If you are overweight when you get pregnant, you are at greater risk for complications. According to the National Institutes of Health, your weight also makes it more likely that you will have a hard delivery and need a cesarean section (C-section). For those reasons, you may consider losing weight while pregnant if your body mass index is too high. But pregnancy weight loss should be handled with care. In fact, in many cases, pregnancy weight loss may actually mean reduced pregnancy weight gain.
Is Losing Weight While Pregnant Safe?
The American College of Obstetrics and Gynecology encourages women to reach a healthy weight before getting pregnant. According to the organization, even a small amount of weight loss can make a difference.
“Losing weight before you become pregnant is the best way to decrease the risk of problems caused by obesity. Losing even a small amount of weight (5–7 percent of your current weight, or about 10–20 pounds) can improve your overall health and pave the way for a healthier pregnancy.”
But what if you get pregnant unexpectedly and your body mass index falls into the overweight or obese categories? Or what if you are following a healthy diet and exercise program for weight loss and you get pregnant before you reach your goal?
According to Dr. Julie Rhee, if you are overweight or obese, there is no need to discontinue a healthy diet and exercise program once you get pregnant. Dr. Rhee is a reproductive endocrinologist and infertility specialist and Director of the Preimplantation Genetic Screening Program at Vios Fertility Institute in St. Louis. She is double board-certified in Obstetrics and Gynecology as well as Reproductive Endocrinology and Infertility (REI).
“Drastic weight loss would be discouraged in pregnancy, but a healthy diet consisting of exercise and portion control with well-balanced meals can be started during pregnancy,” she says. She adds a few cautions, however, for weight loss during pregnancy.
Is a Diet Safe for Pregnancy Weight Loss?
“Dieting during pregnancy can be difficult to assess,” says Dr. Rhee, “as it is important to eat a balanced diet while pregnant.” But she adds that if you are dieting by watching portion control, that can be a healthy practice to continue in pregnancy. She also stresses that if you are on medications or supplements to aid weight loss, you should speak to your health care provider to make sure that they are safe during pregnancy.
Lastly, Dr. Rhee advises that diets in which one eliminates certain food groups altogether should be avoided.
Is Exercise Safe for Pregnancy Weight Loss?
Physical activity during pregnancy is generally recommended. But what if you have been sedentary? Or what if your weight loss program prior to pregnancy included strenuous activity?
Dr. Felice Gersh, M.D. recommends that you continue the level of exercise you’re comfortable with but don’t push too hard and don’t do activities which are high impact. Dr. Gersh is a board-certified OB/GYN who is also fellowship trained in integrative medicine. She stresses that you should place your focus on health—not weight loss—to stay safe and healthy during pregnancy.
Dr. Rhee agrees, noting that any exercise is better than none. “However, women should not suddenly start any type of strenuous or rigorous exercise program.”
Pregnancy Weight Loss vs. Reduced Weight Gain
When you get pregnant, one of your first steps will be to meet with an obstetrician to develop a plan for the next nine months. During your first conversations, you may want to discuss a plan for nutritious eating and healthy exercise. You may also discuss your changing weight.
Depending on your current weight loss program or dietary habits, it is very likely that the focus will be on healthy weight gain rather than weight loss. Your physician may use standardized recommendations and tailor them to meet your needs.
Weight Recommendations for Pregnancy
According to the Institute of Medicine (IOM), there are different weight gain recommendations for women of different weight classifications:
- Underweight women (BMI less than 18.5) should gain 28–40 pounds or about 1–1.3 pounds per week in the second and third trimesters.
- Normal weight women (BMI between 18.5 and 24.9) should gain 25–35 pounds or about 0.8–1 pound per week during the second and third trimesters.
- Overweight women (BMI between 25 and 29.9) should gain 15–25 pounds or about 0.6 pounds per week during the second and third trimesters.
- Obese women (BMI over 30) should gain 15–25 pounds or about 0.5 pounds per week during the second and third trimesters.
