How Much Weight Gain is Normal During Pregnancy?
What is a normal weight gain for a pregnant woman?
When you are pregnant that means eating for two, right? Not quite. It’s essential to eat good food and eat enough in pregnancy, but it is not a free-for-all excuse to eat the buffet.
Why? It can impact your health post-pregnancy and it can harm baby’s health. Healthy mom = healthy baby. Gaining too much weight can actually make you prone to gestational diabetes and the baby is more likely to be heavier and more likely to develop diabetes.
So what is a normal weight for a pregnant woman?
That is a question I often get. The guidelines are set based on research and available at CDC’s website. The guidelines vary based on your starting point when you get pregnant. If you are underweight (BMI <18.5) then you need to gain more weight than if you are overweight (BMI >25.). Here is a BMI calculator to to figure out your number.
Remember BMI measures your weight in relation to your height and it doesn’t account for muscle mass. It is a good measure for an average person, but not someone who has a lot of muscle mass. Muscle weighs more than fat so all athletes are likely to be in the overweight category because they have a lot of muscle. The pregnancy weight gain guidelines differ if you are carrying a single pregnancy versus twins since you need more nutrients to support twins.
Source: NAM
Pregnancy weight gain week by week
Weight gain depends on where you are in your pregnancy. Gaining weight is not something that is the same every week—it’s different each trimester.
According to the American Pregnancy Association, these are average weight gains for each trimester.
First trimester: 1-4.5 pounds
Second trimester: 1-2 pounds per week
Third trimester: 1-2 pounds per week
As a functional medicine nutritionist, I am not big on counting calories or worrying about your weight on a scale when our goal is for you to be healthy. In my blog post on functional medicine for fertility, pregnancy, new mom and baby, I talk about why nutrition is important in each stage. Pregnancy is a uniquely different process in that every week new milestones are achieved. New organs are made and new bones form. Therefore, as the body goes into intensive building mode you need to have all the materials on hand, or else it will pull from your own stores and the baby will get marginal nutrients.
My focus is generally on nutrients and eating good quality foods plus targeted supplementation. Weight is a general marker for health, but not a place to obsess over numbers. However, when you are pregnant, it is important to keep track that you are in range with the guidelines. Why? Because if you put on too much weight in pregnancy it can impact your health during pregnancy and after. Just as important, it can harm your baby’s health.
How does gaining too much weight in pregnancy impact your health as a mom?
Women who gain more than the recommended guidelines are more likely to develop gestational diabetes. Basically, your fasting blood glucose is elevated and that puts you at risk for gestational diabetes, which is the name for diabetes when you are pregnant.
In gestational diabetes, your body doesn’t make enough insulin for what it needs.
Your pancreas makes insulin. Insulin has a major role in the body. It helps take glucose out of your blood and stores the excess amount in your liver in a form called glycogen. Insulin also helps regulate your blood sugar and this a very important function for your body and your brain.
The pancreas can have difficulty producing the right amount of insulin if you are overweight, don’t exercise and your diet has a lot of refined white carbs and sugars. Gestational diabetes happens when your pancreas is not able to regulate blood sugar in pregnancy. Your blood sugar is elevated and this often happens after week 20. You can get gestational diabetes even if you don’t have a family history of diabetes, and you’ve never had it previously.
Symptoms of gestational diabetes
The problem with getting anything during pregnancy is that it can be hard to distinguish what is just “being pregnant” and what is a new symptom.
For gestational diabetes, here are three symptoms to watch for:
You are thirstier than usual
You feel hungrier and eat more than usual
You have to pee more than usual
All these symptoms increase in pregnancy without having gestational diabetes. I suggest getting a fasting blood glucose test and a hemoglobin A1c blood test around week 20-24 in one of your routine appointments if your doctor is not already watching for blood glucose. Many women get an Oral Glucose Tolerance Test in week 26 but I suggest doing blood work earlier or at the same time to monitor your blood glucose.
Will I be fine after pregnancy if I get gestational diabetes?
It is not a given that you will no longer be diabetic after the baby is born. In fact, women who have gestational diabetes are more likely to develop Type 2 diabetes in the next 10 years.
On the other hand, you can lose weight and be healthy post-pregnancy if you gain the appropriate amount of weight during. The bottom line is if you are trying to get pregnant or are pregnant, it is best to gain healthy amounts of weight, with good nutritious, colorful fruits and veggies, lean protein and complex carbs, and moderate movement. This is better for you in the long run and better for your baby.
What other complications can gaining too much during pregnancy cause for you, labor, your baby, and even your growing child?
