Women who have a history of dieting are more likely to experience excessive weight gain during pregnancy, a new study shows.
Researchers from the University of North Carolina at Chapel Hill questioned 1,200 women about their dieting history, weight and weight gain during pregnancy. Recommendations for normal weight gain during pregnancy vary depending on a woman’s size. A woman who is underweight is encouraged to gain 28 to 40 pounds. Normal-weight women should gain between 25 and 35 pounds. Women who are overweight or obese are advised to limit weight gain to 15 to 25 pounds.
Most women with a history of dieting were more likely to exceed weight gain recommendations, regardless of their pre-pregnancy weight. The exception was women who were underweight before pregnancy. Underweight women who had a history of dieting did not gain enough weight, compared to underweight women who weren’t typically restrained eaters. The findings were published this month in The Journal of the American Dietetic Association.
Co-author Anna Maria Siega-Riz said, in a press release, that the findings show that women with a history of unhealthy eating behaviors should be offered counseling and extra support to help them achieve a healthy weight during pregnancy.
In the past, doctors have primarily been concerned with underweight women not gaining enough weight during pregnancy. But the rising prevalence of overweight and obesity has shifted the focus to the effects of excess weight gain. Excess weight gain increases risk for Caesarean sections, having a large baby, shorter duration of breast-feeding and a more difficult time losing weight after delivery. Some studies suggest excess weight gain during pregnancy can also affect the lifelong health of both mother and baby.
In June The American Journal of Clinical Nutrition reported that children of mothers who gain more than the recommended amount of weight during pregnancy are more likely to be overweight at age 7 years.
“The earliest determinants of obesity may operate during intrauterine life, and gestational weight gain may influence the environment in the womb in ways that can have long-term consequences on the risk of obesity in children,” said Brian Wrotniak, the study’s lead author, from the Children’s Hospital of Philadelphia and the University of Pennsylvania, in a press release.
Significant weight gain during pregnancy also may cause changes in breast tissue that increase susceptibility to breast cancer in later life.
Healthy living doesn't happen at the doctor's office. The road to better health is paved with the small decisions we make every day. It's about the choices we make when we buy groceries, drive our cars and hang out with our kids. Join columnist Tara Parker-Pope as she sifts through medical research and expert opinions for practical advice to help readers take control of their health and live well every day. You can reach Ms. Parker-Pope at 
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From 1 to 25 of 72 Comments
‘Tis better to have never dieted at all than to have dieted and lost.
— SusannaAs a pregnant woman who’s always strugged with her weight (and is now struggling with “too much” weight gain halfway into her pregnancy), I have to give this study a great big “duh.” It’s hard enough to watch what you eat and get enough exercise when you’re not pregnant. Once the fatigue and strong hunger pangs that can be a part of pregnancy hit, dieting is the first thing that goes out the window. In my experience, it’s easy to gain more than the recommended amount of weight even while eating healthfully. Sigh.
— SydneyI also was a dieter. Successfully dropped and kept off excess weight 5 years ago. Now I’m pregnant and have gained to much weight at half way through. It isn’t poor eating habits as mine are excellent as someone who has kept weight off for 5 years. After my second trimester kicked in I haven’t even been that hungry so my eating has not been out of line nor do I feel like I can eat whatever I want. Pregnancy has not been an excuse for me to pig out. Yet the weight keeps coming on. I honestly don’t know why other than while I exercise it cannot be as vigorous as b/4 I was pregnant.
— tmrThe old saw goes, “‘Tis better to have loved and lost than never to have loved at all.”
Love makes for catchy aphorisms; diet pap does not.
The fact is, ’tis always better not to have dieted if by diet you mean struggle fruitlessly and guiltily while making yourself miserable with bad food and while denying yourself all kinds of fun as punishment for being in your body (which is serving you as well as it possibly can and keeping you alive, and for the tireless efforts of which you should be nothing but pleased and delighted and grateful), and while delivering constant harangues that agree with the idiots who judge you less worthy because your body is not of the sort they prefer.
However, if by diet you mean gently. gradually and without suffering learn a few healthier eating habits, then ’tis better to have dieted than not to have dieted, leaving the inane notions of “losing” and “winning” out of consideration, since they are halfwitted and can get you killed.
— Nom, nom, nom!Some people have truly efficient systems. Their ancestors were rarely confronted with choices about how much to eat. To their systems, all food is good food. Their operating system says, “Store that food away, it will be needed later.” They usually have another system that say, “Feed baby first…and make him big and fat before he’s born”. There’s another bit of code that goes, “The people who can grow best on our typical diet and is the smartest and fastest, joins the ruling class.” That’s why the “muscle guys” and some of the best looking women run to fat so early. I call these people the “pure food” groups because they don’t prosper in cities. And they shouldn’t be eating city style diets, with highly concentrated nutrients and low levels of vitamins. They come from all over the world. How can you tell which groups are such. Because when they encounter the so-called “Western Diet-city style” they get fat quickly.
