Pound for Pound

How much weight gain is OK in Pregnancy?

That is the magical, mystical question. I can assure you that there is no perfect number I can give you. I can also assure you that whatever preconceived notions you have about what you will and will not gain can go right out of the window.

I have seen morbidly obese women LOSE weight throughout the pregnancy and give birth to perfect, healthy babies and walk away from the experience thinner than they have been in years. I have also seen model thin, skinny minnies balloon up 50+ pounds, have perfect deliveries, and fit back into their True Religions within six months of giving birth.

To truly understand weight gain in pregnancy - let's look at where it goes.  In a weight gain of 29 pounds, the average breakdown is as follows:

• Blood Volume Expansion - 3 pounds
• Breasts - 2 pounds
• Uterus - 2 pounds
• Baby - 7.5 pounds
• Placenta - 1.5 pounds
• Amniotic Fluid - 2 pounds
• Fat, Protein, and other Nutrients - 7 pounds
• Retained Water - 4 pounds

Of course, these are just AVERAGES, and these individual totals may vary. What I generally tell my patients who are of average weight/BMI is, "the first 20 pounds are free, the rest you have to work at."  It seems to be a good rule of thumb for most. 

Of course, there are guidelines - and they should be followed as much as possible. 


If you began pregnancy at a normal weight, you should gain 25–35 pounds over the nine months. Assuming you gain between 1 and about 4 ½ pounds in the first trimester, you should put on about one pound every week in the second and third trimesters

If you began pregnancy underweight, you should probably gain a little more. That's because underweight women are more likely to have small babies. A 28- to 40-pound gain is usually recommended. Assuming you gain between 1 and about 4 ½ pounds in the first trimester, try to gain slightly over a pound a week in the second and third trimesters.

If you began pregnancy overweight, you should gain only 15–25 pounds over the nine months. Assuming you gain between 1 and about 4 ½ pounds in the first trimester, you should put on slightly over ½ pound every week in the second and third trimesters. While you don't want to gain too much weight, you should never try to lose weight during pregnancy because that could harm your baby.

If you were obese at the start of your pregnancy, you should gain only 11–20 pounds over the nine months. Assuming you gain between 1 and about 4 ½ pounds in the first trimester, aim for gaining slightly under ½ pound every week in the second and third trimesters.

If you're expecting twins and began pregnancy at a normal weight, you should probably gain between 37-54 pounds over the nine months. If you began pregnancy overweight, aim for gaining a total of 31-50 pounds. If you were obese at the start of your pregnancy, you should gain between 25-42 pounds over the nine months. That translates into about 1 ½ pounds a week in the last two trimesters.

To find out if you were underweight or overweight before pregnancy, learn your Body Mass Index (BMI). BMI is a measure of body fat based on height and weight.

Putting on weight slowly and steadily is best. But don't worry if you gain less than four pounds in the first trimester, and make up for it later, or vice versa. Also, many women have one or two "growth spurts" during which they gain several pounds in a short time period, and then level off. Again, this is not worrisome unless it becomes a pattern. The important thing is to keep an eye on your overall gain. You can use the weight-gain tracking chart to follow your progress.

Age is Just a Number

How old is too old?

It is a very personal decision.

Many of us delay childbearing while we finish our educations, develop our careers, and hope to find the right partner in life. While our socioeconomic status rises, our biological clock tics away. It is not impossible, nor ill-advised to have children into your 30's or 40's. It is important, however, to understand some of the medical risks you might be taking.

THE BAD NEWS:

Fertility takes a sharp dip after age 35: There's less than a 30% chance of becoming pregnant each cycle if the woman has a partner the same age, and less than 20% if her partner is five years older. (While men's fertility is less affected by age, it significantly declines by the late 30s.)

After age 40, the window of opportunity to become pregnant without assisted means closes quickly: A 40-year-old's chance of conceiving is 5% per month.

At 30, a woman's likelihood of giving birth to a baby who has Down syndrome is 1 in 1,000; by age 35, it's 1 in 400.

At age 40, a woman who has conceived with her own eggs has a one-in-100 chance of having a baby with Down syndrome; at age 45, a one-in-30 chance.

Women over 35 are twice as likely as those in their 20s to develop high blood pressure and diabetes for the first time during pregnancy.

Mothers who were 30 or older had higher rates of pregnancy and delivery complications, including a prolonged second stage of labor and more fetal distress.

Over-35 moms have a 40% chance of delivering by cesarean section -- nearly triple the C-section rate for twenty something moms.

First-time mothers over 40 are 60% more likely to develop high blood pressure and four times more likely to develop diabetes during pregnancy than moms in their 20s.

