Weight gain during pregnancy: the consequences of non-compliance with the norm

What is CPRF during pregnancy? This disease is diagnosed in every third woman expecting a child, who is at risk. This abbreviation hides a medical term that sounds like “chronic fetoplacental insufficiency.” Pathology is the result of a complex reaction of the fetus and placenta to various conditions of the maternal body. In this case, disturbances in the transport, metabolic, trophic and endocrine functions of the placenta are observed, which negatively affects the health of the fetus and newborn.

Risk factors

The diagnosis of CPRF during pregnancy can be due to various factors, which gynecologists divide into several groups: social and everyday factors, features of the obstetric and gynecological history, features of the course of a particular pregnancy, features of the somatic history. Social and everyday causes of placental insufficiency include age up to seventeen years or after 35, work in hazardous industries, heavy physical labor, alcoholism and smoking, psycho-emotional stress.

Often, risk factors for the development of insufficiency are chronic infections, endocrine pathologies of the mother, or extragenital diseases (diseases of internal organs that are not directly related to reproductive dysfunction). Most often during pregnancy, heart defects, rheumatism, hypertension and hypotension, varicose veins, anemia, cholecystitis, and diabetes mellitus worsen.

Common causes of chronic renal failure include menstrual dysfunction, previous gynecological operations, spontaneous or induced abortions, stillbirths, recurrent gynecological diseases, fibroids, endometriosis, the birth of low birth weight children, and infertility. The risk group includes primigravidas over 35 years of age with uterine fibroids. With the same disease, but before the age of 30, the risk of developing CPRF is significantly reduced.

Complications of chronic renal failure, which are typical for a particular pregnancy, are gestosis, threat of miscarriage, post-term pregnancy, multiple pregnancies, anemia, exacerbation of chronic diseases. The degree and nature of pathological conditions with such a diagnosis largely depend on the duration of pregnancy, the state of the mechanisms in the “mother-placenta-fetus” system, as well as on the duration of exposure to negative factors.

How to avoid gaining excess weight during pregnancy?

The basis is proper nutrition. A balanced diet, devoid of too sweet and fatty foods, will help you gain the weight necessary to fully supply the developing fetus with the necessary substances.

Causes of pathological weight gain

Possible factors that cause large weight gain:

• too low weight (very thin women usually quickly gain body weight, ahead of normal indicators, in this case it is better to determine “normal pre-pregnancy weight” using the formula “height (in cm) minus 100”, and calculate the increase based on its value);
• high body weight and obesity;
• high growth;
• large fruit;
• swelling, including with the development of gestosis;
• increased appetite under the influence of high concentrations of estrogen at the beginning of pregnancy;
• polyhydramnios;
• age over 35 years.

What to do with extra pounds?

The daily calorie requirement for a normal weight pregnant woman with little physical activity (less than 30 minutes of exercise per week) is:

• in the 1st trimester 1800 kcal;
• in the 2nd trimester 2200 kcal;
• in the 3rd trimester 2400 kcal.

This calorie content must be achieved by eating cereals, dairy products, animal and vegetable proteins, vegetables, and vegetable oils. Refined foods, sugar and saturated fats (mostly animal fats) should be limited.

Losing excess weight during pregnancy is difficult and in some cases impossible. However, you can slow down your weight gain if you follow these recommendations:

1. Use low-fat dishes - chicken breast, greens, tomatoes, baked potatoes. Avoid French fries, nuggets, and fatty cheese.
2. Avoid fatty dairy products. You should consume at least 4 servings of milk per day, but it should be skim or 1-2% fat milk or yogurt.
3. Limit sweets and sugary drinks, give preference to water, regular or mineral, with or without gas.
4. Do not add salt while cooking.
5. Limit high-calorie foods - confectionery, sweets, honey, chips. Replace them with fresh fruits and low-fat yogurt.
6. Reduce the amount of oil, mayonnaise, and sour cream consumed.
7. Avoid frying foods in oil and instead eat boiled or baked foods.
8. Walk or swim regularly, unless your doctor prohibits physical activity.

What you can eat to avoid excess weight gain:

• bread, pasta, potatoes, rice, other cereals, preferably whole grain varieties (for example, brown rice and cereal breads) - these products should make up a third of the daily diet;
• fruits and vegetables, up to 5 servings per day - this is another third of food for the day;
• meat (but not liver), fish, eggs and legumes;
• skim milk, yogurt, low-fat cheese;
• It is not recommended to limit fluid intake even if hidden edema appears; it is advisable to drink as much as you want.

Recommendations for proper food intake during excess weight gain:

1. Cut food into very small pieces.
2. Eat with a dessert fork, and after each bite, place it on the plate and place your hands on your knees.
3. Chew food thoroughly.
4. After consuming half the serving, take a break for 3 minutes.
5. Do not read or watch TV while eating.
6. Have dinner no later than 19:00.
7. Go grocery shopping after eating.
8. Do not try dishes while they are being prepared, and do not eat leftover food for children.
9. After eating, walk or stand for half an hour.
10. Don't lie down during the day.

In addition, it is recommended to increase physical activity:

1. Do not use the elevator.
2. Do not reach 1 stop before the desired one.
3. While talking on the phone and even watching TV, do not sit, but stand.
4. Do not use the TV remote control, but press the necessary buttons manually.
5. On weekends, take longer walks.
6. Do yoga or swimming at least once a week or more often.

