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"  Almost six years ago, I entered my first pregnancy with the healthiest of intentions. I wasn&amp;#039;t going to be one of those nutty women who jogs right up to her delivery day, but I didn&amp;#039;t buy into the notion that the pink line on my pregnancy test bought me a free pass to lie around and eat with abandon, either. Flash forward two weeks, when morning sickness hit, and my workout routine consisted of racing to the toilet. The only food I could keep down was starchy, high-cal fare like bagels, muffins, and\u2014fine\u2014cookies. By the end of my first trimester, I&amp;#039;d gained 15 pounds, and I was unknowingly on my way to joining the latest mom-to-be trend: pregobesity. That&amp;#039;s REDBOOK&amp;#039;s term for what doctors are singling out as a new health crisis. Pregobesity begins when a woman gains too much weight during pregnancy, and worsens if she doesn&amp;#039;t lose it all before gaining again as she has more children. The number of women who gain 40 pounds or more during pregnancy is up 29 percent over the last 30 years, according to the National Center for Health Statistics. &amp;quot;It&amp;#039;s an epidemic,&amp;quot; says Laura Riley, M.D., medical director of labor and delivery at Massachusetts General Hospital in Boston and an associate professor of obstetrics and gynecology at Harvard Medical School. And it&amp;#039;s not a cosmetic issue: That extra weight may adversely affect her baby and increase her chances of developing high blood pressure, type 2 diabetes, even early-stage heart disease. Why are so many women who may not even have the normal risk factors for obesity dealing with this issue now? Unfortunately, I&amp;#039;m the poster child for pregobesity, so let me tell you how I got there. See how she grows Once I finished puking my way through my first trimester, I became ravenous. A whole block of Parmesan cheese? Clearly my baby needed sodium and calcium. Cookies? Well, she must require carbs for energy! I let myself eat whatever I thought my body wanted, figuring my regular walks and occasional swimming routine would cancel out the extra calories. They didn&amp;#039;t: By the time Johanna was born\u2014a month early but still a whopping 8 pounds, 2 ounces\u2014I&amp;#039;d gained 50 pounds. Most of the weight came off, thanks to my still-sprightly metabolism and a running routine, but when I got pregnant again (Jo Jo was only 8 months old), I was still holding on to an extra 10 pounds. This time, my exercise was keeping up with a toddler, and I was eating what she ate (mostly mac and cheese). I gained 50 pounds again, and swore all my pregnancy flab would come off pronto. Yeah, right. Before I knew it, I was pregnant again (whoops!) and, at 5 feet 7 inches and 160 pounds, with a BMI of 25.1, I was technically overweight. I tried to forgo chicken nuggets and sneak in walks, I really did. But my treadmill gathered dust as I battled intense morning sickness and exhaustion. I was juggling part-time work and caring for two children, one of whom has special needs, and since I could no longer unwind with a jog or a glass of wine, I often turned to food for solace. At the end of my eighth month, I stared in horror at the scale at my checkup as it inched just over 200 pounds. &amp;quot;Well,&amp;quot; the nurse said sympathetically, &amp;quot;you did have three back-to-back.&amp;quot; I was dismayed, but my friends, my family, and my doctor reassured me that the weight was drop-able. I arrived home from the hospital with a swaddled newborn and a list of diet apps to get me motivated. Now, 20 months later, I&amp;#039;m at a prepregnancy weight\u2014but it&amp;#039;s what I weighed before having number three. Yup, I&amp;#039;m still holding on to 20 extra pounds. Though I wasn&amp;#039;t overweight before my first pregnancy, I was by the time my third started, which is what makes me your pregobesity spokesperson. There are three issues here: our weight at the outset, how much we gain before the baby is born, and whether we take it off before getting pregnant again. I didn&amp;#039;t seem like a health risk, but I became one as soon as I ended my very first trimester 15 pounds heavier. No one called me on it, probably because so many of us are in the same boat. &amp;quot;I see a lot of women who take weight off after the first pregnancy but not the second or the third\u2014they&amp;#039;re older, so their metabolism has slowed down, plus they are already chasing after a toddler, so they don&amp;#039;t have time to take care of themselves,&amp;quot; Riley explains. &amp;quot;Then they wonder why they&amp;#039;re 45 and developing heart disease.