First-time moms over 40 were up to eight times as likely as women in their 20s to have placenta previa.

The risk of miscarriage to be more than 50% by age 42 and about 75% after 45.

THE GOOD NEWS:

Women over 30 are the most likely to breastfeed, according to the March of Dimes, and breastfed babies generally have a higher IQ and greater protection from ailments such as ear infections, asthma, and diabetes.

Women who delay childbirth until their late 20s and early 30s tend to live longer and have healthier infants than those who begin having babies earlier in life.

Women who delay childbearing until their 30s often have a financial edge over younger moms.

Twins and triplets who were born to older mothers were just as healthy as -- or healthier than -- those born to younger moms.

Fertility treatments are making it possible for more women in their 40s and older to bear a child. In the mid-1980s, only a few hundred babies were born per year through assisted reproductive technologies (ART). By 1999, that number had skyrocketed to more than 30,000, according to the American Society for Reproductive Medicine in Birmingham, AL.

While late motherhood appears to increase the risk for some health problems and labor and delivery complications for the over-40 mother, it does not appear to affect neonatal outcomes.

I say go for it, just understand your risks. Talk to your physician BEFORE you start trying so you can minimize your risks and not waste any precious time. Like anything worthwhile in life, this takes work too - but the rewards far outweigh the risks.

Is Bigger Really Better?

Coming Soon: How much weight should I gain in pregnancy?

A Little Pick Me Up

How much caffeine is really safe in pregnancy?

I completely understand addiction to caffeine.

I am the girl who has GOT to have her coffee in the morning. I was a full 2 - 3 cup a day girl when I (finally) got pregnant with my first.

I managed to quit the coffee products cold turkey.

Oops! I forgot about caffeine withdrawal. Nothing like daily headaches to go with your morning sickness.

Note to self: wean yourself off caffeine before you get pregnant if you are going to go cold turkey. The headaches are normal and expected and will go away in time.

Caffeine has been studied extensively in pregnancy and its use is risky past a certain ingestion level.

How much is too much?

It seems that 100 mg/day is the breaking point.

Above that, the risks of growth restriction in your baby starts climbing.

Do you know how much caffeine is in the common products we consume? How much of your favorite beverage can you drink before you hit the magic number?

I was surprised to find out the following:

• Decaffeinated coffee 2 mg
• Espresso, 1 fluid oz. 64 mg
• Instant coffee 8 oz. 62 mg
• Plain, brewed, 8 oz. 95 mg
• Starbucks Latte, 16 oz. 150 mg
• Starbucks Grande, 16 oz. 330 mg
• Brewed Black Tea, 8 oz. 47 mg
• Starbucks Tazo, 12 oz 75 mg
• Most 12 oz. soda 45 mg
• AMP Tall Boy Energy 143 mg
• No Name, 8.4 oz 280 mg
• Rockstar, 16 oz 160 mg
• Excedrin Extra Strength 130 mg
• NoDoz Max Strength 200 mg
• Starbucks Coffee Ice Cream 60 mg

Once I got out of the first trimester - caffeine found its way into my diet once again.

I would have a "1/2 caff" brewed coffee once in a while if I was working long shifts and was exhausted.

I kept it well below the recommended ranges and was able to treat myself once in a while.

Dying for Fabulous Hair

For many of us - enhancing our hair color is a regular part of our beauty routine. Many of my patients considering pregnancy wonder if they are going to be doomed to long roots and dull hair for 9 months. You don't have to feel frumpy or dumpy, fabulous hair is an absolute necessity in pregnancy!!!

I am asked on at least a weekly basis about the safety of hair coloring in pregnancy. The medical literature is again limited and not consistant on this issue.

The articles I reviewed exposed rodents to very large amounts of the chemicals - much larger doses than would be expected in human exposure during hair coloring AND the results were inconclusive at best.

Remember that they baby's organs are finished forming around the end of the first trimester - so most physicians will agree that waiting until AFTER the 12th week is advisable.

Is coloring safe after 12 weeks? Most likely yes. Some practitioners will tell you no - but likely they don't have to deal with roots or grey hairs. The amount of hair dye that is absorbed into the scalp is minimal and most likely not harmful to a growing fetus.

If you decide to go for it - use your common sense. Make sure the room is well ventilated and the product is only left on as long as is absolutely necessary. Remember that highlights only cover the shaft of the hair and not the root where the chemicals could be absorbed - so theoretically it is safer than all over color. There are some hennas and vegetable dyes that are considered to be safer in pregnancy as well.

Yes, I colored my hair in both of my pregnancies. Due to premature greying, I have colored my hair since I was in my 20's. Knowing I would abstain from coloring during the first trimester - I tried to make sure that my roots were in tip top condition before attempting pregnancy. That way, the three month wait was more bearable.