Rapid weight gain may be a sign of hidden edema. In this case, it is necessary, in addition to body weight, to control the volume of fluid drunk and excreted per day. If a woman drinks more fluid than she produces urine, the weighing readings increase quickly. In such cases, obstetricians often prescribe treatment in a day hospital.

Acute and chronic

According to the clinical course, FPN is divided into acute and chronic. Acute most often occurs against the background of placental abruption. It is diagnosed mainly during childbirth, but the occurrence of acute placental insufficiency at any stage cannot be ruled out. Chronic deficiency can be diagnosed at any stage of pregnancy. It is divided into compensated, decompensated (additional degrees are distinguished) and subcompensated.

Compensated form of chronic renal failure during pregnancy - what is it and what does it lead to? This is a pathology in which metabolic processes in the placenta are disrupted, but blood circulation remains normal. At the same time, due to the capabilities of the mother’s body, the fetus does not experience discomfort, so the consequences of this form of CPRF are minimal. However, observation is necessary, because this form of pathology, in the absence of therapy, becomes more serious.

A subcompensated form of deficiency is a condition in which the resources of the mother’s body begin to be depleted. This happens if the causes of the compensated form of chronic renal failure are not eliminated. The decompensated form is the progression of pathology with circulatory disorders in the “mother-placenta-fetus” system.

Using Doppler ultrasound, you can determine the degree of decompensated form of placental insufficiency. CFPN 1a during pregnancy is characterized by circulatory disorders only in the uteroplacental blood flow. In form 1b, disturbances occur only in the fetal-placental bloodstream. At the second degree, violations are determined at two levels, but are not critical. The third degree of CPRF is a critical level of impairment that puts the life of the fetus at risk.

Is it necessary to undergo a medical examination?

To avoid conflict situations at work, you need to familiarize yourself with labor legislation and Article 254 of the Labor Code of the Russian Federation in particular.

In general, while she was telling me what tests had come and what was good about it, plus she gave me to fill out an application for milk, as usual, I missed half of it. I donated blood recently, they took as many as 7 samples, but they were for measles, antibodies, thyroid, biochemical, etc. There are others at the screening and hCG is there.

The obstetric department of the Perinatal Center invites women from the city of Khabarovsk and the Khabarovsk region to give birth. Individual birth rooms, partner births, sharing the room with the child, family orientation. The sex of the child is determined in the second trimester of pregnancy) After an ultrasound examination of the fetus, a blood test is taken from the patient.

Prenatal (antenatal) examination is aimed at preventing and early identifying congenital and hereditary pathologies in the fetus.

According to the Order of the Ministry of Health of the Russian Federation dated December 28, 2000 No. 457 “On improving prenatal diagnostics in the prevention of hereditary and congenital diseases in children.”

If a woman has suffered this viral disease in the first trimester of pregnancy, then the risk of giving birth to a child with damage to hearing (deafness), vision (cataracts) and heart (congenital defect) - the so-called Gragg triad - is 50%.

The main design tasks that the recommendations are aimed at: creating a safe, comfortable and high-tech environment in perinatal centers and other obstetric institutions.

With a regular (28-30 days) menstrual cycle, the gestational age is calculated based on the first day of the last menstruation.

By following the examination schedule, a woman provides herself with confidence that the pregnancy is proceeding without complications and the child is developing normally.

Symptoms

A serious diagnosis is CPRF during pregnancy. What kind of pathology is this and by what symptoms can one suspect a pathology? Disturbances in the “mother-placenta-fetus” mechanism, which in the most severe cases can lead to developmental delay or intrauterine death of the fetus, can occur as a result of bacterial or viral infections suffered in the first trimester, endocrine pathologies or genetic disorders. Therefore, the management of patients who are at risk for these factors should be especially careful.

What is this - CFPN with compensation during pregnancy? All expectant mothers need to know about this dangerous condition so that they can independently identify alarming symptoms and consult a doctor. The disease practically does not manifest itself at all. The woman is feeling well, and disorders can only be determined through additional studies (ultrasound or Doppler).

Alarming symptoms begin to appear only with a decompensated form of placental insufficiency. First, signs characteristic of various diseases are noted, against which CPRF usually develops, namely edema with gestosis or headache with hypertension. In parallel with this, the frequency and intensity of fetal movement decreases.

In the case of intrauterine growth retardation, the doctor may note a discrepancy between the height of the uterine fundus and the gestational age. This is an indirect sign, but you should pay attention to it. A dangerous symptom is the appearance of bloody discharge from the vagina at any stage of gestation. This indicates premature placental abruption, which can lead to fetal hypoxia. If bloody discharge occurs, a woman should immediately seek medical help.

Why does natural weight gain occur during gestation?

During gestation, hormonal changes occur in the body aimed at protecting the fetus from any adverse factors. They mainly involve the accumulation of fat reserves in the mother's body. Adipose tissue not only serves as a good shock absorber for the growing fetus, but is also a source of energy and, in the future, lactation.

Conditions for enhancing fat synthesis:

• high concentration of estrogen and progesterone in the blood;
• physiological decrease in tissue sensitivity to insulin;
• increased insulin levels in the blood;
• increased synthesis of adrenal hormones - cortisol and androgens.

All these changes are aimed at increasing fat deposits in the 1-2 trimesters and mobilizing it at the end of pregnancy.

What makes up a pregnant woman's weight?

