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Weighty matters

WEIGHT AND WATCH Avoid consuming extra calories during and after pregnancy

WEIGHT AND WATCH Avoid consuming extra calories during and after pregnancy  

How many women think about pre and post-partum weight management?

We plan many things in our life. Right from the courses we study and the job we choose to even pregnancies. But do we think of weight management before pregnancy?

The risk of obesity becomes most problematic for women during childbearing years. Many enter pregnancy overweight, gain more weight during pregnancy, and fail to return to their pre pregnant body weight, leave alone the appropriate weight. Therefore, the post partum period is critical for changing behaviours to promote healthful weight management in women. An increasing number of women are becoming pregnant with excess body weight.

A study conducted in the U.S. revealed that approximately 40-50 per cent of women were overweight when they become pregnant. A pre pregnancy BMI >30 is considered a high risk pregnancy, as it confers risk to the mother (gestational diabetes, hypertension, thrombo embolic disorders, and complications during delivery etc.)

During the post partum period, there are many contributory factors in becoming obese — excessive weight gain during pregnancy, post partum weight retention and additional weight gain after delivery. The optimum weight gain for a normal weight woman should be 10-12 kg during pregnancy.

Most of this excess weight is a result of an increase in fat stores. A study conducted in the U.S. by Butte and colleagues revealed that obese women accrued a higher fat mass during gestation than their normal-weight counter parts. This excess fat deposit contributes to the problem of post partum weight retention. The larger the amount of excessive fat stores, the longer it will take the mother to return to her pre pregnancy weight. Pre pregnancy BMI is the strongest predictor of excess gestational weight gain and future obesity. So it is essential to return to the pre pregnancy BMI before the next pregnancy is planned.

Diet with excess calories than required, inactivity and high stress levels can also contribute to weight gain in the post partum period.

Eating for two

In our Indian culture, the pregnant mother is always encouraged to eat for ‘two’. It is wrong. One needs to consume only the recommended extra amounts of calories, proteins, calcium and iron. The extra calorie to be consumed is only 300, and 15 grams of protein per day. Definitely not double the requirement.

Activities also need to be streamlined as per the gynaecologist’s advice. Unless and otherwise advised bed rest, one needs to continue normal activity and during periodic visits (may be once a month during the first and second trimester and more frequent in the last trimester) the pregnant woman should check with the doctor about activities that can be performed. Definitely weight gain needs to be checked.

Post partum weight gain

Post partum weight gain can occur due to extra calorie consumption out of fear that the lactating mother will require twice as much the calories as she normally does. During lactation, a mother will require 500 calories extra per day, definitely not more than that. She also needs 20 grams of additional protein a day.

One gets so involved in the newborn that one forgets about one’s own health. The first step in weight management in the post partum period is to assess readiness, intention and barriers to change. Since infant care can be over whelming, women might not believe that they have the time or energy to commit themselves to a weight management programme at this vulnerable time.

A second step to weight management is to assess lactation status, dietary intake and activity levels. Replacing high fat foods with fruits and vegetables is a must.

The third factor that could affect the weight management could be the perceived stress or depressive symptoms.

BHUVANESHWARI

(The author is chief consultant dietician, Apollo Hospitals Group)

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