Bad Advice for Pregnant Women

People like to help pregnant women.

On buses it is routine to give up one’s seat for a pregnant woman. In Boston, drivers try less hard to run over pregnant women in crosswalks. And so on. But sometimes good intentions can lead to bad advice.

First, I’d like to point out that there is reasonably good evidence that obesity has negative health effects, and obesity in relationship to pregnancy is probably worse. So women who are planning on getting pregnant should probably trim down a bit if they need to. Also, exercise is good for many many reasons, so women who are planning on getting pregnant should look at their own exercise and activity routines and see if some adjustment can be made in those areas. And certainly, activity levels and patterns of diet and fat storage are all related, so in making these considerations do remember that this is all an interconnected complex whole.

And then, if you do actually get pregnant, don’t listen to anyone.

Or at least, think about the advice you are getting when people are yammering at you.

In particular, cast off and ignore the following pieces of advice that you will receive again and again and again:

1) Forget about healthy eating, just shove whatever food is in front of you into your mouth, preferably focusing on saturated fats; and

2) Stop all forms of exercise for the next several months as your brood develops inside you.

Now, you might be thinking “I’ve never heard anyone say those things to a pregnant woman” but if you are thinking that, then you are just not listening. You hear it all the time. Maybe not in exactly those words, but this is what people are telling the pregnant women.

You, the pregnant woman, are NOT eating for two. You are one person, you weigh somehwere between 90 and 160 pounds (leaving lots of room for variation) and for the first third of your pregnancy, the unit of additional biomass that you are also eating for will reach a whopping two pounds or so. So for your first trimester you need to increase your intake by about one percent to make up the difference. In the last trimester, you’ll have a lot more extra tissue that you are feeding via your blood supply, but still, imagine a 7 pound baby and add 7 pounds overhead (because for some reason we never weigh the placenta as part of the baby, even though it is, and there’s the expanded uterus) and you get 14 pounds. Maybe, maybe, the additional tissue that you are feeding will be about 8-15 percent.

If you were eating for two you’d be eating 200% of your normal diet, and to do that in terms of calories, you are going to have to eat a LOT of fatty foods because there is just not enough time in the day to double your caloric intake by eating leaves and other low-quality “diet” food.

In terms of activity levels, I would say that a pregnant woman should start, by the end of the first trimester, to avoid activities in which you have an elevated risk of injury. Motorcycle racing, water skiing, that sort of thing. This is because of the significant added medical complications of combining trauma with pregnancy. Later, activity levels will also have to be modulated in certain ways because of balance issues, and the simple fact that certain activities could damage the offspring directly. So no fencing or boxing.

But activity levels need to be maintained just to keep healthy for a reasonable amount of time, adjusting as needed for all those common issues that happen late in pregnancy.

In other words, when it comes to activity levels and types, as well as diet, follow the advice of:

  • Mainstream books and possibly web sites
  • Your doctor and/or
  • Your certified midwife

Ignore the advice of

  • Everybody else that you know, especially
  • Anyone who has had a baby but not in the last five years or more; and especially especially
  • Anyone who has not had a baby

…. when they tell you to sit quietly on the couch and eat ice cream for six months. As much as that sounds like it might be fun.

And take your prenatal/pregnancy vitamins, of course.

Comments

  1. #1 Stephanie Z
    June 18, 2009

    Oh, dear. People “being helpful” at Amanda, are they? Good thing she has politely noncommital down pat.

  2. #2 abb3w
    June 18, 2009

    So, in the “Ignore the advice of anyone who has not had a baby”, should that include you and your advice? =)

  3. #3 Wilfred
    June 18, 2009

    Your weight estimates are off. Pregnant women should gain 10 to 15 kilograms. 14 pounds is way too little.

  4. #4 Greg Laden
    June 18, 2009

    abb3w: My random advice is useless. Consult experts, as I say in the post.