By the end of the gestational period it increases due to:

• child's weight (3.5 kg);
• placenta (1 kg);
• increasing the volume of interstitial fluid (2 kg);
• uterus (1 kg);
• breast mass (1 kg);
• increased blood volume (2 kg);
• reserves of fats and proteins in the maternal body (3.5 kg);
• amniotic fluid (1 kg).

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In total, the usual increase is about 15 kg. After childbirth, a woman quickly loses up to 10 kg, the remaining kilograms disappear gradually. It is recommended that the process be done slowly, no more than 4 kg per month. Most breastfeeding women return to their original state fairly quickly.

Diagnostics

Doctors need to pay more attention to women who are at risk for developing CPRF during pregnancy. What kind of condition this is was described above. So, during each examination, the gynecologist should pay attention to weight gain, determine the height of the uterine fundus and abdominal circumference. A signal for additional research is a decrease in the number of fetal movements, dullness of heartbeat sounds, and discrepancy between the fetal period and the gestational age.

Pathology can be determined using ultrasound, Doppler or cardiotocography. Ultrasound diagnostics allows you to assess the condition of the placenta and fetus and measure the amount of amniotic fluid. Based on the results of Doppler measurements, the degree and level of disturbances in the “mother-placenta-fetus” system is determined. This diagnostic procedure also allows you to select the optimal therapy. The condition of the fetus can be indirectly judged by cardiac activity, which is determined during cardiotocography.

Prenatal (antenatal) examination

Publication (partial or complete) in printed publications is only with the written permission of the resource owners.

Pregnant women with congenital malformations in a fetus of this type can also be consulted by medical specialists of the perinatal council of doctors (obstetrician-gynecologist, pediatric surgeon, geneticist, ultrasound diagnostic doctor) of federal medical organizations.

The rules for organizing the activities of the nursing care department for pregnant women, recommended staffing standards and the standard of equipment for the obstetric care department for pregnant women are determined by Appendices No. 28 - 30 to this Procedure.

Yes, and she made a reservation that they do it after 30 weeks. At that time I had 27. “The study is paid, if you want, go” - her words.

Childbirth with CPRF

If the condition of the fetus is satisfactory, then even with such a diagnosis a woman can give birth naturally. Otherwise, CPRF is an indication for cesarean section. A CS is performed when there is a threat of miscarriage or early placental abruption in the later stages (when the fetus is already viable), or in case of prolonged fetal hypoxia recorded during childbirth. Both planned and emergency CS can be prescribed. It all depends on the specific case.

Special groups of women

The weight gain schedule may look different for women in special groups.

Short women

A height of less than 157 cm is considered short. Studies have found that this increases the risk of cesarean section. However, this did not increase the likelihood of having a too small or large fetus, and postpartum weight restoration occurred in the same way as in women of higher stature. Therefore, for short patients, all indicators of normal growth do not change.

Teenagers and young women

If the body mass index (BMI) in women under 20 years of age is normal for older patients, their gain should also be normal. If you have a low initial weight and high height, it is permissible to gain more than 18 kg during pregnancy.

Multiple pregnancy

• with initial normal weight - 17-25 kg;
• with excess BMI - 14-23 kg;
• for obesity - 11-19 kg.

Risks and consequences

The consequences of CPRF during pregnancy for a child can be very serious, but the risks depend on the type and stage of the pathology. Placental insufficiency can lead to spontaneous abortion, delayed growth and development of the fetus, and hypoxia. The risk of intrauterine fetal death also increases. The consequences of CPRF during pregnancy are serious, but this diagnosis does not mean that the child will be born with developmental delay or prematurely. With early detection of pathology and adequate treatment, the prognosis for the mother and fetus is favorable.

Bronchial asthma

Almost 5% (and according to some reports, up to 9%) of pregnant women suffer from asthma. None of the doctors undertakes to predict how the “interesting” situation will affect the course of the disease.

Why is it dangerous?:

If an attack of suffocation occurs, not only the expectant mother feels it, but also her baby. Hypoxia occurs, that is, a lack of oxygen, which interferes with the proper development of the fetus, and if the attack occurs during a significant period for the baby, when organs are being formed, then it will almost certainly not pass without a trace.

What to do:

Modern anti-asthma medications are safe for a pregnant woman and fetus. But it’s still better to take care and try to avoid contact with allergens. Typically, chronic “asthmatics” know what exactly can cause an attack. The most common allergen is ordinary dust. Its sources are soft toys, draperies, carpets. But everything is in your hands: curtains can be easily replaced with blinds, books and small things can be hidden on glass shelves. Try to change bed linen as often as possible, wash pillows and blankets, and, if possible, purchase special anti-allergic covers.

You can also purchase an air purifier. But before buying it, find out how the filters work so as not to harm yourself and your baby. If a pregnant woman cleans the apartment herself, she should use a respirator, and after restoring order, ventilate the room for at least an hour.

Prevention

So, it was determined that this is CPRF during pregnancy. The main preventive measure is maintaining a healthy lifestyle both at the planning stage and during pregnancy, giving up bad habits, eating well, and taking vitamins. When planning, it is necessary to undergo examination by a gynecologist, treat chronic diseases and sexually transmitted infections. During pregnancy, you should not ignore visits to the antenatal clinic and recommended diagnostic procedures, namely blood and urine tests, ultrasound, and so on.

What causes weight gain

While carrying a baby, many changes occur in a woman's body. They are necessary for the pregnancy to proceed normally and for the baby to develop at the right pace. Therefore, there are special schemes by which the doctor determines what weight gain should be during pregnancy.