— Jackie AldridgeOne of the mis-apprehensions of moden medicine is that it abnormal behavior to gain weight on a Westernized-City Diet.
I find it interesting how recommendations change over the years.
When my mother was pregnant with my siblings in me in the late 1960’s / early 1970’s, she was counseled to gain as little weight as possible, even though she was thin to begin with. Photos of her toward the end of each pregnancy show someone resembling a rope with a knot tied in it. She said she gained less than 20 lbs with each of us.
Meanwhile, my cousin had a baby a few years ago was told to shoot for a 25-30 lb gain as a normal weight woman.
It’s enough to make one’s head spin!
— SharonI agree with the “duh” statement. I gained about 70 pounds when I was pregnant due to poor eating habits and the idea of “I’m pregnant and can eat whatever I want!”.
After I had my daughter though, I totally changed my ways. I don’t diet but I eat healthier (I avoid man made chemicals like the plague and eat plenty of fruits, veggies, nuts and legumes) then I ever did before. I jog every other day with my daughter in tow and now, 20 months later, I weigh less than I did before I was preggo.
My main secret to success: I don’t think about food and exercise as much as I used to. I’d obsess about it SO much and exercising for five minutes was like torture due to the fact that I was so aware of what I was doing. Now I just do it, then say “hey, I don’t have to exercise for a day” and don’t have any bad food in the house.
It’s amazing what listening to what doctors and nutritionists say can do for ones health.
— StevieWow, my problem has been the opposite. With breast feeding, lack of sleep and chasing around a toddler, I can’t seem to keep weight on.
I started my pregnancy slightly underweight and gained 35 pounds. But it turned out to be mostly baby and water, so I was nearly back down to my pre-pregnancy weight a month after giving birth, without doing anything at all.
A year later, I could use a few pounds. Not sure why…I was never one of those women with a super fast metabolism, though maybe I am now. .
— dianaI have never been on a diet because I am a naturally petite person. Now I am a few days overdue with my third child and have gained 60 pounds this pregnancy. Much more than with my other two. I seem to be retaining much more water this time. I am hoping the weight will melt off from breast feeding, just as it did after the other pregnancies. With children at home to take care of it is harder to find time for exercise during subsequent pregnancies, but eating a healthy diet is always a priority in our household.
— mom“‘Tis better to have never dieted at all than to have dieted and lost” (weight)
Because, as the article notes, women who have needed to lose weight and have indeed lost it gain weight more easily while pregnant than women who have always been of normal weight and thus never have needed to diet.
This is what my take on Tennyson meant to convey.
It is not about losing as in “winning and losing”. Certainly, there is no reason why a normal-weight woman should diet. That would make her underweight.
Of course, as with verse always, there are many inane interpretations that lend themselves readily from people who have no time to think but a lot of time to write long tirades on the net. It is for them that you have to spell things out. If you can be bothered to.
I’m sure that my explanation will provoke an even longer tirade, which I cannot be bothered to answer.
— SusannaI was put on my first diet by the school nurse when I was five so I’ve been dieting for 70 years. Anorectic from 11 to 16. I was 128 pounds (5′7″) when I became pregnant and 198 pounds before my C-section delivery (my son was 8-1/2 pounds).
That was 48 years ago. I still look pregnant. However, both my son and I are glowingly healthy (no surprise, he has a weight problem).
All of these reports are meaningless because there is no consensus among medical professionals defining an optimal diet. If the doctors could reach an agreement, we’d all benefit. It appears low-carb, adequate protein and abundant good fat is the ideal way to eat. But many/most physicians still promote low-fat, grains, carbs, etc. as the preferred plan.
— marly harrisWell, don’t be bothered, then, but I will just say that I think we oughtn’t to compare “women who have needed to lose weight and have lost it” to “women who have been of normal weight and thus never have needed to diet.” We should rather compare women of some weight status before/during/after pregnancy who DID diet to women of the same weight status before/during/after pregnancy who did NOT diet. Comparing “overweight” dieters with “normal weight” nondieters and then throwing pregnancy into the mix is doing something, but it doesn’t sound much like science. Maybe it’s grant-getting, I dunno.
