Advice for pregnancy

Finding out you are expecting can be a very exciting but also anxious time for mums-to-be. If you become pregnant whilst following one of our programmes, you will have to come off the plan for the duration of the pregnancy. This can often cause frustration and anxiety due to worry about undoing all your hard work, potential weight gain during the pregnancy, and feelings of loss of control. Pregnancy should be a time to embrace the changes in your body and look forward to a new season in your life. So we have written this article to let you know what to expect (weight gain wise) whilst you’re expecting, and some tips to help you keep control during your pregnancy and after the birth.

Why is Slim & Save not suitable during pregnancy?

Firstly, active weight loss should not be the focus of pregnancy (see information on weight gain during pregnancy in the next section). Secondly, it’s generally accepted that ketosis during pregnancy may be harmful for the growing baby.

Good research studies in humans to determine the effects of potentially harmful diets during pregnancy are obviously ethically challenging. Therefore, studies to date have involved animals, with these studies finding potential issues such as organ dysfunction and behavioural change in the infant (1).

Weight gain during pregnancy

Worries about weight again is extremely common in mums-to-be. Most women put on between 8kg and 14kg through the pregnancy, the majority of which tends to be put on after week 20, with weight gain slowing down around week 35. There are no ‘official’ UK guidelines for appropriate levels of weight gain during pregnancy, however the US guidelines are generally accepted here in the UK and are quoted in the UK NICE guidelines 2010 (2).

These guidelines state that if you’re overweight when you fall pregnant (BMI of 25-29), you should gain 7-11kg in total. If you are obese when you fall pregnant (BMI of 30 or more), you should only put on 5-9kg – around a stone. You don't need to gain more than this, because your body will use the excess fat stores you already have to ensure the healthy development of your baby.

Evidence suggests that if you keep the recommended weight gain ranges, you and your baby are likely to have better outcomes. Gaining too much weight will put you at increased risk of developing gestational diabetes and pre-eclampsia. It will also increase your risk of needing an assisted delivery (e.g. forceps or C-section). Avoiding excess weight gain will also mean you’ve got less to lose after the birth – you’re more likely to get back on track quicker after the birth.

However, having quoted the above weight gain ranges, there is ongoing debate about the optimum amount of weight that obese women should gain during pregnancy – mainly because of the complexity involved in carrying out this sort of research. Some people suggest that maintaining weight or even losing weight during pregnancy helps to reduce post-birth weight and risk of future obesity in the baby (3). However, others suggest that low weight gain or active weight loss during pregnancy may increase risk of stillbirth or premature birth (4).

Speak to your midwife about the level of weight gain they would recommend, which may differ depending on your pre-pregnancy BMI. Depending on where you live, if you have a BMI or 30 or more, you may be able to access a weight management programme during your pregnancy - ask your midwife about this.

Our top tips for managing weight gain in pregnancy:

1. Don’t eat for two

   'Eating for two' during pregnancy a myth. During pregnancy your body becomes much more efficient at absorbing nutrients from your diet, meaning your baby can get the nutrients it needs without you eating more calories (in the first 28 weeks). This means you should gain small amounts of weight gradually without actually eating more. You don’t need any extra calories until the third trimester, and even then, you only need an extra 200kcal a day. 200kcal is probably less than you think too! – It’s the equivalent of a slice of peanut butter on toast, two chocolate hobnobs or a crumpet with melted cheese.

   Rather than focussing on eating more, be guided by your hunger, and when you do feel hungry, focus on choosing healthy snacks such as fruit, veggie sticks, crackers with low fat cheese or hummus, unsalted nuts or seeds, a piece of toast, low sugar cereal or natural yoghurts. Drinking plenty of sugar-free fluids can also help to stave off hunger.

2. Watch those cravings

   Cravings are common in pregnancy and there are several speculations about why women experience cravings, such as hormonal changes and nutritional deficiencies (5). However, there is limited evidence that you crave what your body needs. Food cravings often increase consumption of traditional unhealthy foods (mainly sweet foods) which may lead to additional weight gain. It’s therefore important to really keep your cravings in check, and find ways to avoid them if they involve unhealthy high-calorie foods (e.g. distraction techniques, mindfulness). Remember that there are foods that should be avoided during pregnancy (see: Foods to avoid when pregnant ), so don’t eat these even if you do crave them!

3. Eat regularly

   Regular healthy meals and snacks will help keep your hunger at bay, and ensure you have enough energy to get through the day. Try to include a portion of wholegrain starchy carbohydrate with each meal to provide slow-release energy (examples include granary bread, wholewheat pasta, basmati / brown rice, wholewheat cereals, oats), a portion of protein-rich food (e.g. beans, eggs, fish, poultry) and plenty of vegetables. Focus on healthy snacks such as fruit.

4. Move more!

   Doing 30 minutes of moderate-intensity physical activity (e.g. brisk walk, swimming, aqua-natal class) each day during your pregnancy will help prevent you from gaining too much weight and should help make birth easier. It will also promote a change in your habits and get you used to being more active which should help you after the birth too. If you're not used to exercise, begin slowly and gradually build up to 30 minutes. Always remember to consult with your GP or midwife before you start a new exercise regime.

Resuming weight loss after childbirth

You may be eager to get back on track with your weight loss, but try not to focus on actively losing weight straight after birth. If you decide to breastfeed, you should find your pregnancy weight gain gradually decreases over time if you follow a healthy balanced diet. If you are keen to get back on a Slim & Save programme, wait until you finish breastfeeding. If you choose not to breastfeed, you can resume one of our programmes sooner – you could talk to your GP to get their advice on when to restart. It’s worth noting though that in the weeks after childbirth, it’s normal to feel more tired than usual, and tiredness and sleepless nights may make our plans more difficult to stick to. As usual, if you have any questions, please speak to one of our support team.

Written by Annemarie Aburrow RD BSc (Hons) PGDip, Slim & Save Dietitian.

References

• Sussman et al (2013). Effects of a ketogenic diet during pregnancy on embryonic growth in the mouse. BMC Pregnancy Childbirth. 13: 109
• https://www.nice.org.uk/guidance/ph27
• Artal et al (2010). Weight gain recommendations in pregnancy and the obesity epidemic. Obstet Gynecol. 115(1):152-5
• Rasmussen & Yaktine (2009). Institute of Medicine (US) and National Research Council (US) Committee to Re-examine IOM Pregnancy Weight Guidelines
• Orloff & Hormes (2014). Pickles and ice cream! Food cravings in pregnancy: hypotheses, preliminary evidence, and directions for future research. Front Psychol. 5: 1076