&amp;quot; The health fallout At the risk of freaking all you other moms out, let me run through some of the troubling health issues linked to pregobesity. &amp;quot;It increases chances of developing pregnancy-related issues like preeclampsia and gestational diabetes,&amp;quot; explains Diane Ashton, M.D., deputy medical director of the National March of Dimes Foundation. Both conditions can be life-threatening for mother and child, and they&amp;#039;ve increased significantly in the last 20 years, right along with the country&amp;#039;s pregobesity trend. It&amp;#039;s also harder for doctors to do ultrasounds on heavier women, making it more difficult to track both your and your baby&amp;#039;s well-being. Now let&amp;#039;s move on to the ugly suspicion that pregobesity harms your child&amp;#039;s long-term health. Preliminary research suggests a link between Mom&amp;#039;s weight gain and her baby&amp;#039;s developing allergies and asthma, and a mother&amp;#039;s weight at the outset might even be related to developmental conditions such as autism (one 2012 NIH-funded study found that women who started pregnancy obese were 67 percent more likely than normal-weight women without diabetes or hypertension to have children on the autism spectrum). &amp;quot;When you&amp;#039;re overweight or obese, your body churns out more insulin, which in turn causes inflammation that could possibly affect your baby&amp;#039;s cognitive development,&amp;quot; says Jill Baley, M.D., a professor of pediatrics at Case Western Reserve University School of Medicine. And the larger you are on delivery day, the more likely it is you&amp;#039;ll need a C-section, which has been associated with an increased risk of childhood obesity.  Why no one&amp;#039;s telling pregnant women they weigh too much Chances are, if you look at pictures of your mom when she was pregnant with you, she was a comparatively skinny minnie: Until the 1970s, doctors made it clear to women that they were not to gain more than 15 pounds, Riley explains. Then, after a wave of low-birth-weight babies, doctors wised up and encouraged women to gain more. But the Institute of Medicine recommends gaining only 25 to 35 pounds, and that&amp;#039;s if you&amp;#039;re at a healthy weight to start. If you enter pregnancy heavy, you shouldn&amp;#039;t gain more than 15 to 25 pounds\u2014close to what our moms and grandmothers gained. But we run into a problem: pregnancy cravings. There&amp;#039;s good evolutionary reason for them. Even 100 years ago, food was harder to come by, and cravings were a way to ensure that women got more calorically dense food, says Sharon Phelan, M.D., a professor of obstetrics and gynecology at the University of New Mexico. Today, with highly processed and readily available food, cravings work against us. &amp;quot;In caveman days, if a pregnant woman had a craving for something sweet, she had to fight off the bees to get to the hives for honey, which expended a lot of calories,&amp;quot; says Phelan. &amp;quot;Now she can just go to McDonald&amp;#039;s and consume 1,200 calories when the only work she&amp;#039;s done is hand the cashier a five-dollar bill.&amp;quot; Given the dangers of pregobesity, you might expect doctors to be monitoring weight gain closely. But research shows they might not be: One small 2012 study of overweight or obese women found that more than a third of doctors didn&amp;#039;t bring up appropriate weight gain with them at all. &amp;quot;The earliest doctors usually refer patients to me is around six months, and most of the time it&amp;#039;s because they&amp;#039;ve already gained 50 pounds,&amp;quot; says Jamie Steckler, a Chicago registered dietitian and nutritionist. &amp;quot;But I really should have seen these women at the end of the first trimester. It should be made clear at the get-go that pregnancy is no excuse to eat like a starving person,&amp;quot; Steckler says. While doctors agree in theory, they also point out that today&amp;#039;s ob/gyn is forced to convey more info in less time. &amp;quot;With the explosion of genetic testing, a lot of ob/gyns spend most of the initial visits discussing