Anyway, people with a history of dieting, where dieting = stuff like eating meal replacement gruels or pucks, purchasing fat free cheese food, eating half a raisin for a snack, etc., are usually people with either real or perceived weight problems. Their tendency to gain weight is WHY they’re dieting in the first place. Thus, although dieting and weight gain are correlated, it may be that “dieting” does not cause weight gain at all. It is true that the set: people who are “overweight” and the set: people who “diet” share many many members. But this may just as well be because overweight causes dieting as because dieting causes overweight.
If you had sufficient numbers of always-fat pregnant women who never dieted and always-fat pregnant women who dieted and you compared the two groups, then youmight have something to say,but the way this thing is worded it’s hard to see what in hell they were comparing, beyond apples and oranges. Or to put it in poetic diction, oranges and lemons.
“Oranges and lemons”, say the bells of St. Clement’s
“You owe me five farthings”, say the bells of St. Martin’s
“When will you pay me?” say the bells of Old Bailey
“When I grow rich”, say the bells of Shoreditch
“When will that be?” say the bells of Stepney
“I do not know”, says the great bell of Bow
Here comes a candle to light you to bed
And here comes a chopper to chop off your head!
I’m sorry for implying that Tennyson has nothing to contribute to diet literacy. He may be the precursor to Pritikin for all I know; I frankly don’t get this English poetry stuff at all. A nice little ditty about citrus diets and bells and they have to end it with a beheading? What’s the thinking there? Poetry mystifies me.
— Nom, nom, nom!That women who are prone to dieting gain more weight in pregnancy reflects their underlying endocrinology. Pregnancy induces a state of high adrenal axis stimulation thanks to the exponentially increasing secretion of CRH from the developing placenta. Hypercortisolism, a condition marked by obesity, fluid retention and several other symptoms common to pregnancy (mood swings, depression, insomnia, leg cramps, etc.) results. Cortisol levels generally rise three fold at term. Women with weight problems often have exaggerated cortisol responses to adrenal stimulation tests. It’s entirely understandable then that these same women would gain more weight than average during their pregnancies as their hypercortisolism is likely to be more severe.
Elevated cortisol levels are also implicated in fetal programming, a condition which predisposes infants to obesity and heart disease as adults. A key enzyme that converts cortisol to a more inert form is deactivated in the placentas nourishing these fetuses, significantly raising their cortisol levels. As children, they suffer the same exaggerated cortisol response after adrenal stimulation as their mothers. In essence, they are programmed to be fat in their mothers’ wombs.
One word of warning: pregnant women who gain more than 40 lbs. or more than 1 lbs./day should contact their obstetrician immediately, especially if accompanied by headaches; this is often symptomatic of a serious medical condition know as preeclampsia.
— CordellGenetics rears its head, yet again.
— rini10We are only discussing the women - as if their babies have nothing to do with it.
With my daughter, I gained 25 pounds; with my son 40. With both I suffered from morning sickness. The difference was that with my daughter, eating made me sicker; with my son, eating made me better.
They both weighed 8 pounds at birth. Except for my pregnancies, I have maintained the same weight since puberty. But I definitely don’t eat the Standard American Diet (SAD).
Alexa Fleckenstein M.D., physician, author.
— Alexa Fleckenstein M.D.I think there is a big difference between eating healthfully and “dieting”. If a woman was dieting before she got pregnant, it means she was depriving herself. Therefore, perhaps becoming pregnant becomes a green light for her to go ahead and stop depriving herself - thus the excess weight gain. “Dieting” doesn’t work. What works is making gradual eating and lifestyle changes, figuring out foods to eat that are healthier but are also satisfying to you. It has to be a way of eating that you can stick to, that slowly becomes just a way of life.
— CeejayThis just in:
If you’re a woman, and you’re not “naturally” thin, you’re screwed.
Funny, that’s no surprise to the majority of American women who don’t fit the “acceptable” stereotype of what size a woman “should” be.
— rickiTo Nom x 3! in #4 and 12: Is this an imposter Nom I see before me? Where is the Nom of yore? Where is the feisty, creatively-crazy lady who placed dazzling tropes and neologisms before our very eyes? Did she disappear along with the 33 pounds she shed for a shoddy Gym People weight-loss contest whose rules changed while the game was being played?
(See http://visitnomnomnom.blogspot.com/ for details)
Instead we are treated here to a dispirited creature who lamely attempts to find an argument within researches about pregnancy, weight-gain and dieting. This Nom is a person who has lost her heart, and who indiscriminately mixes British children’s playground doggerel about fruit with quotes from serious poets such as Tennyson.
I ask “What does it profit a woman if she gains a contest win, but loses her soul (along with her weight) in the process?”
Nom, if my barnstormer bi-plane (named The Enola Not Gay) were in a flying mood, I would go see you pronto and make you forget all your woes and Gym People chicanery by doing my impression of Pee Wee Herman singing “I left my heart in San Francisco” that you liked so much. We would drink Red Stripe beer and watch “My Girl Friday” on AMC as though it were more important than some meaningless Veep debate.