Extra pounds do not appear only because of adipose tissue. They consist of:

1. Fetal weight (by the end of pregnancy 3300-3500 grams).
2. Weight of the placenta (by the end of pregnancy 650 grams).
3. Amniotic fluid (approximately 800 ml).
4. Weight of the uterus (970 grams).
5. Enlargement of the mammary glands (about 500 grams).

There is also an increase in the volume of blood and intracellular fluid by a total of 2000 grams. Normally, the weight of adipose tissue should increase by no more than 3000 grams. If a woman does not overeat and does not suffer from edema, then by the end of pregnancy the normal weight gain should be no more than 12 kg.

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Contents [Show]

How are the kilograms added over 9 months distributed, what are the norms for weight gain, what are the dangers of undereating and overeating, how to spend fasting days? What are the norms for weight gain while expecting a baby?

A woman’s weight undergoes significant changes during the 9 months of pregnancy. Why does this happen? The body weight of the unborn baby gradually increases, the uterus and mammary glands increase in size, and fat deposits increase.

The kilograms gained during pregnancy are not “extra” at all; they are the body’s “reserve” in case of an extreme situation, if suddenly the expectant mother cannot get enough energy from food. At the same time, this is preparation for breastfeeding, which is the strongest burden on the female body. Breastfeeding requires a lot of energy, which is taken, among other things, from fat deposits made by a woman during pregnancy. Unfortunately, all these very necessary “reserves” appear mainly on the hips, stomach and lower back. But don’t worry: if your weight gain was within normal limits, you will easily return to your original weight after you stop breastfeeding.

During pregnancy, weight gain is distributed as follows: approximately 40% occurs before 20 weeks and 60% after 20 weeks. Moreover, the first trimester accounts for only about 1-3 kg. And with severe toxicosis, you can even lose a lot of weight - up to 6-8 kg!

If a woman is just planning a pregnancy, it is advisable that she reach her optimal weight several months before the planned conception. Overweight women should limit their diet and engage in fitness to strengthen their muscles and cardiovascular system. For women who are too thin, on the contrary, it would not hurt to gain a few kilograms and also work out in the gym, since with a large weight deficit, problems associated with pregnancy are more common.

After 20 weeks, the weekly gain is ideally about 400g, but these are averages: in fact, one week you can gain almost no weight, and the next you can gain more than normal.

There is no optimal scale for weight change during pregnancy. This question is very individual and depends on many factors: initial body weight (BMI) before pregnancy, which is calculated, lifestyle and eating habits. The body mass index (BMI) will help determine the optimal weight gain for you. It is calculated using the formula: weight (kg) / height2 (m).

• BMI < 19.8 – women with reduced body weight can gain up to 18–20 kg during pregnancy.
• BMI from 19.8 to 26.0 – women with normal body weight can gain 11–14 kg.
• BMI > 26 – women with excess body weight; weight gain should be kept to a minimum, maximum 7–8 kg.

If the expectant mother loses a lot of weight at the beginning of pregnancy and at the same time she is unable to adjust her diet at home due to constant nausea and vomiting, then this situation is unfavorable for the normal development of pregnancy. The woman requires hospitalization in a hospital, where nutrients will be delivered to the body using infusion therapy, normalizing the water-salt balance in the body (she will be given IVs).

Many women decide that pregnancy is a time when they need to eat “for two,” and begin to eat in accordance with this principle, without denying themselves anything. As a result, due to overeating, they gain more weight than they should. This is not very good, because excess weight can lead to increased blood pressure, progression of varicose veins and even diabetes.

Overweight women have a greater load on the cardiovascular system. At the end of pregnancy, they feel worse, they experience shortness of breath, and it is more difficult for them to move. Such women are more likely to have complications during childbirth, not to mention that after the baby is born, it will be more difficult for them to return to their original weight.

However, if a woman was very overweight before pregnancy, she should not lose much weight while expecting a baby, as this could be dangerous for the baby. For full development, a child needs to receive enough protein and fats, therefore, if the mother suddenly decides to lose weight, he simply will not have anything to build his small body from. So pregnancy is not the time for strict diets!

Why do all doctors scold pregnant women so much for gaining too much weight? Are they only afraid of women getting fat and feeling worse about themselves? There is another, more serious reason: excessive weight gain is one of the symptoms of gestosis, a dangerous complication of the second half of pregnancy. Preeclampsia occurs not due to overeating and eating too high-calorie foods, but due to fluid retention in the body. This delay occurs due to disruption of the functioning of many organs, primarily the kidneys, liver and heart. Preeclampsia has three main symptoms:

• excess weight gain, swelling,
• increased blood pressure,
• the appearance of protein in the urine.

In order to track gestosis in a timely manner, doctors, at every visit to a pregnant woman’s antenatal clinic, ask her to take a urine test, and also weigh her on a scale and measure her blood pressure.

If two of the listed symptoms are already present, the woman is diagnosed with gestosis and is recommended to go to the hospital. Refusing treatment in the pregnancy pathology department is very dangerous, since gestosis threatens not only the woman’s health, but also the condition of her baby, who almost always has signs of fetoplacental insufficiency (underweight, signs of oxygen starvation). The risk of premature placental abruption and even intrauterine death of the child increases.

To check whether there is fluid retention in the body, you need to compare the ratio of fluid consumed and excreted per day. In a healthy woman, these numbers are approximately equal; they even secrete slightly more fluid than they consume. (In hot weather, allow for profuse sweating.)

