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Eating for two?

Eating for Two

It's hard being a woman. Many of us spend much of our adult lives watching our weight, struggling to get enough exercise and disciplining our eating. When we become pregnant it can seem like the perfect opportunity to relax the reins a little; after all, we are eating for two, right? Not quite.

The job of growing a baby undoubtedly places additional demands on a pregnant woman's body and adequate nutrition is critical. In low resource settings or during times of hardship where food is scarce and all members of the community struggle to consume enough food to meet their nutritional needs, it makes sense to privilege pregnant women in the rationing of food. Perhaps this is where the notion of eating for two comes from. While too little food is a problem for pregnant women, so too is too much food. In well resourced countries like ours we are much more likely to suffer from too much food rather than too little. Paradoxically, this does not necessarily mean that we are well nourished.

More than half of the Australian population is overweight or obese and women of childbearing age form an increasing proportion of this group. Overweight and obesity increase the risk of a range of complications in pregnancy (including diabetes and hypertension) and adverse outcomes for the woman and her baby. These risks increase in line with increasing BMI. Excessive weight gain in pregnancy has also been associated with adverse maternal and neonatal outcomes and overweight and obese pregnant women are more likely to gain excessive weight during pregnancy. So, the notion of "eating for two" in pregnancy especially if this means eating twice as much, can be harmful.

As most women with children can attest, pregnancy weight gain can be difficult to lose. Most of us don’t bounce back to our pre-baby weight as easily or as quickly as celebrities seem to manage. In fact most of us don’t bounce back at all. Women tend to retain a proportion of pregnancy weight gain, carrying this into future pregnancies. Studies have shown that pregnant women having their first baby tend to be most inclined to eat for two in pregnancy, perhaps reflecting the understanding of more experienced women that the weight gained in pregnancy is not so easy to shift post baby.

Despite the magnificence of pregnancy and the magnitude of the changes that occur within the pregnant body, the body's energy needs in fact only increase slightly during pregnancy. While this seems unfair, it attests to the incredible efficiency and brilliance of the female form. Women should focus on eating nutrient rich foods across the five food groups in pregnancy with particular attention to calcium, folate and folic acid, iron, iodine, zinc and protein. It is advisable to achieve a healthy weight gain during pregnancy though in Australia, we do not have nationally agreed guidelines. The Institute of Medicine (based in the US) recommends that women with a normal BMI gain 11.5-16 kg, that overweight women gain 7-11.5 kg and that obese pregnant women gain 5-9 kg.

Our maternity services can do more to support women to achieve a healthy weight gain in pregnancy. Many health professionals are uncertain about what to recommend to pregnant women and thus avoid the topic of weight altogether and many are also ill-equipped to speak to women about this sensitive issue. Sadly too, some are judgmental and this is felt keenly by women on the receiving end. While it would be ideal if women attained a normal BMI prior to pregnancy, this is not the reality for many women.  In pregnancy however many women are motivated to make positive health and lifestyle changes so it is a good time for health professionals to raise the issue; albeit sensitively.

For further information and references that support this article email Deborah davis@canberra.edu.au

Originally published Midwifery News Spring 2013 page 27 by the Australian College of Midwives.

Written by Prof Deborah Davis on request from a popular column that puts evidence-based practice into plain language

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