If you are overweight you may, like Zoe, experience confidence-sapping comments. The best advice is listen to the health professionals but get facts not opinions or knee jerk prejudices (ask, if necessary, for references so you can look yourself). Do not allow anyone to force you into believing that because you are overweight, you will necessarily have a complicated pregnancy and birth. Here are the basic things you should know about obesity and pregnancy.
Being clinically obese (two to three stone overweight, BMI over 35), rather than just a bit chubby has the following documented risks:
1 It can be harder for midwives and doctors to assess the pregnancy and labour as it is harder to feel the baby and your womb. (Some health professionals, by the way, can be offensive. ‘I can’t see baby, because of too much mummy,’ snapped one sonographer to a friend of mine, who, while plump and curvaceous is certainly not vastly overweight.)
2 You will be, statistically, more prone to pregnancy complications like hypertension, pre-eclampsia and oedema – where your body swells more because of fluid retention.
3 You have a slightly higher risk of developing gestational diabetes and consequently of having a larger than average baby.
4 You have a slightly higher chance of having a caesarean section (because of the baby’s size, or your blood pressure).
5 If you are obese and have a caesarean you have a slightly higher risk of some operative complications.
Ask your doctor to refer you to a dietician for dietary advice and support during pregnancy if you are obese, and if any of the above worry you, discuss them in detail. Most overweight women have perfectly healthy babies.
Eating: the basics
Pregnancy eaters divide roughly into two extremes: neurotic self-abnegators, who take the books literally, cut out anything fun and start weighing out grams of fat and protein. And self-indulgers, who think ‘Wey hey! Eating for two!’ and start deep frying their Mars Bars. Ideally, you want to be somewhere in between the two. ‘Before you close your mouth on a forkful of food,’ says the pregnancy book that tyrannized me the most in my first pregnancy, ‘consider “is this the best bite I can give my baby?”…if it’ll only benefit your sweet tooth or appease your appetite, put your fork down.’ Now, forgive my selfishness here, but satisfying my appetite, and even – gasp – my sweet tooth are, I believe, not an insignificant part of my overall well-being. This kind of nutritional fascism should really be outlawed by publishers of pregnancy books. You are pregnant. You are not on a diet. You are not sick. You are not going to harm your baby if you have the occasional bag of maltesers. However if you start eating in earnest for two, three or four, polishing off an entire tub of Haagen Dazs on the sofa, and generally throwing caution to the wind you will put on extra weight (just as you would if you weren’t pregnant) and you might produce a slightly bigger baby. Being really too heavy will not help you feel good later in pregnancy, and of course it’ll be harder to shift afterwards. Perhaps most important of all, you may not be giving yourself and your baby adequate nutrients if you’re eating a lot of junk.
Most pregnancy books tell you that you only need to eat about an extra 300 calories per day when you are pregnant. This in itself is shocking news if you were expecting to be wolfing down the cream buns for the next nine months. Brace yourself now because many experts say the reality is even harsher than this. The most recent Department of Health guidelines conclude that (partly because of our reduced levels of activity, and partly because our metabolism alters) pregnant women don’t strictly need any extra calories whatsoever in the first two trimesters of pregnancy. In the final trimester – hooray – we need about an extra 200 calories a day (a couple of large bananas).
Most of us, of course, eat loads more than this – because it’s socially acceptable to do so when pregnant – and so we get a bit fat. This does us, and the baby, no harm. Most of us lose it afterwards if we eat sensibly and are reasonably active. (I put on 45lb with Sam largely as a result of moving to ‘supersizing’ America. My weight gain was technically 10lb or so ‘too much’. I felt lardy afterwards, but the weight slowly came off and I was back to roughly my normal weight after maybe nine months.)
Verboten foods: what’s the truth?
It’s all horribly confusing. Can you eat that kind of cheese, or not? Can you drink that glass of wine, or not? One recent survey of British women by a baby formula manufacturer7 found that most of us don’t fully understand which foods to avoid when pregnant. Indeed, we often cut out foods that are beneficial, in the mistaken belief that they are somehow dangerous. Cottage cheese, for instance, is a good, low fat source of calcium. But many women avoid it in pregnancy thinking it’s a ‘soft’ cheese, therefore verboten.
Our paranoia is understandable. For a start, the goalposts keep changing. When I was pregnant for the first time I stuffed myself with tuna, which I’d been told was an excellent source of fatty acids, protein and vitamins. Five years later, pregnant with number three, I was only allowed a couple of medium-sized cans a week. In the interim, studies had found that tuna may contain too much mercury and so harm a baby’s developing nervous system if you eat too much of it in pregnancy (see guidelines). Swordfish, marlin and shark are now officially out, for the same reasons. And some reports have recently suggested that farmed salmon may contain unacceptable levels of toxins, though the Food Standards Agency says the benefits of eating salmon outweigh any potential harm as salmon is a fantastic source of protein, vitamin D and good fats that can help your baby grow. (If you’re really worried you could try buying organic or wild salmon instead of cutting it out.)
There is, among all this confusion, some sensible evidence that certain foods should indeed be avoided during pregnancy. Mostly they are the ones that carry a very small risk of food poisoning such as listeria or salmonella, which studies have found may damage your fetus or cause miscarriage. Apart from this relatively short list of foods (see Pregnancy Eating Crib Sheet below), most doctors say you should eat basically as normal during pregnancy.
Why you should stop obsessing now
Phil Baker, Professor of fetal and maternal health at St Mary’s hospital, Manchester says, ‘I see so many women who are blaming themselves for a miscarriage or still birth when usually they could have done absolutely nothing to avoid it. It is important to have a basically balanced diet, which includes vegetables, protein, carbohydrate, fats and vitamins. If you are entirely starved it will have implications for the birth weight of your baby.’ Most of us do our best to eat more healthily when pregnant but even if we can’t – because, for instance, we’re throwing up – our bodies, says Professor Baker, should already contain good stores of certain nutrients which will get us through pregnancy. (This might explain why women with severe morning sickness, who can keep nothing down, can still produce miraculously healthy babies.)
Supplements
There is some debate over whether taking a general vitamin supplement in pregnancy is necessary or even helpful. (This does not include folic acid – see below – or iron supplements if you are anaemic.) I take a pregnancy vitamin pill each day when pregnant, but my attitude is that of the agnostic praying in times of duress: you don’t want to rule anything out. ‘You can look upon a general vitamin supplement as an insurance policy,’ says Dr Toni Steer, a nutritionist at MRC Human Nutrition Research in Cambridge, ‘but make sure that your vitamin and mineral supplement doesn’t exceed daily recommendations – don’t take megadoses of one particular vitamin.’ Many nutritionists argue that it’s the combination of nutrients in real food that produces benefits. And certainly, taking a daily dose of pregnancy vitamins, then eating crap all day is not the best option if you want