The main thing is not how much weight you gain, but how you will feel, how your body will work and how your baby will develop. If everything goes well, then even a little more than expected weight gain is not terrible. But if there are deviations from the normal course of pregnancy, then it is better to listen to the doctor’s opinion and undergo a course of treatment, because you are already responsible not only for yourself, but also for the little life inside you!

obstetrician-gynecologist

“No matter what a woman is, even if she is very thin, a developing child will still take from her everything he needs. Therefore, it is not necessary to gain weight on purpose before getting pregnant. Another thing is that the lack of nutrients, vitamins and microelements can affect her own body - it is more likely that her hair will fall out, her teeth will begin to decay, her skin condition will worsen, etc. But the baby will receive everything that is due to him - this is how nature provided it"

For your information

The kilograms added over 9 months are distributed approximately as follows (calculation for 12 kg):

• child – 3.0–4.0 kg,
• placenta – 0.7 kg,
• amniotic fluid – 0.8 kg,
• enlarged uterus – 0.9 kg,
• mammary glands – 0.45 kg,
• maternal blood volume – 1.5 kg, maternal muscle tissue and fluid – 1.4 kg,
• maternal fatty tissue – 3.25 kg.

Author:

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Many women are concerned about whether they will be able to regain their normal weight after giving birth. In addition, the expectant mother is simultaneously concerned about another problem: is her baby getting enough nutrients in her tummy?

Maintaining a balance between the intake of food into the body and its expenditure for various needs, and primarily to meet the needs of the developing fetus, is one of the most important tasks during the entire period of pregnancy. Therefore, it is important to have an idea of ​​the norms for weight gain when carrying a baby and to control your diet.

Weight gain during the 9-month period of bearing a baby depends on many factors: the woman’s body weight before pregnancy (overweight women are recommended to gain a little less than overly slim ones), metabolic characteristics, the presence or absence of toxicosis and other reasons.

information Before the birth of the baby, the expectant mother usually gains from 7 to 16 kg - such an increase in body weight is within the normal range. During multiple pregnancy, weight gain can reach 20-22 kg.

When calculating individual weight gain rates, you need to know your body mass index , to determine which you need to divide your body weight by your height in meters squared. For example, if a woman’s weight before pregnancy was 58 kg and her height was 165 cm (i.e. 1.65 m), then body mass index (BMI) = 58 / (1.65 x 1.65) = 21.3 .

important A normal body mass index is between 19.8 and 26. A lower figure indicates underweight or exhaustion, a high one indicates the presence of excess fatty tissue in the body or obesity.

Depending on the value of the body mass index before pregnancy, the norms of weight gain by week:

• in the first trimester (1-13 weeks), a woman usually gains no more than 0.5 kg per month and gains about 2 kg during this period;
• in the second trimester (14-26 weeks) her body weight increases by 6-7 kg compared to the initial weight;
• in the third trimester (27-42 weeks), the rate of weight gain slows down, and throughout pregnancy, women with a high BMI usually gain from 7 to 12 kg, with an average BMI - from 12 to 14 kg, with a low index - from 14 to 17 kg.

During pregnancy, there may be either very low weight gain, which is caused by insufficient intake of nutrients from food, severe toxicosis, certain diseases or stress, or too intense weight gain.

Pathological weight gain in a pregnant woman can occur in the following cases:

• excess caloric intake of the diet: excessive consumption of bakery and confectionery products, fatty meats and other products;
• hypothyroidism, in which the metabolism slows down as a result of insufficient production of hormones by the thyroid gland;
• fluid retention in the body due to impaired kidney function, which leads to the formation of edema.

If you notice too rapid weight gain during pregnancy, your doctor may recommend the following measures to normalize this indicator:

• Selection of a balanced diet that meets the nutritional needs of the fetus, but limits the consumption of high-calorie foods.
• Undergoing a comprehensive medical examination to determine the cause of excessive weight gain and choose a treatment method. Blood tests may be prescribed: general and to determine the level of thyroid hormones; Ultrasound of the kidneys and other organs.
• Compliance with the recommended physical activity regime: regular walks in the fresh air, doing feasible housework.

dangerous Excessive accumulation of body weight during pregnancy can pose a danger to both the expectant mother and her baby.

The negative impact of this factor is as follows:

• in the case of late toxicosis and the appearance of edema, as a result of which the woman’s body weight increases, the fetus may experience oxygen starvation;
• the risk of placental abruption increases;
• the load on a woman’s lumbar spine increases, which increases the likelihood of hernias and disc protrusions;
• the load on the cardiovascular system increases;
• If the fetus is too heavy, the risk of ruptures and other problems during childbirth increases.

To maintain body weight within the recommended limits during pregnancy, you must:

• adhere to the principle of moderation in nutrition;
• lead a fairly active lifestyle;
• promptly correct identified metabolic disorders (thyroid activity, kidney function, etc.).

Maintaining a normal level of weight gain while carrying a child is not so difficult; it is enough to organize regular meals, reduce the amount of sweets in the diet, undergo the necessary examinations and pay attention to possible alarming symptoms in time. Excessive weight gain can lead to a number of health problems not only for the expectant mother, but also for the baby, so it is necessary to take care of the health of the future family member from the very first days of pregnancy.

All women, one way or another, pay attention to their weight, but if in ordinary life diets, physical activity and other activities are designed only for your body, then with the onset of pregnancy you are responsible for the health of both. And, therefore, in a special state the norms will be different. In our article we will use the terms “weight” and “body weight”, in this context they are the same thing.