The organization acknowledges that there has been some controversy over the recommendations for obese women because there is no distinction between classes of obesity. So, for example, the guidelines may not be appropriate for morbidly obese women.
According to the guidelines (reaffirmed by ACOG in 2018), weight gain below the IOM recommendations among overweight pregnant women does not appear to have a negative effect on the health of the baby. Overweight women who gained 6–14 pounds have had outcomes as healthy as overweight women who gained weight within the currently recommended guidelines.
“For the overweight pregnant woman who is gaining less than the recommended amount but has an appropriately growing fetus, no evidence exists that encouraging increased weight gain to conform with the current IOM guidelines will improve maternal or fetal outcomes.”
Both Dr. Rhee and Dr. Gersh say that the key is getting personalized advice from your own healthcare provider.
“I’ve had obese patients lose weight while pregnant with no apparent harm to the baby, but it is never recommended to try to lose weight, even if quite obese, while pregnant. Very obese women likely don’t need much weight gain during pregnancy, however, but real hard data isn’t available. I would say that weight loss should be avoided while pregnant, but not much weight gain is needed if the woman already is carrying excess weight,” says Dr. Gersh
Diet Tips for Pregnancy Weight Loss
Dr. Gersh advises that overweight pregnant women continue to eat wisely and eat large amounts of vegetables while adding some additional protein. “Stop trying to lose weight but don’t abandon your overall plan to be healthy,” she says. “Don’t focus on weight gain or weight loss. Rather, focus on getting lots of high quality, nutrient-dense foods into your diet and nature will take care of things naturally.”
Deborah Malkoff-Cohen, MS, RD, CDN, CDE adds that eating for two is an outdated recommendation, especially during the first trimester when the baby is very small. She suggests these tips to create the most healthy diet during pregnancy if you are overweight or obese:
- Meet with a registered dietitian (R.D.) to help guide you and give healthy, delicious substitutions for what you already eat.
- Eat only whole grains carbs (brown rice, quinoa, buckwheat). Portion them out and eat them minimally. Limit white, refined grains.
- Cut your sugar intake. Choose only natural sugar—such as fruit—but limit yourself to two servings daily. Pair the sugar with a protein (such as apple and peanut butter) and try to choose high fiber fruits such as berries, apples, or pears. Limit bananas, mangoes, pineapple, watermelon, grapes, and cherries.
- Increase your vegetable intake. Fill half of your plate with veggies at mealtime.
- Eat lean protein such as chicken, fish, turkey, but avoid foods that are fried. Try to consume mostly fresh meat and seafood and limited processed meats like bacon, sausage, and hot dogs.
- Do not skip meals. Eat on a schedule to make sure you are getting adequate nutrition.
Exercise Tips for Pregnancy Weight Loss
Dr. Gersh says that even sedentary women can benefit from initiating an exercise program during pregnancy. “Walking is wonderful!” she says, adding that pregnancy yoga classes or prenatal fitness classes are available to keep women fit while expecting. “Being sedentary while pregnant is a bad thing. Get up and move!”
Dr. Rhee adds that light to moderate activity is healthy. “Light jogging, walking, or aerobic exercise at least 30 minutes per day can be beneficial to both mom and baby and also potentially help with labor and postpartum recovery,” she says.
A Word From Tips For Healthy Living
Your weight can have a big impact on your comfort level during pregnancy, you and your baby’s health while you are expecting, childbirth, and your postpartum experience. These are good reasons to reach a healthy weight before pregnancy. But it is not unusual for women to get pregnant when their weight is too high.
Losing weight during pregnancy should be discussed with your healthcare provider. According to Dr. Rhee, there are varying degrees of being overweight all dependent on BMI, and not everyone’s weight gain is distributed uniformly—so it is important to get personalized advice. But Dr. Gersh adds that if you are on a weight loss plan and find out you are pregnant, don’t abandon your overall plan for wellness. Simply work with your obstetrician to create a tailored plan for a healthy baby and a healthy mom.