Diabetes risk
New research shows that if you get gestational diabetes in pregnancy, your child is more likely to get diabetes as a teenager.
When researchers followed obese adolescents for three years in a study, they found that one in five of their mothers experienced gestational diabetes when pregnant. When children are born to mothers with gestational diabetes, their pancreases show reduced function in the production of insulin. This, in turn, puts children at later risk for developing diabetes even if they do not have it when they are born.
Gestational diabetes is more likely to occur in women who gain weight rapidly in pregnancy and are overweight or obese during pregnancy. Diabetes takes a toll on life outcomes both in quality of life and longevity. The take home message: being overweight during pregnancy puts you and your child at risk for diabetes later in life.
Preeclampsia
Being heavy can increase your risk for preeclampsia. Preeclampsia is a pregnancy complication that includes high blood pressure and signs of damage to another organ system, most often the liver and kidneys. It is serious and shows up after 20 weeks of pregnancy. It happens when women have a chronic condition in pregnancy, high blood pressure, gestational diabetes, and/or Vitamin D deficiency. The symptoms are the following:
Excess protein in your urine (proteinuria) or additional signs of kidney problems
Severe headaches
Changes in vision, including temporary loss of vision, blurred vision or light sensitivity
Upper abdominal pain, usually under your ribs on the right side
Nausea or vomiting
Decreased urine output
Decreased levels of platelets in your blood (thrombocytopenia)
Impaired liver function
Shortness of breath, caused by fluid in your lungs
Source: Mayoclinic
If you have any of these symptoms, contact your ob/gyn or midwife immediately. Preeclampsia requires close management by your doctor. It can be deadly, needs to be taken seriously, and requires medical supervision.
Complications in labor
Women who gain excess weight are more likely to have large babies. While we often think of having a “big baby” as a healthy thing, there is such a thing as being too heavy when you are born.
The idea of a “little football player” is a bit of a myth. There is a genetic link between the birth weight of the child and birth weight of the parents, but having a “big baby” because of weight gain and prediabetes is not a health benefit. I really like this article in The Journal of Pediatrics titled Bigger is not Always Better.
Babies who are “large for their gestational age” have difficulty in labor. Labor times are often longer if a baby is large for their gestational age and there is risk to the child during delivery. The mother is more likely to be induced and the mom is more likely to have a cesarean birth, which is riskier for mom and baby (although in some cases medically necessary).
Complications postpartum
Women who gained more weight in pregnancy were less likely to breastfeed, but that is not a given. Breastfeeding is one of the best things you can do regardless of your weight or the baby’s weight, and I advise doing everything possible to breastfeed your infant.
The biggest risk for women post-partum is being unable to lose the weight and being risk for chronic conditions including Type 2 diabetes going forward.
What if you weigh too little during pregnancy?
There is such a thing as too little weight gain
If you don’t gain enough weight in pregnancy, you can put you and your baby at risk. You both need more nutrients during this time. Interestilying, evidence shows that women who are underweight are also more likely to have children that become overweight or obese children. If you are underweight, the baby may be born preterm or at a low body weight for their gestational age.
How to prevent gestational diabetes
If you have already gained excess weight or have other risk factors in pregnancy, it’s not too late to do something. What you eat, how you move, and supplements you take can help.
I highly recommend connecting with a nutritionist and you can also check out my blog on how I worked with a client to reverse gestational diabetes in pregnancy. I had this client tell me that her doctor said “nothing can be done.” We did it ! We reversed her gestational diabetes and got her blood glucose to return to normal, thanks to her hard work following my evidence-based guidance on lifestyle and nutrition changes. Her baby boy was born at a normal body weight and she had a vaginal delivery.
My motto is moderation.
Being healthy and gaining a healthy amount of weight can lead to better outcomes for both you and your baby. This means eating healthy food: good fats, lean protein, complex carbs, organic and local veggies, not too much fruit (2-3 servings daily max). Limiting refined sugars to a once in a while treat (that includes cakes, cookies, sweet drinks and candy), and gaining weight within the guidelines. It also means moving daily, getting a moderate amount of activity, as much sleep as possible, and being in a positive mental space.
These tips can not only help you better enjoy pregnancy but also have a healthier pregnancy, healthier baby and healthier life in years to come.
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Annina is a PhD, Registered Dietitian, Licensed Dietitian Nutritionist and Board Certified in Functional Medicine specializing in nutrition and functional medicine for fertility, pregnancy and new mom and baby. She has 7 years of practice experience and has co-authored several books on infant, child nutrition and obesity prevention.