    Wilfred, I did not give an estimate as to how much weight a woman should gain in pregnancy. I was estimating (accurately) how much tissue is added by the baby, placent, and enlarged uterus. This is refutation for the concept that a pregnant woman is “eating for two”.

  5. #5 becca
    June 18, 2009

    You forgot breast tissue. And technically fat stores are still tissue, although we could certainly discuss how much anyone needs. But more importantly, there’s a fair amount of fluid besides the tissue.

    (Standard breakdown:
    Baby: 7 pounds
    Placenta: 1.5 pounds
    Amniotic fluid: 2 pounds
    Breast tissue: 2 pounds
    Blood supply: 4 pounds
    Fluids in maternal tissue: 4 pounds
    Fat stores for delivery and breastfeeding: 7 pounds
    Uterus increase: 2 pounds
    Total 30 pounds)

    I was suprised that I feel like I need to breathe for two (and have felt so since very early on- before significant weight gain). Then my Aunt (who is a very experienced nurse) pointed out that there’s about a 30% increase in vascular activity.
    That, more than anything else, probably provides incentive for reduced activity levels. But then, I’m the kind of person who decides the standard advice about dangerous activities doesn’t apply to whitewater rafting (so my normal desired activity level is probably a bit on the high side).

    The ice cream advice should probably be skim milk advice, but the calcium is incredibly important. Mmmm delicious rationalizations.

    However, Greg- I remember a study or two about *male* weight gain during their partner’s pregnancy. Just remember that while Amanda might need an extra ice cream sandwich a day, you do not.

  6. #6 D. C. Sessions
    June 18, 2009

    In terms of activity levels, I would say that a pregnant woman should start, by the end of the first trimester, to avoid activities in which you have an elevated risk of injury. Motorcycle racing, water skiing, that sort of thing.

    Step one: ignore me. I am not an expert.

    Step two: water skiing in particular is contraindicated due to the nontrivial possibility of a “straddle fall” pushing far-from-pure water up the birth canal. Bad Idea. (I haven’t checked the current literature on this, but it was in the stock advice back when mine were in production.)

    Disclaimer aside, I am a ski patroller and the question comes up pretty often — so we’re trained by medical authorities on the answer. The basic rule is a variant of your “keep active, but be more careful than usual.” In particular, it’s a good idea to maintain the same activity patterns as prior to pregnancy while possible.

    Modifications?

    Running and other high-impact exercise isn’t going to be terribly practical in the third trimester, but barring fanaticism the body is pretty good with the “pain is Nature’s way of telling you this is stupid” feedback. Mogul skiing likewise. Pregnant competition skiers are advised to stick to intermediate runs in the third trimester and to be a bit more careful about speed control; the shift in center of gravity is going to be a problem.

    Ski patrollers are trained to deliver babies when there aren’t better alternatives; I understand flight attendants are too. We’d much rather not, thank you, so that trip to Europe or Whistler at 39 weeks is not a real bright idea.

    Don’t forget that decalcification and ligament loosening are going to make a woman more vulnerable to musculoskeletal injuries, and tacking on twenty off-center kilos to her weight ain’t going to help.

    Within reason, avoid higher altitudes than you’re used to. Even if you plan on sticking to the green runs (or even the spectator seats) that trip from the Twin Cities to Vail is not a very good idea thanks to the reduced oxygen tension (one reason that the Spanish never got very far in the Andes was that they had to send their women to low altitude to prevent miscarriage.)

    Support stockings before you trash the valves in your leg veins are a very good idea (that’s courtesy of my vascular surgeon.) Speaking as someone with those trashed veins, you don’t want them.

    Step three: see step one.

  7. #7 Colin
    June 18, 2009

    Is the assumption that fetal and non-fetal tissue consume the same energy per pound valid?

    Does 14 pounds of fetal tissue consume the same amount of energy as 14 pounds of adult tissue?

  8. #8 Greg Laden
    June 18, 2009

    Becca: I was suprised that I feel like I need to breathe for two (and have felt so since very early on- before significant weight gain).

    Amanda is definitely breathing for two.

