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Rethinking Pregnancy Weight in Obesity

Pregnancy weight gain may not be necessary for obese women, provided they get solid nutritional advice throughout their pregnancy.

That’s according to researchers including Yvonne S. Thornton, MD, MPH, clinical professor of obstetrics and gynecology at New York Medical College in Valhalla, N.Y.

Thornton and colleagues have just published a study about pregnancy weight gain in obese women.

It’s a topic Thornton knows personally, not just professionally. Her own struggles with weight inspired the study.

“I’ve had a lifelong battle of being overweight,” Thornton tells WebMD.

Thirty years ago, during her first pregnancy, Thornton says her doctor gave her prenatal nutrition advice. But Thornton, herself a doctor specializing in maternal-fetal medicine, says she set that advice aside.

“I was so happy to get pregnant. I just ate everything,” she recalls. “I need protein; let me get some spare ribs and barbeque sauce. I need dairy products; let me get some Haagen-Dazs.’ You know? And I gained 67 pounds.”

After her son was born, Thornton joined Weight Watchers, and she lost some weight, but she was still overweight when she learned she was pregnant again.

“I said, ‘I’ll be danged if I’m going to gain another 67 pounds,’” Thornton says. She decided to focus on eating healthfully, and she kept her weight steady during her pregnancy.

“I didn’t gain; I didn’t lose any weight,” Thornton says. “I stayed 200 pounds the entire pregnancy. At the end, just before my daughter was born, I gained a half a pound.” She says her daughter, who was born healthy, is now a Stanford University graduate.

“I said to myself, ‘It worked for me. Why can’t it work for other patients?’ And that planted the seed of doing this randomized clinical trial,” says Thornton, cautioning that her approach is geared only to women who are obese when they become pregnant.

In Thornton’s study, obese women still gained weight while pregnant, but not as much when they followed personalized eating plans and kept food diaries that got reviewed at each prenatal checkup.

But overeating during pregnancy is “ingrained” in society, Thornton says.

“It’s the only time in a woman’s life when society will give her the license to be looking like Frosty the Snowman,” says Thornton. “How many times can we take the opportunity to do that? And so, many women do. But I still profess that it is not the time to overeat.”

Still, the new guidelines from the Institute of Medicine (IOM) recommend that obese women gain 11-20 pounds while pregnant.

Where do you stand? Should obese women just focus on eating healthfully, instead of the numbers on the scale? Or does it help to have a specific weight range as a benchmark?

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