Total pregnancy weight gain is a measure of weight gain from diagnosis of pregnancy to delivery.

The biological value of weight gain during pregnancy is to create additional protection for the fertilized egg and the fetal sac. During pregnancy, adipose tissue is deposited mainly in the area of ​​the mammary glands, buttocks, thighs and abdomen. In addition to mechanical protection, fat plays an energy-storing role in case of hunger; it happened evolutionarily and your body simply performs its assigned task.

Optimal weight gain is one of the indicators of a normal pregnancy.

When registering you will be asked:

— do your blood relatives (mother, grandmother, sister) suffer from obesity, diabetes mellitus or metabolic syndrome (complex metabolic disorder),

- have you been overweight before?

— whether there was a sharp gain or loss of weight and, if so, how it affected the menstrual cycle,

- how much weight you gained during your previous pregnancy (if this is not your first pregnancy), did you regain your weight and how quickly.

They will also measure your height and weight.

Weight control is carried out every visit and helps to suspect the development of various pathological conditions as early as possible. At home, body weight control is carried out weekly, in the morning you weigh yourself on an empty stomach, after the morning toilet, in the same clothes. It is expected that when you come to your appointment, you will weigh yourself in approximately the same clothes to avoid diagnostic errors.

Initially, a woman has a certain weight indicator; the body mass index is used to objectively assess it.

Body mass index (BMI) is a relative value that allows us to assess the degree to which a person’s weight corresponds to his height.

To calculate BMI, the height in meters must be squared (for example, 1.75 × 1.75 = 3.06). Then divide the weight in kilograms by the square of height (for example, 67 ÷ 3.06 = 21.9 and this is the norm).

BMI < 16 – severe underweight (wasting) BMI = 16-18.5 – underweight BMI = 18.5-25 – normal weight BMI = 25-30 – overweight BMI = 30-35 – first-degree obesity BMI = 35-40 – obesity of the second degree BMI = 40 or more - obesity of the third degree or morbid (pathological, painful).

Taking into account the initial body weight, the permissible weight gain will be calculated.

However, there are categories of women for whom weight gain will be calculated individually:

- women with a BMI less than 16

- young pregnant women (less than 18 years old), who themselves are still growing and need an optimal supply of nutrients

- women with multiple pregnancies (especially if it is triplets/quadruples, etc.).

For other patients, the following table shows the total body weight gain during pregnancy .

Weight gain occurs unevenly, about 40% of the increase occurs in the first half of pregnancy, and 60% in the second.

Not all women experience weight gain from the very beginning of pregnancy. In the first weeks, there may even be a decrease in body weight caused by toxicosis, vomiting during pregnancy, and loss of appetite. For some women, the increase begins only at 20 weeks of pregnancy.

Weight gain occurs not only due to the accumulation of fat mass in the mother and increased weight of the fetus. Weight gain is a collective concept and includes several components:

1) Full-term fetus (indicators from 2500 to 4000 grams are considered normal, average weight 3500 grams)

2) Placenta (weight about 600 grams)

3) Umbilical cord and membranes (about 500 – 600 grams)

4) Amniotic fluid or amniotic fluid (approximately 1 liter)

5) Uterus (during pregnancy, the uterus stretches significantly, muscle fibers are rearranged, it receives a massive blood supply, and its weight is about 1 kg)

6) The volume of circulating blood in the “mother – placenta – fetus” system (or “third circle of blood circulation”, which is 1.5 – 2 liters)

7) Deposition of subcutaneous fat, gradual development of mammary glands (about 2 - 3 kg)

We provide a table showing approximate figures for weight gain by week of pregnancy . However, you should always discuss this issue with the obstetrician-gynecologist caring for your pregnancy.

Excessive weight gain in a pregnant woman can lead to the most serious consequences:

• Blood pressure may rise, diabetes mellitus may develop, and early aging of the placenta may occur;
• the development of late toxicosis is not excluded;
• excessive gain sometimes leads to fetal hypoxia and serious complications during childbirth.

Weight gain during pregnancy is a pressing problem in modern obstetrics. The average body mass index of women of all ages is increasing, many of them are obese before pregnancy, which leads to threats to the health of the expectant mother and child. Also, many women become pregnant later in life while already suffering from diseases such as hypertension or diabetes, which increase the risk of complications. Therefore, controlling pregnancy weight is an important part of having a healthy baby.

Since the 1970s of the last century, the answer to the question of how many kilograms you can gain while carrying a child has sounded differently. Before this, it was believed that a normal increase was a maximum of 9 kg. Since the 1970s, this figure has been increased to 11 kg. However, in recent years, given that women with a large increase in body weight give birth to healthy children, these recommendations required revision.

In 2009, a new table for weight gain during pregnancy was developed in the United States based on WHO data. It takes into account a woman’s body weight before conception.

The norm for weight gain in the 1st trimester is 0.5-2 kg.

Women with an overweight BMI are likely to have greater than normal gains under these new guidelines. Therefore, they need to be provided with appropriate assistance in the early stages of the gestational period. Recommendations may include both a balanced diet and increased physical activity in the early stages. It is also necessary to monitor the appearance of edema.

The weight gain calendar is individual. Some people gain weight at the beginning of pregnancy, others only in the third trimester.

However, there are average values ​​that doctors rely on.

Average weight gain by week:

• in the 2nd trimester, 300 grams per week;
• starting from the 7th month - 400 grams per week (about 50 grams per day).

