Dr. Sarah Stombaugh:
This is Dr. Sarah Stombaugh and you are listening to the Conquer Your Weight Podcast, episode number 21.

Announcer:
Welcome to the Conquer Your Weight podcast where you will learn to understand your mind and body so you can achieve long-term weight loss. Here’s your host, obesity medicine physician and life coach, Dr. Sarah Stombaugh.

Dr. Sarah Stombaugh:
Hi everyone. Alright, so today we are going to talk about weight gain in pregnancy. I am 35 weeks pregnant this week and I’ve been promising you, I’m going to talk about this for a while now. So let’s do it before baby gets here. Both of my boys came after their due date, so it’s gonna be interesting to see what happens with our little girl. Honestly, my mind has not entertained the possibility that my baby could ever come before my due date, but of course I know that could happen and as a third time mom, I should probably be more prepared than I am, but I feel like we basically have all the stuff I need to dig it out from storage. Should probably grab a pack of newborn diapers, maybe a couple of girly clothes because I’m certainly not above dressing my daughter in our blue hand-me-downs.

But it might be nice for her to have a few things on her own. I will tell you too, I have a little bit of a cold right now. I don’t know, I had COVID probably about a month, month and a half ago now and I don’t have it again, so I’m pleased that that’s the case, but some are cold, still do go around, so hopefully y’all don’t hear that too much in my voice here today, but if you do, that’s what’s going on. Alright, so let’s get into it. Pregnancy weight gain. This is such a sensitive topic and of course this episode is going to be most applicable for women who are currently pregnant or planning to become pregnant, but there’s some really great information here just in general about nutrition and keeping balanced blood sugar levels and managing cravings. So even if you are a man or you’re a woman who doesn’t want kids or is done having children, still take a listen to today’s episode because I think most of my listeners will find some helpful information within the episode today.

Talking about weight gain in pregnancy can be so triggering because so many women gain weight during pregnancy that they later have trouble losing. And just like so many aspects of pregnancy, there can be so, so much blame put onto the mother. And as if our society doesn’t give women enough things to feel guilty about, we tell women things like don’t gain too much weight, but then we really give them little to no guidance about eating healthy during pregnancy. And then if they do gain more weight than recommended, we say like, shame on you. That’s unhealthy for you and for your baby. And particularly in American healthcare, we don’t have great resources set up to help support our pregnant patients because no matter how great your OB/GYN physician is, they usually don’t have the time to provide in-depth guidance on weight gain and nutrition and pregnancy.

And to be honest, it’s not completely their job. Their job is to monitor the mom and the baby for signs of developing medical issues in the pregnancy. And for example, my current OB group has 10 minute appointments for follow-up prenatal visits. So I’m not saying they don’t know this information or they don’t care, but there’s really only so much that you can do in a 10 minute visit. So certainly an OB is going to be there to diagnose conditions like gestational diabetes and then make sure you have access to maternal fetal medicine doctors who are high risk OB doctors and a nutritionist. If you’ve gotten a diagnosis like that but you might not have gotten, they might not have that time to provide the preventative advice about weight gain and nutrition from the beginning of pregnancy. And interestingly, in my three pregnancies, no one has ever actually mentioned to me how much weight I should gain during pregnancy.

And you know, I’ll give my physicians for the benefit of the doubt. I’m a physician too. I previously worked in family medicine, meaning that during my medical school and my residency training I did prenatal care and delivered babies. And of course now I’m a weight loss physician. So it’s probably fair to assume I know all the information and that’s a totally fair assumption. I do know the information I have and in the past have had wonderful OB physicians, I love them so much. But despite all of that, despite being a weight loss physician, I did actually gain more weight than advised during my first two pregnancies. And in talking with dozens of my patients and even just my friends, very few of them have spoken to their doctors about weight gain and pregnancy. And I’m not putting this in my OB colleagues honestly as a physician in my experience with having conversations.