— Rob L, N Myrtle Beach SCI’ve neither been pregnant nor on a diet, but following up on #8, I think that nursing your baby would take the weight right off of you.
You’ll probably have to eat extra food.
— HFROM TPP — Were it so simple, I think we’d have a rash of breastfeeding in this country. If anything, I think your body holds on to a bit of weight when you’re nursing. Also, you get seriously hungry when you’re nursing, so if you had a habit of making bad food choices before pregnancy it’s a bigger risk post-pregnancy when you’re really famished AND sleep deprived.
so instead of the “PC” description of “women who diet” why doesn’t the author try “FAT WOMEN ” or “OVERWEIGHT WOMEN”- since later in the article it says doctor’s advice is to only gain 15-25 lbs since they probably already have the extra 40 on .
FROM TPP — Because that wouldn’t be accurate. Many women with a history of dieting are not overweight.
— GlennRob, quit trying to gaslight me into a major depressive episode, it’s not going to work because my revenge plot against the Gym People is too invigorating. As for your literary snobbery, Tennyson, Schmennyson. “The Lady of Shallot” can K my A, all staring in the mirror and WEAVING 24/7 and then floating off to her lame demise lying down in the bottom of a canoe–what a crank. I would rather hear about ding dong dell pussy’s in the well any day, or maybe catch up on what Jack and Jill are up to than read some 70-stanza snoozefest about a too-rich-for-her-own-good hippie-lady with the fantods. (it is possible I’m not remembering this poem exactly right, since I haven’t glimpsed it for over 20 years. nevertheless, I feel I’ve covered the basics.)
And Red Stripe is a bitter, bitter beer. I prefer Old Milwaukee tallboys or PBR–please to remember that the next time you fire up Enola Not Gay.
I’m in a terrible mood! Why couldn’t they have gotten Katie Couric to moderate that debate so we could’ve seen some of those Palin verbal fireworks to which I’ve grown addicted? Why can’t there be more veep debates? Just one? This is stupid!
For the next, no-doubt-lame presidential debate, I’m hosting a party. We are having Boston butt and deviled eggs. I hope you will show up and bring the beer.
— Nom, nom, nom!From TPP — I think your body holds on to a bit of weight when you’re nursing. Also, you get seriously hungry when you’re nursing, so if you had a habit of making bad food choices before pregnancy it’s a bigger risk post-pregnancy when you’re really famished AND sleep deprived.
I agree on this one, Tara. Nursing did not peel the baby weight off me. I was larger to start with, they told me to eat 1,200 cals curing my pregnancy. Hey, the stuffed grape leaves I craved came to that much! I gained a lot, and despite nursing, some stayed. Endy story.
From TPP — And sadly, my main reaction to your post is: “Mmmmm, stuffed grape leaves…”
— StarThe only time in my life that weight truly fell off me was when I breast fed my bouncing baby boy. Actually I jest with the image…he was skinny, I was skinny. There were many photos of me nursing while enjoying a chocolate covered ice cream pop.
Hmmmm. Makes me want to reestablish my milk and be a wet nurse.
Triple nom…is your visor too tight?
— PatI think your body will gain the amounts of weight it needs to support a growing baby. I know women who ate well but gained a lot and someone like me who didn’t stress over it, gained the “normal” weight and pretty much ate whatever I wanted. I’m not naturally thin but not over heavy. The weight after this last pregnancy came off easier due to breastfeeding, but it’s not easy. I think we have to stop racking our brains as women, eat what you can during pregnancy, as you may not be able to tolerate everything, and enjoy being pregnant.
— LJBWhy do ob’s insist that pregnant women take prenatal vitamins? They assume their patients’ diets are poor. It is a shame that in such a rich country women do not have the access to good (read: real) food or, worse, enough knowledge about nutrition during pregnancy.
I feel blessed to have found a midwife that was obsessed with my diet and really held me to a high standard (high quality protein, whole grains, vegetables). It was hard (I was already eating a fairly healthy diet), but it was so worth it! I controlled my weight (29 lbs gained), had an easy, natural childbirth, and lost the weight easily with breastfeeding. Oh yea, my child is exceptionally healthy.
I agree with the article though. I have always thought that is was the dieters’ unhealthy relationships with food that was at the root of weight gain issues during pregnancy. They need a good midwife (and counselor) to guide them through pregnancy. Most ob’s just don’t care (they figure: “if she gets too big, I’ll just ’section’ her.).
Any ob’s out there to counter me?
— natural mommy