A low rate of body weight gain is recorded when the supplement is less than 270 grams per week, too high - more than 520 grams.

To monitor your body weight, you need to weigh yourself correctly. It is best to do this in the morning after visiting the toilet in the same clothes that do not tighten the body. In addition, weighing must be carried out at the antenatal clinic. Both a pathological increase and its delay can be a sign of trouble.

Thus, weight gain data for a woman with an initial body weight of 65 kg may look like this:

• at week 15: (+ 2 kg) 67 kg;
• at week 20: (+ 1.5 kg) 68.5 kg;
• at week 25: (+ 1.5 kg) 70 kg;
• at week 30: (+ 2 kg) 72 kg;
• at week 35: (+ 2 kg) 74 kg;
• before birth: (+ 2 kg) 76 kg.

During the entire period of bearing a child, the total increase will be 11 kg, that is, within the normal range. In some cases, at 36-38 weeks the weight decreases slightly, by about 200-300 grams, this is normal. However, sharp fluctuations in body weight over long periods of time are dangerous and indicate trouble in the body.

Total weight change by month of pregnancy for a woman with normal body weight:

The weight gain schedule may look different for women in special groups.

Short women

A height of less than 157 cm is considered short. Studies have found that this increases the risk of cesarean section. However, this did not increase the likelihood of having a too small or large fetus, and postpartum weight restoration occurred in the same way as in women of higher stature. Therefore, for short patients, all indicators of normal growth do not change.

Teenagers and young women

If the body mass index (BMI) in women under 20 years of age is normal for older patients, their gain should also be normal. If you have a low initial weight and high height, it is permissible to gain more than 18 kg during pregnancy.

Multiple pregnancy

Normal indicators during twin pregnancy:

• with initial normal weight - 17-25 kg;
• with excess BMI - 14-23 kg;
• for obesity - 11-19 kg.

During gestation, hormonal changes occur in the body aimed at protecting the fetus from any adverse factors. They mainly involve the accumulation of fat reserves in the mother's body. Adipose tissue not only serves as a good shock absorber for the growing fetus, but is also a source of energy and, in the future, lactation.

Conditions for enhancing fat synthesis:

• high concentration of estrogen and progesterone in the blood;
• physiological decrease in tissue sensitivity to insulin;
• increased insulin levels in the blood;
• increased synthesis of adrenal hormones - cortisol and androgens.

All these changes are aimed at increasing fat deposits in the 1-2 trimesters and mobilizing it at the end of pregnancy.

What makes up a pregnant woman's weight?

By the end of the gestational period it increases due to:

• child's weight (3.5 kg);
• placenta (1 kg);
• increasing the volume of interstitial fluid (2 kg);
• uterus (1 kg);
• breast mass (1 kg);
• increased blood volume (2 kg);
• reserves of fats and proteins in the maternal body (3.5 kg);
• amniotic fluid (1 kg).

In total, the usual increase is about 15 kg. After childbirth, a woman quickly loses up to 10 kg, the remaining kilograms disappear gradually. It is recommended that the process be done slowly, no more than 4 kg per month. Most breastfeeding women return to their original state fairly quickly.

The basis is proper nutrition. A balanced diet, devoid of too sweet and fatty foods, will help you gain the weight necessary to fully supply the developing fetus with the necessary substances.

Possible factors that cause large weight gain:

• too low weight (very thin women usually quickly gain body weight, ahead of normal indicators, in this case it is better to determine “normal pre-pregnancy weight” using the formula “height (in cm) minus 100”, and calculate the increase based on its value);
• high body weight and obesity;
• high growth;
• large fruit;
• swelling, including with the development of gestosis;
• increased appetite under the influence of high concentrations of estrogen at the beginning of pregnancy;
• polyhydramnios;
• age over 35 years.

The daily calorie requirement for a normal weight pregnant woman with little physical activity (less than 30 minutes of exercise per week) is:

• in the 1st trimester 1800 kcal;
• in the 2nd trimester 2200 kcal;
• in the 3rd trimester 2400 kcal.

This calorie content must be achieved by eating cereals, dairy products, animal and vegetable proteins, vegetables, and vegetable oils. Refined foods, sugar and saturated fats (mostly animal fats) should be limited.

Losing excess weight during pregnancy is difficult and in some cases impossible. However, you can slow down your weight gain if you follow these recommendations:

1. Use low-fat dishes - chicken breast, greens, tomatoes, baked potatoes. Avoid French fries, nuggets, and fatty cheese.
2. Avoid fatty dairy products. You should consume at least 4 servings of milk per day, but it should be skim or 1-2% fat milk or yogurt.
3. Limit sweets and sugary drinks, give preference to water, regular or mineral, with or without gas.
4. Do not add salt while cooking.
5. Limit high-calorie foods - confectionery, sweets, honey, chips. Replace them with fresh fruits and low-fat yogurt.
6. Reduce the amount of oil, mayonnaise, and sour cream consumed.
7. Avoid frying foods in oil and instead eat boiled or baked foods.
8. Walk or swim regularly, unless your doctor prohibits physical activity.

What you can eat to avoid excess weight gain:

• bread, pasta, potatoes, rice, other cereals, preferably whole grain varieties (for example, brown rice and cereal breads) - these products should make up a third of the daily diet;
• fruits and vegetables, up to 5 servings per day - this is another third of food for the day;
• meat (but not liver), fish, eggs and legumes;
• skim milk, yogurt, low-fat cheese;
• It is not recommended to limit fluid intake even if hidden edema appears; it is advisable to drink as much as you want.