Sometimes we just talk about too much, right? There’s a lot to go through. So I imagine a lot of them probably have a spiel that they go through at the first prenatal visit and it includes a rundown of all sorts of basic information like what to expect through the pregnancy when you need to call the doctor, don’t forget to start your prenatal vitamin, make sure to avoid these foods. This is the healthy amount of weight to gain during pregnancy, et cetera, et cetera. And there’s so much information and sometimes patients are excited and focused on other things like when they get to have their first ultrasound. So even if that weight gain was mentioned, it’s kind of a piece of it and maybe that whole whole spiel isn’t absorbed. But however women end up there, a lot of women go through pregnancy with little to no guidance about healthy weight gain in pregnancy.

Some of the women gain more weight than recommended, which can put them and their babies at risk for certain medical conditions. And honestly, most of them feel pretty hopeless and helpless about the whole thing. And then they have the baby and they’re stuck with the excess weight, which maybe they lose before their me next pregnancy, but maybe they don’t. And if they have more kids, the story repeats itself. But this time they start out the pregnancy of five or 10 or 20 or even more pounds overweight. So by the end of each pregnancy they are heavier and heavier and now they’re in their forties and they’re 20 to maybe even a hundred pounds overweight even if they never struggled with their weight previous to pregnancy. And certainly this isn’t the case for every woman. There’s plenty of women who gain and lose weight, you know, before and after their pregnancy.

But this is a common story that I hear over and over again. So today we’re going to address how do you prevent excess weight gain during pregnancy? And it boils down to a few things. One, how much weight should you gain during pregnancy? Two, what are the caloric needs during pregnancy? Three, what should a healthy diet and pregnancy look like? And four, how do you manage cravings? Because we all talk about pregnancy cravings, but we don’t always talk about how to manage them. So many of my listeners tell me they like the consistency in the length of my podcast episodes. I will tell you, I think we do not have time to talk about all of this in 20 or 25 minutes. So we’re going to start tackling these questions today and we’ll come back next week and possibly the following week as well to make sure we can get through all of the information in depth.

So you’re ready, we’re gonna dive in. So this first, honestly, the first two questions are pretty easy here. Number one, how much weight should you gain during pregnancy? The standard guidelines that we see quoted are from the Institute of Medicine. And if you look at acog, which is the American College of Obstetrics and Gynecology or maternal fetal medicine organizations, which is high risk obstetrics, they will all state these same things. So women who are underweight, that is someone who is starting the pregnancy with a BMI of less than 18.5, are recommended to gain 28 to 40 pounds during pregnancy. A woman who is normal weight so that someone who has a BMI of 18 and a half to 24.9 are recommended to gain 25 to 35 pounds during pregnancy. A woman who starts the pregnancy overweight, so that’s a BMI of 25 to 29.9, is recommended to gain 15 to 25 pounds during pregnancy.

And women who start their pregnancy in the obese category, which is a BMI of 30 or greater, is recommended to gain 11 to 20 pounds during pregnancy. Now of course, these are just general guidelines. They’re all based on a singleton pregnancy, meaning that you have just one, you’re pregnant with one baby, you’re not having twins or anything like that. So if you are having twins or if you might have an exception to this for any reason, it’s best to ask your doctor what your weight gain goal should be. But these are some really good guidelines for starting with number two, what are the caloric needs in pregnancy? So I actually googled this out of curiosity and I was shocked by like how much information and misinformation is out there. So don’t Google it, go straight to ACOG. That is the American College of Obstetrics and Gynecology, and they state during the first trimester with one fetus, usually no extra calories are needed in the second trimester.

You will need an extra 340 calories per day, and in the third trimester, an extra 450 calories per day. And this makes a lot of sense. If you think about first trimester, even by the end of the first trimester, your baby is tiny. I think it’s like the size of a lime by the end of first trimester. And so your little limes size baby does not need very many calories to grow. And even if they did, babies are little parasites. They will take whatever they need from their mother. So during pregnancy, the baby’s nutritional needs will always come first. Your baby is going to be able to get whatever it needs from your body. So as long as you’re taking a prenatal vitamin to get your folic acid and to get your iron, your baby is capable of taking just about everything else it needs directly from your body.