    Greg- I remember a study or two about *male* weight gain during their partner’s pregnancy.

    Wearenotheretotalkaboutme.

  9. #9 Azkyroth
    June 18, 2009

    More to the point, given the rate at which new tissue is being built, I’d think protein and calcium requirements would skyrocket whereas there’s probably less need for a dramatic increase in, say, fats and carbohydrates…

  10. #10 Greg Laden
    June 18, 2009

    Colin: See Becca’s post for important details about tissues.

    Different tissues use different energy amounts, but the fetal tissue itself probably uses something roughly like a typical human at rest but doing a lot of mitosis averaged out, or somewhat less. Same ballpark, anyway.

    But the maternal demand is still high because of other factors.

    The main point of my post, really, is to point out that the average thing you hear from the average person is unlikely to be valid.

    In addition, Americans over-calorate. If you compare maternal mass changes (and relative changes of different types of tissue) across cultures, you will see some interesting variation, and Americans are at or near the far end of the spectrum for many of these measures.

    As far as material weight gain, which, as I have noted above, I’ve not mentioned, there are a few guidelines. The best information is probably obtained from one of the more authoritative sources such as a physician or a qualified certified midwife. A rule of thumb is 5 pounds (or less) for the first trimester (some women, who go into this somewhat overweight, actually go down in the first trimester) followed by about a pound a week until you pop. If you add that up, I think it is close to what Becca has said above.

    But don’t ask me, ask an expert.

  11. #11 Colin
    June 18, 2009

    And I don’t disagree with you. The mode of thinking is different.

    Most people: “1 + 1 => twice the food.”

    Not: “well there’s ultimately a 20% tissue gain which has twice the energy demand itself and 20% more energy for the mother to move that mass, the increased energy demands increase the demand as well, plus some other stuff, and it’s about twice the base non-pregnant energy.”

    I made those numbers up (well, 30 lbs extra relative to the US national 20-74 years average of 164 lbs = 20% wasn’t made up) but the modes of thinking are different enough that in-and-of-themselves is reason to dismiss it as sound advice. Even if it’s right, it’s right for the wrong reasons.

  12. #12 Kate
    June 18, 2009

    Ah, yes, I remember all that. I ignored them and boxed and played soccer my first trimester, ran through my second trimester, then continued a weight lifting workout schedule until the day before my water broke. The cool thing was, I went to an all-women’s gym and I regularly got compliments from other women because I was working out (and pretty hardcore) even when I was enormous. That helped cancel out the obnoxious people who would tell me what to do outside of that space.

  13. #13 Kate
    June 18, 2009

    Forgot to mention: pregnancy expends WAY fewer calories than lactating. 200-300kcals/day for pregnancy, 400-600 for breastfeeding. That’s just an extra snack, and maybe an extra small meal, respectively, during those two reproductive events.

  14. #14 CyberLizard
    June 18, 2009

    When my wife was pregnant I used to feel a little sad that I would never get to experience it myself. Then I came to my senses. I’m mostly very glad I don’t have a uterus and I’m extremely impressed with those who do ;-)

  15. #15 James Sweet
    June 18, 2009

    It seems others have already picked this nit a little, but the assumptions that led you to the 1% number for the first two trimesters are invalid. Your conclusion is not, though: the increased caloric need is more than 1%, but it’s still way less than 10% until pretty close to the end. That’s a far cry from a 2x increase :) so I’m just being pedantic.

    And don’t even necessarily trust medical professionals. My wife’s OB, before we switched to a midwife, told her to not worry about anything and just eat lots of ice cream and Flinstone’s vitamins. Uh…. how about a balanced diet maybe?!? sheesh…

    (Of course, the midwife recommended some woo supplements, so I guess you’re screwed no matter where you go…)

  16. #16 Pierce R. Butler
    June 18, 2009

    Is there any point in attempting to advise pregnant women?

