Putting on weight during pregnancy used to be a given. After all, your baby needs extra calories to grow properly. But the rules are changing. According to new information from the Institute of Medicine and the National Research Council in the United States, it all depends on how much you weigh to start with. New guidelines have been released outlining appropriate weight gain in pregnancy, particularly relating to those already overweight, suggesting that the old adage of eating for two is only relevant if you're within healthy body-mass index (BMI) limits when you conceive. If you're big, they say, getting pregnant isn't a free pass to the all-you-can eat buffet. On the flip side, concerns are building about the modern trend towards slim or skinny pregnancies, fuelled by the "yummy mummy" phenomenon, thanks to celebrities such as Nicole Kidman, Heidi Klum and Victoria Beckham, who appeared to drop their baby weight within weeks after giving birth.
So what should expectant mums be doing? The Dubai Department of Health and Medical Services recommends gaining between 11.5-16kg while you are pregnant, or between 13-18kg if you are underweight. This gain should be slow and steady. Ideally, you should put on 1-2kg in the first trimester and about a pound a week after that. It cautions against dieting during pregnancy, suggesting that cutting out fats and sugars is the better option.
It all sounds simple enough to follow but if you're in the grips of a pregnancy craving, refusing that last bowl of ice cream can take a great amount of mental strength. On the other hand, some mothers find that their morning sickness is so bad during the first trimester that they actually lose weight, as opposed to putting it on. The received wisdom is that this is normal and will pass, but worries of undernourishing the unborn child are enough to instil fear and guilt in even the most weight-conscious first-time mothers-to-be.
The new advice from the US echoes that of DOHMS, with the addition of two extra clauses: Pregnant women who are overweight should only put on between 7-11.5kg and those with a BMI of 30 or more should limit their weight gain to between 5-9kg. The previous guidelines issued in the US were set in 1990 but due to the ongoing obesity crisis, an update was thought appropriate. The report also looked at the crux of the matter - how weight gain or loss affects the health of the mother and the baby. It found that too much weight gain raised the chances of having a Caesarean section, and made losing weight after the birth more difficult. By monitoring babies' development, they found that mothers who put on too much weight during pregnancy were at greater risk of having a premature baby larger than normal and with extra fat. By contrast, not eating enough could lead to stunted fetal growth and similarly, a higher risk of an early birth.
Dr Ibrahim Abd Elrahman, the specialist obstetrics and gynaecology consultant at The City Hospital in Dubai says that he believes guidelines are useful but prefers to offer individual advice for each patient. "These days, there is no absolute target for weight increase in pregnancy. Previously some would have suggested a weight increase of approximately 10kg. However, that was before ultrasound was commonplace.
"With ultrasound, we now have a way of monitoring the baby's development in the womb and as long as it is developing normally, there is no absolute weight increase that needs to be achieved by the mother." A recent US study suggested that for overweight women, it's best to lose the excess before conceiving and begin the pregnancy at a normal BMI. In Abd Elrahman's experience, body image can be a huge source of anxiety for some women during pregnancy, especially those who already have issues with their weight. He continues that women who have specifically lost weight to aid fertility tend to be reluctant to put it on again.
"Pregnancy is not a time to diet. Of course a pregnant woman should look after her diet and the kinds of foods she is eating," says Abd Elrahman. "This is more important now than at any other time. If a mother is not eating enough then there are not enough nutrients in the blood that can cross the placenta and nourish the baby - especially with regard to glucose, amino acids and proteins." Still, gossip magazines continue to sell the yummy-mummy dream. A case in point is Angelina Jolie looking more red-carpet-ready than ever after having her twins Knox and Vivienne in July last year. The social pressure can lead to some new mums feeling like a failure if they don't look glamorous and are saddled with baby weight for the next year or so.
Jenny Haddad, 31, of Dubai, is six months pregnant with her second child. She runs the Dubai Mums Club and Dubai Babies, an online boutique for baby products. She knows first-hand what it feels like to panic about putting on baby weight. "I am paranoid about my weight," she says. "In my first pregnancy I put on just the right amount and lost it quickly afterwards. But you show quicker the second time around and your body reacts differently."
Typically, women experiencing a second pregnancy will find that their bellies will pop out more as their stomach muscles are stretched from the first time and don't need as much encouragement to loosen up again. Haddad has been balancing the bump with regular exercise, and admits to being "a bit excessive". "I'm going to yoga twice a week and light gym sessions too," she says. "I wanted to get a personal trainer but my husband put his foot down. There's definitely an issue of staying thin here. There's such a culture of dressing up and being on the beach. You're supposed to be good at everything and not let yourself go." The Dubai Mums Club website echoes Haddad's concerns with features on weight and exercise during pregnancy. "How to lose your baby fat fast" is a particularly popular read.
Other researchers in the UK and US have theorised that dieting during pregnancy could lead to a tendency toward obesity in resulting children. Starved, the unborn child develops a way of storing as much fat as possible (the same thing can happen when adults crash diet). This is yet to be proven, although experiments have been conducted on rats and lambs. Still, in extreme cases of dieting, it is suggested that possible side effects include stunted growth, emotional and cognitive underdevelopment and an increased risk of birth defects.
Certainly, Abd Elrahman believes that guidelines aside, society's continuing pursuit of physical perfection is at the core of the problem. He says it can be OK to be big when you're pregnant, and OK to be thin, depending on the person, and allowing a good nine months to lose baby weight is a perfectly reasonable time frame for most women.