Weight Gain, Exercise and Diet in Pregnancy

Weight Gain in Pregnancy

In normal pregnancy, variable amount of weight gain is a constant phenomenon. In early weeks the patient may loose weight because of nausea and vomiting. During subsequent months, weight gain is progressive until the last one or two weeks, when the weight remains static.

The total weight gain during the course of a normal pregnancy averages from 11 Kg. (24 lb) to 12.5 kg. (27.5 lb). The fetal weight gain at term is distributed as follows.

1. Reproductive weight gain: 6 Kg.
   (A) Foetus - 3.3 Kg, Plcenta - 0.6Kg, Liquor - 0.8 Kg.
   (B) Uterus - 0.9 Kg and Breasts - 0.4 Kg.
   
   
2. Net maternal weight gain: 6 Kg.
   (A) Increase in blood volume - 1.3 Kg.
   (B) Increase in extracellular fluid - 1.2 Kg.
   (C) Accumulation of fat(mainly) and protein - 3.5 Kg.
   

Recommended weight gain for

• Underweight women - 12.5 to 18 Kg. (28 to 30 lb)
• Normal weight woman - 11.5 to 16 Kg. (25 to 35 lb)
• Overweight woman - 7 to 11.5 Kg (15 to 25 lb)

Water is the chief component of the net weight gain. The amount of water retained during pregnancy at term is estimated to be 6.5 litres. Thus slight oedema of the legs is not uncommon in normal pregnancy. Slight oedema appears with a gain of 7.2 litres and massive oedema with 8-5 litres.

Importance of weight checking

Single weight checking is of little value except to identify the overweight or underweight patient. Periodic and regular weight checking is of important to detect abnormality.

Weight gain is 0.7 lb/week in early months of pregnancy (0 -20 weeks) and 1 lb/week in later months of pregnancy (20-40 week). Weight gain is distributed to approximately 1 Kg in first trimester and 5 Kg each in second and third trimester.

Rapid gain in weight of more than 0.5 kg (1 lb)/ week or > 2 Kg (5 lb) a month in later months of pregnancy warrants investigation as it may be an early manifestation of toxemia of pregnancy (high B.P.)

Stationary or falling weight / low weight gain is suggestive of low birthweight / preterm infant or intrauterine death of the foetus. It could also be due to poor nutrition of the mother.

Excessive weight gain is linked to large for gestational age infants and is associated with an increased caesarean delivery rate.

Not all the weight put on during pregnancy is lost during and immediately after delivery. The normal woman who gains 12.5 kg in pregnancy is about 4.4 kg (9 lb) above her prepregnant weight after delivery.

Breast Changes In Pregnancy

The changes in the breasts are best evident in the first pregnancy. In a person who has once lactated the baby, the changes are not clear.

Size: Increased size of the breasts becomes evident in early weeks. This is due to marked proliferation of the ducts and the alveoli. The vascularity (blood vesels and blood flow) is increased which results in appearance of bluish veins running under the skin. There may be evidence of striae due to stretching of the skin.

Nipples and Areola: The nipples become larger, erectile and deeply pigmented. Montgomerly's tubercles appear surrounding the nipples on the areola (dark brown skin surrounding the nipple). An outer zone of less marked and irregular pigmentation appears in second trimester and is called secondary areola.

Secretions: Secretions can be squeezed out of the breast at about 12th week which becomes sticky. Later on by 16th week, it becomes thick and yellowish.

Exercise In Pregnancy

In general, it is not necessary for the pregnant woman to limit exercise, provided she does not become excessively fatigued or risk injury to herself and her fetus. Well-conditioned women who perform aerobics or run regularly were found to have shorter active labors and fewer cesarian deliveries and less fetal distress. However, continuation of regular aerobic and running exercise programs results in reduced birth weight of the baby.

It is recommended that light exercise like walking, moving her limbs & back is good for pregnant worman. The women who are accustomed to aerobic exercises before pregnancy can be allowed to continue this with less intensity and no new aerobic exercise should be started.

In some cases of complicated pregnancy, the mother is not advised exercise but she may benefit from rest. Like, multiple pregnancy, pregnancy induced hypertension, heart disease and women suspected of having a growth retarded fetus.

Diet In Pregnancy

Diet is very important in pregnancy to maintain health status of the mother and to ensure proper growth of the fetus. Pregnant women should be advised:

• To eat what she wants in amounts she desires and salted to taste.
  
• Make sure that there is ample food to eat.
  
• By serially weighing every pregnant mother that she is gaining weight. Ideal gains in pregnancy are 22-27 pounds.
  
• Periodically, explore the food intake by dietary recall to uncover the ingestion of any bizarre diet.

Caloric intake:
A daily caloric increase of 300 Cal (over and above her normal intakes) through out pregnancy has been recommended for every mother.
Recommended daily caloric intake during pregnancy and lactation are:

• NON PREGNANT - 2200 Kcal
  
• PREGNANT - 2500 Kcal
  
• LACTATING - 2600 Kcal

Nutrients in the diet:
Proteins:
There are added demands for growth of the fetus, placenta, uterus, breasts and increased maternal blood volume. During the last 6 months of pregnancy about 1 kg of protein is deposited in the body. Majority of proteins should be supplied from animal source like, meat, milk, eggs, cheese, poulty and fish, because they supply aminoacids in optimal combination. Milk and milk products are good source of proteins and calcium.

Minerals:
Practically all diets that supply sufficient calories will contain enough of other minerals to prevent mineral deficiency Use of iodozed salt is very important.

Iron:
Average Iron requirement in pregnancy is 6 mg/day plus 1 mg to compensate for exccretion. This amount of iron is seldom supplied even by balanced diet, so supplementation is recommended in form of tablets in later half of pregnancy - 60 to 100 mg of elemental Iron per day is given. In the first 4 months, Iron is avoided due to nausea, vomiting and also the requirement is less. In the diet it is supplied by green leafy vegetables.

Calcium:
In pregnancy, there is increased calcium absorption & progressive retention. One quart of cow's milk or calcium tablets providing 1 gm of calcium is considered sufficient supplementation.

Vitamins:
Increased requirements for vitamins during pregnancy can be supplied by a balanced diet adequate in calories and proteins. Multi-vitamin preparations are given in later half of pregnancy to women who do not take enough calories.

Folic Acid:
Maternal requirement is increased during pregnancy. It is necessary to prevent birth defects in the fetus, absortions, and hypertention. Folic acid is supplied by green vegetables and is supplemented in forms of tablets containing 0.5 mg of folic acid per tablet.

Pregnant should take adequate amount of calories, milk and milk products, high protein sources like pulses, eggs, paneer (cottage cheese) and green leafy vegetables and fruits like banana, apple, grapes, etc. for vitamins and iron and minerals.