A while back, a pregnant friend informed me that her ob-gyn had issued some pretty strict guidelines about her pregnancy weight. I was surprised to hear some of her doctor's recommendations and asked this friend if I might interview her for my book/blog; we agreed to talk once she had delivered. Said friend is now the proud mother of a healthy, adorable baby girl, has returned to work (as a psychologist), but still found time to answer the questions below:
1) What foods were you advised to eat, to avoid? Did she propose a daily caloric intake?
She said to avoid fruit (eat it only once or twice a week), avoid the "bread basket" and refined flour. . . . It sounded to me like she was recommending a low carb diet. I was told not to eat any more than I was eating before I got pregnant since I looked "normal" and "thin" (pre-pregnancy). She said that the fetus does not need much in terms of calories.
I told her that I was eating fruit, bread, etc. She said "okay" but encouraged me not to eat more than I was already eating or change my eating habits (except to avoid high mercury fish, more than one serving of caffeine per day, avoid alcohol, etc.).
Another patient that I met in the waiting room (our doctor told her that she was gaining too much weight) said that our doctor told her to eat the following: eggs for breakfast and maybe some yogurt and then salad with protein for lunch and dinner (fruit as a dessert/treat 1-2 times per week). She was told to avoid bagels since they are high in carbohydrates/calories.
2) What did your doctor suggest would be a healthy weight-gain during your pregnancy? What were her concerns about you gaining more?
She said that she recommended to her patients not to gain more than 20-25pounds despite the standard medical recommendation being 25-35 pounds because you don't need more than 20-25 pounds. . . . She explained that any more is "just weight you have to lose."
3) Do you think the above information was correct? How do you think the advice would have differed in a non-NYC population?
Most doctors (even in NYC) suggest gaining 25 to 35, but there is definitely more emphasis on weight gain here. I don't think her advice was very helpful. The way she encouraged her patients to eat (avoid fruit when it is so rich in vitamins, etc.) did not seem helpful. A plan-based diet rich in whole grains (e.g., whole wheat bread) and fruits, etc. is a part of a healthy diet during pregnancy (and always). She is encouraging eating behaviors that are not consistent with nutrition research or standard advice given to pregnant women (especially for someone that may have struggled with an eating disorder). Then again, doctors don't get much nutrition training in medical school.
The average weight gain during pregnancy is supposedly 25-35 pounds (that is what most doctors recommend to their patients). Most people I know gained at least that, often 40 or 50 pounds. To be honest, I don't think you have total control over it. My girlfriends have varied so much! And it did not totally have to do with how much or what they were eating. With respect to weight gain during pregnancy...I think some of it genetic, depends on body type, weight before pregnancy, etc. You can stay active (exercising in moderation) and avoid binge eating, eat healthy, etc. to prevent excessive weight gain but at a certain point you only have so much control.
I felt that her advice was extremely troubling! There seemed to be more emphasis on weight gain than eating healthily. I understand gestational diabetes is a problem and some people see pregnancy as a break from watching their weight (e.g., eating a lot of sweets or high fat foods, etc.) and end up gaining a large amounts of weight...HOWEVER, women already have enough to worry about during pregnancy (the baby, health, body changes, etc.).
I think the advice should should be on health NOT weight gain. It should be to eat as healthily as possible and to eat sweets, etc. in moderation...and to stay active (doing exercises adapted for pregnancy) to promote a healthy baby (first priority) and healthy pregnancy and postpartum recovery. Weight monitoring should be emphasized to make sure the baby and mother are healthy...not as pressure to keep your weight gain low so that you look good afterwards. Patients should be informed that there is a great deal of individual variation, so they should just try their best to eat a healthy diet and exercise in moderation (to feel well and prepare for late pregnancy when it harder to get around & labor & recovery).
4) Did you follow your doctor's guidelines? Did you, at any point, think about switching doctors?
I was quite ambivalent about staying with her. I felt self-conscious and the major goal of each check-up was to check my weight gain (even during visits when she did not bring it up, I found myself bring it up and seeking her approval). I think that if I had gained more than her recommended amount, I would have changed. I seriously thought about it during my second trimester (when I gained the most weight, at the point I had gained 15 pounds) and she suggested that if I wanted to "follow" her recommendation of 20-25 pounds instead of the average 25-35 (30ish), I should slow the weight gain down. She asked me if I was exercising as "vigorously" as before, what types of foods I was eating, etc. She said not to "stress" too much since I was "thin" to begin with if I ended up gaining around 30. She said that if I had been overwieght to begin with, she would have been "upset" that I had already gained 15 pounds.
I did not gain much during the third trimester and she complimented me on it several times, telling me that she was "really happy" with my weight gain. The reality is that everyone's weight gain occurs at a different rate (some people gain more in the middle, others at the end). I don't think it was due to me doing anything to slow my weight gain down.
I ended up gaining 22 pounds. However, I did not really follow her diet advice. I think it was just genetic (similar to my mother during her pregnancies). I ate a decent amount of fruit and bread products, chocolate, etc! I was just mindful of eating everything in moderation (not restricting), trying to eat as healthily as I could) and staying active.
5) What did your doctor have to say about you losing the baby weight post-delivery?
Not much, thank god. But if I had gained more weight, I am sure she would have! If there's anything else, please let me know! Thanks so much, Stacey