Recommendations for proper food intake during excess weight gain:

1. Cut food into very small pieces.
2. Eat with a dessert fork, and after each bite, place it on the plate and place your hands on your knees.
3. Chew food thoroughly.
4. After consuming half the serving, take a break for 3 minutes.
5. Do not read or watch TV while eating.
6. Have dinner no later than 19:00.
7. Go grocery shopping after eating.
8. Do not try dishes while they are being prepared, and do not eat leftover food for children.
9. After eating, walk or stand for half an hour.
10. Don't lie down during the day.

In addition, it is recommended to increase physical activity:

1. Do not use the elevator.
2. Do not reach 1 stop before the desired one.
3. While talking on the phone and even watching TV, do not sit, but stand.
4. Do not use the TV remote control, but press the necessary buttons manually.
5. On weekends, take longer walks.
6. Do yoga or swimming at least once a week or more often.

Rapid weight gain may be a sign of hidden edema. In this case, it is necessary, in addition to body weight, to control the volume of fluid drunk and excreted per day. If a woman drinks more fluid than she produces urine, the weighing readings increase quickly. In such cases, obstetricians often prescribe treatment in a day hospital.

Risk factors for low nutrition in a pregnant woman:

• diabetes of both types;
• previous birth of a child with a nervous system defect;
• history of gestational diabetes, early toxicosis, preeclampsia or polyhydramnios;
• phenylketonuria, leucinuria;
• resection of the stomach or intestines, previous bariatric surgery;
• cystic fibrosis, colitis, Crohn's disease;
• obesity or underweight;
• smoking, drinking alcohol or using drugs.

Patients in this group should carefully monitor their weight, trying to avoid small gains during gestation.

Too slow weight gain or even weight loss may be due to the following reasons:

Nausea and vomiting

Weight loss occurs even with moderate toxicosis in the first half of pregnancy. Its symptoms appear at 6-12 weeks, after which the lost kilograms return.

Diet

Proper nutrition is important during pregnancy. A special calorie-restricted diet is not recommended. However, women with initial obesity, switching to healthier foods, can lose several kilograms from their “previous reserves”.

Pregnancy symptoms

Some signs that accompany early pregnancy can affect your eating habits. This may be an aversion to certain smells, tastes or textures of foods. At the same time, heartburn and constipation occur, which forces the woman to eat less and, accordingly, lose weight.

Toxicosis

With severe nausea and vomiting, electrolytes and nutrients are removed from the body, and this condition may persist beyond the 12th week. Appropriate treatment is necessary, including dietary changes, rest, and antacid medications. In severe cases, the patient is hospitalized for intravenous fluids.

Miscarriage and frozen pregnancy

These pathological conditions usually occur closer to the 13th week. Weight loss is one of the first signs of a frozen pregnancy. Then they begin to worry about pain in the lower back, pinkish discharge from the genital tract, turning into bleeding. Additional signs of pregnancy, such as taste preferences, disappear. If such symptoms appear, you should immediately consult a doctor.

If you do not gain weight during pregnancy, your doctor may recommend the following measures:

1. Eat small portions up to 6 times a day.
2. Always have light snacks on hand - nuts, raisins, cheese, crackers, dried fruits, yogurt.
3. Add milk to mashed potatoes, omelettes, porridge.
4. Introduce additional foods into your diet - butter, cheese, sour cream.

In case of insufficient or excessive gain, you must follow all the doctor’s recommendations, since these conditions can cause severe pathological processes.

Excess weight can provoke the following conditions:

• stillbirth;
• premature birth;
• C-section;
• gestational diabetes, and after childbirth - type 2 diabetes in the mother;
• heart defects in a child;
• maternal hypertension;
• attacks of sleep apnea (short-term cessation of breathing during sleep), causing fetal hypoxia;
• preeclampsia is a complication of pregnancy, accompanied by a sharp increase in blood pressure, impaired brain and kidney function;
• thrombosis of the veins of the lower extremities;
• infectious diseases in the mother, including postpartum endometritis.

If a woman was overweight before pregnancy, and her gain is higher than normal, this is associated with the risk of such serious complications:

• defects of the nervous system and brain of the fetus;
• intrauterine infection of the fetus;
• spontaneous miscarriage in the first 12 weeks;
• fetoplacental insufficiency;
• premature birth;
• pyelonephritis and diabetes in pregnant women;
• severe gestosis;
• delayed fetal development;
• macrosomia (large fetus).

Undergrowth is less common and less well studied, but there is strong evidence that children born later have a higher risk of mental disorders and schizophrenia. This may be due to a malnutrition of nerve cells during brain formation.

Other possible consequences of insufficient weight gain:

• premature birth;
• low fetal weight;
• the need for additional medical care for a newborn child, nursing him in a hospital setting.

Patients with inadequate weight gain require more careful medical supervision. It includes:

1. The use of micronized progesterone before the 16th week to prevent miscarriage.
2. Treatment of hypertension (magnesium sulfate, calcium antagonists, etc.).
3. Treatment of fetoplacental insufficiency.
4. Monitoring blood sugar levels, and at 24 weeks - a glucose tolerance test (for obesity).
5. Urine examination to detect asymptomatic pyelonephritis.
6. In obese patients, delivery at 38 weeks is recommended by inducing labor.