Julie Barlow and her colleagues interviewed twelve pregnant women about their experience of being hospitalized with high blood pressure. The interviews were held within three days of the woman's hospital admission.
Assessment of the women's comments revealed four key elements: (1) They were searching for meaning in what happened to them especially if they had no symptoms of preeclampsia (2) They searched for possible causes of preeclampsia (3) They were frustrated with conflicting information from clinical staff (4) Their sense of well-being was altered by perceived "social factors" like spousal support and seeing that other women with preeclampsia were able to have a normal delivery.
Jean Cox, a registered dietician and Sharon Phelan, an obstetrician authored an excellent review article: “Nutrition During Pregnancy” (1) in the September edition of Obstetrics & Gynecology Clinics of North America.Nutritional concerns in pregnancy are gaining importance as we see increasing rates of obesity, poor nutrition and improper weight gain during pregnancy that can result in complications for both mom and her baby.
Prevention is always the best medicine.Preparing for pregnancy is no exception; this includes optimizing your health before pregnancy – including your weight. Research has shown that normal maternal weight before pregnancy and appropriate weight gain during pregnancy have been associated with better outcomes for both mom and baby.The converse is also true: obesity, poor nutrition and improper weight gain puts you and your baby at increased risk of developing complications both during and after pregnancy.
Risks associated with pre-pregnancy obesity:
Mom during pregnancy:Increased miscarriage rate, gestational diabetes, high blood pressure, development of blood clots
Mom during delivery: Cesarean section, stillbirths, hemorrhage, wound infections
Mom postpartum: depression, difficulty breast feeding
Fetus: Increased risk of birth defects including neural tube defects
Newborn: Born either too large or too small
Childhood: Childhood obesity
Risks associated with excessive weight gain:
Mom: delivering a baby greater than 9 pounds, increased risk for cesarean section, failing to initiate breastfeeding or early termination of breastfeeding, postpartum weight retention
Baby: respiratory distress, infection, low blood sugar, admission to ICU, longer hospital stay and childhood obesity.
The table below published by the Institute of Medicine shows the recommended weight gain given your pre-pregnancy BMI. Pregnancy weight gain goals were set by the Institute of Medicine (IOM) in 1990 (2). The goal at the time was to optimize pregnancy outcome (ie, full-term delivery of a healthy baby weighing 3 to 4 kg). An attempt was made to balance the needs of mother and baby. An updated report will be published soon by the IOM. For now, we know that following these recommendations improves your chances of a better outcome for both you and your baby.
. Table 1 -- Institute of Medicine prenatal weight gain goals
Body mass index
Total weight gain (lb)
Total weight gain (kg)
Normal
19.8–26.0
25.0–35.0
11.5–16.0
Underweight
<19.8
28.0–40.0
12.5–18.0
Overweight
>26.0–29.0
15.0–25.0
7.0–11.5
Obese
>29.0
≥15.0
≥6.0
Twins
Ignore
35.0–45.0
16.0–20.5
The authors recommend nutritional counseling for all obese prenatals and women who have inappropriate weight gain (both too much and too little). Others who have a particular need for medical nutrition therapy include young teens, mothers with multiples, women who have poor dietary patterns, and women on restrictive diets (e.g. vegan). Those with previous bariatric surgery, other recent weight loss, some pre-existing (or current) medical conditions, and eating disorders will benefit from the more nutritionally focused care.
To obtain the best nutrients from your diet choose
small frequent meals
milk or yogurt - low fat, then skim later in pregnancy
lower fat meats and red meats more than white
minimize juice
whole grains
water instead of sports drinks
fresh or frozen fruits and vegetables
minimize juices
avoid fried foods
avoid added fats and sugars
Prenatal vitamins (multivitamin/multimineral) are recommended for those who have higher than average needs (women pregnant with multiples, women who have HIV, and women who smoke, drink alcohol, or take drugs) or those who eat little or no animal products. For others, they are used as insurance, not as a substitute for a good diet.
1. Cox JT, Phelan ST. Nutrition during pregnancy. Obstet Gynecol Clin North Am 2008:35 (3) 369-83, viii
2. IOM. (Institute of Medicine). Food and Nutrition Board. Nutrition During Pregnancy, Executive Summary. Report of the Subcommittee on Nutritional Status and Weight Gain During Pregnancy and the Subcommittee on Dietary Intake and Nutrient Supplements during Pregnancy. Washington, D.C.: National Academy Press, 1990
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