  17. #17 Joseph
    June 18, 2009

    Congrats! I didn’t know you two were expecting. :)

    I don’t know about food intake and medical things, but I know one vital piece of information, as the father of a 2+-month-old: the mother-to-be and father-to-be should be enjoying their sleep as much as is humanly possible. You’ll yearn for those sleep-filled halcyon days very, very soon. :)

  18. #18 D. C. Sessions
    June 18, 2009

    I know one vital piece of information, as the father of a 2+-month-old: the mother-to-be and father-to-be should be enjoying their sleep as much as is humanly possible. You’ll yearn for those sleep-filled halcyon days very, very soon.

    My youngest turns 24 soon — and I’ll second that. I’m just now starting to be able to take naps again.

    My own personal theory is that the napping tendencies of the aged is just catching up.

  19. #19 Mike
    June 18, 2009

    The only advice I recall giving a pregnant woman was a minor modification to her technique on the rowing machine. My rowing club has had a number of women who have continued to use the machines while heavily pregnant – one of them a few months later found that her son found the noise of a rowing machine rather soothing, and would promptly fall asleep, allowing her to exercise in peace…

  20. #20 aunt benjy
    June 18, 2009

    I got some seriously bad advice when I was pregnant last year. Fortunatley I have a well developed BS detector, and was able to smile and nod while I ignored most of it.

    I wish I could have exercised more, as it would have made life easier now. Unfortunately my hips separated at 3 months, and I spent the rest of my pregnancy holding myself together with a support belt.

    As someone who got pregnant as a result of losing about 20 kg, I found it very hard to add some fat back into my diet. I felt so much better once I did this, although it was not excessive.

  21. #21 jj
    June 18, 2009

    And take your prenatal/pregnancy vitamins, of course

    Phew… I thought you were going to say not to take prenatal vitamins. I’d like to keep my job

  22. #22 Azkyroth
    June 18, 2009

    As someone who got pregnant as a result of losing about 20 kg

    I didn’t realize sex burned that many calories. O.o

  23. #23 D. C. Sessions
    June 18, 2009

    I didn’t realize sex burned that many calories.

    If at first you don’t succeed …

  24. #24 Heralicdes
    June 19, 2009

    Unsolicited (and probably unwanted!) advice: If you’re after vitamin A, make sure you’re taking beta carotenes, rather than vitamin A itself.

  25. #25 momkat
    June 19, 2009

    As a labor/delivery nurse and women’s health nurse practitioner in the deep South, you would not believe the craziness I’ve heard and seen in the last 20+ years of practice. It amazes me how many women love to tell you their horror stories about pregnancy. Best thing to remember about advice is that if it sounds crazy it probably is.

  26. #26 Pen
    June 19, 2009

    Ignore the advice of
    …. anyone who has not had a baby

    Ahem!

    PS when it comes to parenting, do the same only double!

  27. #27 DRK
    June 19, 2009

    Ooh, are we doing unsolicited advice? Take an infant CPR class NOW, during the pregnancy. You won’t have time or energy to do it after the baby is born, and it will worry you quite a bit after the baby’s born, if you don’t do it.

    And congratulations, kids are fun!

  28. #28 greg laden
    June 20, 2009

    DRK: You are absolutely correct. Pay special attention to saving the choking child from death. I can’t tell you how many times I did that, and it was nice to have some idea what I was doing.

  29. #29 D. C. Sessions
    June 20, 2009
  30. #30 How to do
    June 23, 2009

    Excellent Tips! I’ve also found such interesting and useful information on how to tell you are pregnant in another blog site. The posts provide great tips on various other interesting topics.

  31. #31 Beer and Burgers
    June 24, 2009

    some of the comments were interesting. sex and weight loss…

  32. #32 Special K Diet
    June 25, 2009

    I am not giving any bad advice here. My advice for those women who are pregnant and afraid of gaining weight after delivering a baby. So You don’t Need to worry. You don’t need to go to Gym or any exercises to lose weight besides you have to eat to lose weight. Follow Special K Diet Plan and lose weight upto 2.5 Kg.