those options with patients, and if they mention weight, it&amp;#039;s more as an afterthought at the end,&amp;quot; says Joshua Copel, M.D., a professor of obstetrics and gynecology and reproductive sciences at the Yale School of Medicine. They may also push the subject to the back burner because they&amp;#039;re worried about hurting a woman&amp;#039;s feelings, says Copel. Let&amp;#039;s face it: No one wants to lecture a hormonal, highly sensitive pregnant woman about her weight. &amp;quot;When my own wife started gaining a little too much during her first pregnancy, I tried to gently tell her, and she told me in no uncertain terms to back off,&amp;quot; recalls Jacques Moritz, M.D., director of gynecology at St. Luke&amp;#039;s Roosevelt Medical Center in New York City. &amp;quot;She felt that she&amp;#039;d spent her life thin and this was one of the few times she didn&amp;#039;t have to watch what she ate.&amp;quot; She was not alone: &amp;quot;The minute I got that first positive pregnancy test, it was like a get-out-of-jail-free card,&amp;quot; says Shira Enstrom, who had always tightly controlled her weight before conception but gained 55 pounds with her first pregnancy, despite taking regular spin classes. &amp;quot;My pregnant friends and I figured, since we were all eating healthy fare like veggies along with our ice cream, it wasn&amp;#039;t so bad.&amp;quot; Hilary Hanson Bruel, a mom of two in Newton, MA, who gained 50-plus pounds with each pregnancy, agrees. &amp;quot;You feel like, when you&amp;#039;re pregnant\u2014after years of working your ass off to be skinny and eating salad\u2014you can say, &amp;#039;Finally! I&amp;#039;m pregnant! I&amp;#039;m having a burger.&amp;#039;&amp;quot; Doctors see this sentiment all the time. &amp;quot;We live in such a diet-crazy culture that many of my patients tell me they feel like this is the one time in their life where they don&amp;#039;t have to watch every morsel and can gain weight,&amp;quot; Riley observes. The result of all this: Talking about pregobesity is practically taboo. And now, some solutions For the pregnant women out there, know this: Eating for two is bogus. All you need is an extra 300 calories, and not until the second and third trimesters, Copel says. That&amp;#039;s not much\u2014essentially a yogurt and a couple of pieces of fruit each day. Track your weight as you go, and if you find you&amp;#039;re gaining more than one pound per week in the second and third trimesters, ask your ob/gyn to refer you to a nutritionist. And you should still be getting 30 minutes of exercise most days, even if it&amp;#039;s just brisk walking. New moms, you may find yourself feeling ravenous, like I did, and turn to high-fat, high-carb foods for a pick-me-up. This is the moment to ask helpful friends to prep veggies and make sure you have a freezer full of lean meals (not cheesy casseroles). Breast-feeding does burn about 500 calories a day, so consider that your weight-loss jump-start. Then there are the rest of us: We&amp;#039;re not exactly new moms, but we haven&amp;#039;t had the same body since our kids were born. To reach your healthy weight, combine good eating habits with exercise. Women who followed a low-cal diet (ranging from 1,200 to 2,000 per day) and did 45 minutes of moderate to vigorous exercise five days a week were able to lose roughly 20 pounds, in a 2011 study from the Fred Hutchinson Cancer Research Center in Seattle. It can also help to track your calories, a Northwestern Medicine study found. At my last physical, my doctor told me flat-out that my extra 20 pounds weren&amp;#039;t just a cosmetic nuisance; my blood pressure, cholesterol, and blood sugar had all gone up. She also gave me some reassuring news, which other doctors I spoke to echoed: &amp;quot;If you lose that weight, you also shed those health risks immediately.&amp;quot; Sure enough, when I started tracking my food and running daily, the number on the scale started dropping, my blood pressure went down, and my numbers returned to normal. I still have a ways to go, but I&amp;#039;m hopeful I&amp;#039;ll fit into my wrap dresses again. More important, shedding my pregnancy padding has made me feel more energized, which I certainly need for those three small children my brave body brought into this world. "^^<http://www.w3.org/2001/XMLSchema#string>
<http://www.redbookmag.com/life/mom-kids/advice/a16836/pregnant-and-obese/>