Seventy-three percent of female patients at Huddinge University Hospital's Obesity Unit in Stockholm started gaining weight with their first pregnancy. According to Professor Stephan Rössner, the director of the unit, this is a problem that many women face.
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He recently placed the spotlight on pregnancy and the implications of weight development during the first Regional Congress on Obesity, organised by the International Association for the Study of Obesity (IASO).
On average most women retained 1,5 kg of weight gained during pregnancy one year after delivery, Rössner said. Women who started their pregnancies with a high body mass index (BMI) had an even higher BMI after delivery.
The BMI is a measure of body weight and/or obesity. The weight of individuals with a BMI of between 18 and 25 is regarded as normal, while a BMI between 25 and 30 indicates overweight, and a BMI of more than 30 signals obesity.
Causes of post-pregnancy obesity
A variety of factors contribute to excessive weight gain during and after pregnancy. Firstly, researchers have identified a sub-group of women who seem to gain more weight during pregnancy and have greater difficulty in losing this weight after their babies are born.
Most of the women in this subgroup will take the extra weight they have gained during pregnancy into their future lives. As yet, researchers do not know why this happens.
'Eating for two'
The old idea of "eating for two" during pregnancy is one factor that can cause excessive weight gain during pregnancy.
In reality it is the composition of the diet that is important during pregnancy, not its energy value.
Most women who start their pregnancy with a normal weight do not need to eat more food during the nine months of gestation. They do need to ensure that they are eating healthy food such as fruit and vegetables, fat-free milk and dairy products, unsifted grains and cereals, lean meat, fish (three times a week for omega-3), eggs, legumes, and small quantities of mono- and polyunsaturated margarine or oils.
Only mothers who are seriously underweight at the start of pregnancy should be encouraged to eat larger helpings of healthy food during pregnancy than they did before.
Irregular lifestyles and eating patterns
Irregular lifestyles and eating patterns after the baby's birth – when the mother suddenly has to cope with feeding and looking after a baby, a household, and often also a job – may contribute to weight gain.
A woman who is exhausted, who never sleeps for more than two hours at a stretch, who is overwhelmed by the sudden responsibility of caring for a baby, who may be faced with a difficult infant which fusses and cries, cannot be blamed for not giving attention to what she is eating and the fact that she is no longer exercising.
If you are a mother who is overwhelmed by the sudden change in your life, go for help. Ask your husband, mother, siblings or friends to help you cope. Give attention to yourself, not just the baby. Try to get back to eating regular, balanced meals and doing some exercise.
Postpartum depression
Prof Rössner also mentioned postpartum depression, a condition that is often overlooked and not treated properly, as a contributing factor.
A woman who is depressed because of hormonal changes in her body after giving birth, or due to being isolated from society while caring for her child, can easily turn to food as a crutch.
By eating more and either not losing weight gained during pregnancy or gaining extra weight after pregnancy, the mother's depression will increase. Given that a brain chemical called serotonin, which makes people feel more positive, is stimulated by sugar and carbohydrate intake, it is not surprising that women start eating sugar, sweets and chocolate, and drinking sweetened cold drinks to boost their mood. Unfortunately, this piles on the kilograms.
If these women were able to follow a balanced diet that contains an adequate supply of high-fibre and/or low-glycaemic index (GI) carbohydrates and some low-fat protein, they could increase their brain serotonin levels and combat depression to a certain extent without gaining so much weight.
Lack of exercise
Some women do not exercise at all during pregnancy and once the baby is born have no time, energy or inclination to do any physical activity.
Prof Rössner pointed out that we don't have much information at present about physical activity during pregnancy. He did suggest that pregnant women should ask their doctors if they are able to exercise without endangering their pregnancy and if given the green light, to engage in some form of physical activity every day.
Probably the safest type of exercise is going for walks on a daily basis. After giving birth, mothers should also continue walking for at least 30 minutes a day. One solution is to put the baby into a pram or, even better still, to carry her on your back, when you go for your daily walk. This will ensure that you get plenty of healthy exercise and that your baby gets fresh air.
Breastfeeding
Prof Rössner said that lactation uses up about 500 cal or 2100 kJ a day. Studies have shown that women who breastfeed for 12 months or longer lose the most weight.
This does not mean that a breastfeeding woman should increase her energy intake indiscriminately, as is often the case.
Don't think that because you are breastfeeding you can eat as much as you like. 500 calories or 2100 kJ would amount to having one cup of full-cream milk (for the extra calcium), 2 slices of wholewheat bread with margarine and jam, and one apple extra per day. This is not a lot of additional food, so be careful not to overeat when you are breastfeeding.
In addition, lactating women are urged to increase their liquid intake. Use tap water or bottled water for this purpose, not litres of sweetened cold drinks (400 cal or 1680 kJ per litre) or fruit juice (500 cal or 2100 kJ per litre).
Gestational diabetes
The diabetes that many women develop during pregnancy is associated with a greater tendency to gain weight during and after pregnancy.
Prof Rössner acknowledged that the experts don't know why this happens. He also pointed out that women who suffer from gestational diabetes and gain excess weight, are much more likely to develop full-blown type 2 diabetes 15 years later.
Most women are not advised to see their doctors for follow-up checkups after pregnancy to monitor if they have recovered from gestational diabetes or not.
Having regular checkups to see if you have a tendency to insulin resistance or diabetes after your pregnancy is an important way of ensuring that you will be given the right treatment as soon as possible (a low-GI diet and possibly also anti-diabetic medication).
If you suffered from gestational diabetes, you should see your doctor for regular checkups and ask him/her to monitor your insulin levels and weight. Prevention is always better than cure.
Prof Rössner's talk indicates that pregnancy can cause overweight and obesity, as well as type 2 diabetes in later life. It also underlines the importance of maintaining a normal weight before falling pregnant, not gaining too much weight during pregnancy, keeping active, following a healthy diet and going for help if you suffer from depression or have gestational diabetes. – (Dr Ingrid van Heerden, DietDoc)
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