And if you look at weight gain charts during pregnancy, it reflects us exactly. Women typically gain very little weight during the beginning of pregnancy. And a lot of women actually even lose weight during first trimester, especially if they’re dealing with significant morning sickness and food aversions. So most of that weight gain for women is happening in a second and third trimester number three. Alright, this question y’all is gonna take us probably the rest of the episode to get through. We may not even finish it today, but number three, what should a healthy diet look like in pregnancy? Your diet should be well balanced. It should include healthy carbohydrates, protein and fat. And again, sort of excluding first trimester, just do the best you can. If you can only eat cheese and bread, don’t beat yourself up about it, but do your best. Eat foods that sound good, eat foods that stay down and most importantly, take your prenatal vitamin.

If you can’t stomach your prenatal vitamin, sometimes the iron and vitamins can make you nauseated as well. You can ask your doctor about a gummy version or a Flintstone version or if there’s something else that you can consider personally. I actually ended up taking my prenatal vitamin at bedtime every night, which helped me to be able to not deal with any of the morning sickness getting worse from the vitamin itself. And then so as you get further into pregnancy, hopefully your morning sickness is starting to improve and your diet can return a little bit back to normal. So that means eating regularly throughout the day, eating all of the macronutrients and limiting excess sweets in the diet. And if you go and look at the nutritional guidelines for gestational diabetes, they are honestly reasonable guidelines for every pregnant woman to follow. Now, if you don’t have gestational diabetes, I’m not saying you should get caught up in counting your exact grams of carbohydrates and calories, and you certainly don’t need to be tracking your blood sugars after meals.

But the guidelines are actually a pretty good blueprint for most women during pregnancy. Let me read them to you just so you can see what I mean. So we recommend getting at least 71 grams of protein per day and at least 175 grams of carbohydrates per day and at least 28 grams of fiber per day. And then the remainder coming from healthy fats. And then there are some specific notes about carbohydrates, which is make sure to choose healthy carbohydrates. Things like fruits, vegetables, beans, whole grains, and whole wheat. Try to avoid processed food and white products such as white rice or white bread and try to avoid fruit juices, sugary drinks, candy cakes, cookies, added sugars and processed sugary snacks.

So do you see what I mean? Pregnancy is not a time to exclude or excessively limit carbohydrates from your diet. So you certainly should not be doing a ketogenic diet or anything like that. Carbohydrates are really important for the development of your baby, especially your baby’s brain. But just because it’s okay to eat carbohydrates doesn’t mean that it’s a great idea to eat processed carbohydrates like crackers and cereal and ice cream every day. Because like we’ve talked about before, all carbohydrates are not created equally. The blood sugar response of a complex carbohydrate like a whole grain or a piece of fruit or vegetables or nuts, it’s going to have a much more rounded blood sugar response as opposed to eating things that contain flour and sugar. And whether you have gestational diabetes or not, following these principles as part of your routine can help you to maintain a healthy weight gain during pregnancy.

And in fact, it’s so sad to me. I’ve seen so many women who’ve gotten diagnosed with gestational diabetes and they feel like they have to make these huge overhauls to their diet. But the reality is, if we taught all women how to eat healthy from the beginning of pregnancy, or honestly maybe if we just taught all people how to eat healthy as part of their life, it might not feel like their whole world has been flipped upside down when they get the diagnosis of gestational diabetes. Sure, it might mean that they’re tracking their food a little bit more closely and they have to start checking their blood sugars after meals, but it wouldn’t be totally changing their diet from what they were doing before. So using the dietary recommendations for gestational diabetes as a guideline, I want to give you an example of what 71 grams of protein and 175 grams of carbohydrates look like.