A few more words of sage advice:

If you don't color your hair - pregnancy is certainly not the time to start! Your body is going through enough changes - and a drastic new hair color may be ill advised. The hormonal changes in your hair may not take to a new color very well and you might be very disappointed.

Stretch Marks the Spot

STRETCH MARKS

I am asked questions about stretch marks all the time. "Will I get them? How do they form? What can I do about them? What creams should I use???

How Do Stretch Marks Form?

It seems that hormonal changes in pregnancy combined with a rapidly growing belly are responsible for the development of stretch marks.

Stretch marks usually appear during the sixth or seventh month. Why?

Your hormone levels are sustained and raging - combine that with skin being subjected to higher levels of stretching forces.

Will You Get Them?

Take this simple test. Go lift up your Mom's shirt.

If she has stretch marks, you are are at increased risk. You can't fight your genetics. But don't feel too bad, between 75% and 90% of women develop stretch marks to some degree during pregnancy. Also remember - the more distended your abdomen, the more likely you are to develop them. Limiting your weight gain may be the only risk factor you can control!

What Can I Do About Them If I Get Them?

The medical literature is not really helpful. Only one study has been published which claimed to test whether oils or creams prevent the development of stretchmarks. This study found a daily application of a cream (Trofolastin) containing Centella asiatica extract, vitamin E, and collagen-elastin hydrolysates was associated with fewer stretch marks during pregnancy - I have never seen or heard of the stuff and have no idea where you would get it.

Another study, though lacking a placebo control, examined a cream (Verum) containing vitamin E, panthenol, hyaluronic acid, elastin and menthol. It was associated with fewer stretch marks during pregnancy versus no treatment.

Although your skin will feel lovely and smell really good, no research studies have shown cocoa butter has an ability to either prevent stretchmarks, or to reduce their appearance once a stretch mark has already formed.

Buyer Beware

When I Googled the topic - a zillion ads popped up with all sorts of claims - I warn you not to waste your money. The vast majority of the claims are unfounded!!!!!

The Good News

If you develop stretch marks - Don't panic! They will never look as bad as they did when you delivered. They will fade and look less prominent over time. Science has a few good options as well.

Be warned: some of these treatments are VERY expensive, are not covered by insurance and have no guarantee they will work.

Of the treatments are available for the purpose of improving the appearance of existing stretch marks, only laser treatments, dermabrasion, and prescription retinoids have been proven to have any benefit.

Most of these treatments decrease pigmentation and help collagen to "plump up" in the grooves of the stretch marks.

Of course, the surgical procedure for removing lower abdominal stretch marks is the tummy tuck, which removes the skin below the navel where stretch marks frequently occur. This is major surgery and should only be attempted after your are done with childbearing.

It Is What It Is

My gorgeous friend M delivered twins. She developed stretch marks with her pregnancy and it has never bothered her. She still wears a bikini, and let me tell you, she rocks it. When I see her, I think she is beautiful - the marks are faded and small and remain reminder of her two precious children.

Bernstein, Eric. What Causes Stretch Marks?. 15 December 2008. The Patient's Guide to Stretch Marks. 10 Feb 2009
Mallol, Belda, Costa, Noval, and Sola. (1991). "Prophylaxis of Striae gravidarum with a topical formulation. A double blind trial.”". International Journal of Cosmetic Science 13 (13, 51-57): 51.

Young GL, Jewell D. (2000). "Creams for preventing stretch marks in pregnancy". Cochrane Database Syst Rev (2): CD000066.

This is the debut of my new blog about pregnancy.

My goal is to eventually set up a real website, but this will have to suffice for now.

Yes, this was me in 2005 - working OB/GYN physician, happily married, mother of a three year old daughter, and 36 weeks pregnant.

I am temporarily giving up my OB/GYN practice so I can accompany my husband on an overseas assignment/adventure with our kids who are now 8 and 5.

Why am I blogging about Glamorous Pregnancy? I loved my job and was very good at it. My patients always commented on how well I listened and how I was able to take scary subjects and break them down into terms that they could understand. I also had a fabulous rapport with most of my patients - and that is the thing I will miss the most. This blog is my temporary outlet - my way to still be the type of doctor I love to be.

The information on this website will be grounded in real, well studied medical data - and I will provide the references I use. It will also contain my personal opinions and tips I have learned from my own pregnancies and practice.

My friends and family graciously submitted some good questions and topics to get me started. Things they were too embarrassed to ask their own doctor about - but were comfortable asking me.

Remember, this is only advice. Talk to your own health care provider before making any changes to your current pregnancy plan.