And y’all know I do not count calories or macros, but I love you all so much. So I did count both my calories and my macros yesterday for the sake of talking through this with you all. And while I’m fortunate not to have gestational diabetes in this pregnancy or during my previous two pregnancies, I will share with you all that my second son was born weighing nine pounds and six ounces, which y’all, that is a big baby <laugh>. And in fact, like medically, so any baby over nine pounds is considered LGA or a large for gestational age baby. And a woman who has had a large for gestational age baby is at risk for gestational diabetes and insulin resistance in future pregnancies. So I’m pregnant right now and while I don’t have gestational diabetes, I’m a lot more conscientious about my food choices and weight gain during this pregnancy because to be honest, I really just don’t wanna push out a nine pound, six ounce baby again.

Alright, so I did it. I counted all my calories and my macros for you all yesterday and here’s what I ate and here’s how it added up for breakfast. Yesterday morning I had a bowl of plain cooked rolled oats and ground flaxseed around nine o’clock in the morning. I topped it with a cutup peach, a tablespoon or so of sliced almonds. Then a couple tablespoon of pepitas, which are pumpkin seeds, a little drizzle of honey and some sea salt. And then I top it with half and half. I always have plain iced black tea on the side for my daily caffeine intake. And that was my breakfast for lunch around 1230. I had four Greek turkey feta meatballs, which oh my gosh, these are my absolute favorite and I will have to share the recipe with you all sometime. The problem is that I don’t actually have a recipe.

I’m so bad. I love cooking, I love food science. And so I often don’t use recipes to cook food. I will read recipes, certainly from time to time to get ideas and to get some guidance, some cooking times. But in the end, I just like to measure ingredients from my soul. And so I actually don’t have a meatball recipe, but I made some this week and I had four of those yesterday and I had that with a generous helping of tzatziki sauce. And then on the side I had made a Greek salad, which was cucumbers, red bell peppers, cherry tomatoes, parsley, feta, orzo, olives, and then dressed with garlic, lemon and olive oil, salt and pepper too. And then on the side I had half of a whole grain pita bread and some plain hummus around 3, 3:30 or 4:00 PM I had a Cliff Bar duo, which is like a mini cliff bar and a single serving of dark chocolate raisin nut trail mix.

And then I had dinner around 7:00 PM and I had a Mexican street corn skillet dish. It was made of red potatoes, corn, chorizo, and then topped with salsa and pepitas. I also had half a peach on the side of that. And then throughout the day I drank plain water and sparkling water. Alright, so drum roll please. That comes to a total of just under 2000 calories. I had 180 grams of carbohydrates. I had 70 grams of protein and 102 grams of fat, 28 grams of which was saturated fat, and 74 grams of which was unsaturated fat. And I’m actually not sure how I hit the protein and carbohydrate targets so closely, but there you have it. Remember, the guidelines for gestational diabetes are for at least 71 grams of protein and at least 175 grams of carbohydrate.

And you can see that I didn’t really limit carbohydrates during my day. I had them during every meal, but most of them came in the form of whole food sources from rolled oats, from flaxseed, nuts, peaches to tomatoes in my lunch pita bread. That was a like a hundred percent whole grain P bread, potatoes, and corn. And I’ll be honest, the cliff par probably was not the best option, um, especially for someone with gestational diabetes because those things have some added sugar. But overall, my yesterday’s eating habits even fit within the guidelines for someone so with gestational diabetes. So while I don’t recommend counting calories or counting macros for my average patient and certainly not my average pregnant patient either, it’s actually really interesting to do it from time to time as a check-in. Alright, so we are gonna go ahead and pause today’s episode.

Next week we’ll keep talking about nutritional information, we’ll do some more food comparisons and hopefully we’ll also have time to discuss managing pregnancy cravings. If not, we’ll just turn this into a three part series. Thank you for joining me today. If you’re interested in learning more about me or if you live in Illinois or Virginia and you’d like to be a patient in my telemedicine based weight loss practice, check out my website at www.sarahstombaughmd.com. If you’ve enjoyed today’s podcast, please subscribe and leave me a review wherever you listen to podcasts. I’d appreciate if you share this with any of your friends, especially your pregnant friends. And I look forward to seeing you next week. Bye-bye.