Dear Doctor,

This is my first pregnancy and I am in my second trimester. I seem to be gaining so much weight yet I do not eat that much. The baby is also fine, as per my last antenatal visit. But what can I do to control this upsetting weight gain? Maria

Dear Maria,

Accept my compliments on your first pregnancy.  How much weight have you gained? Normally a woman gains a minimum of eight to 10 or more kilos during pregnancy, and this usually occurs part in second and more in the final trimester. Whether weight is normal or not, depends on BMI (body mass index), which is determined by height and weight both. The baby’s body is formed both externally and internally during the first trimester, after which the baby starts to grow progressively till delivery. This contributes to weight gain. Other pregnancy-related factors contributing to weight gain are fluid retention due to increased circulation, increase in amniotic fluid which surrounds the baby in gestational sac and weight of placenta. Whether weight gain is excess or not is difficult to judge in an otherwise healthy woman. The general recommendation by doctors is that a woman with normal BMI before pregnancy can gain up to 16 kgs during pregnancy, women with less than normal BMI can gain slightly more weight. For those who are obese before becoming pregnant, weight gain should be restricted, not exceeding 10 kilos or so. Excess weight gain during pregnancy can cause problems during delivery and create health issues for women, like diabetes, heart problems, and et cetera.  The excess weight gain becomes difficult to lose after childbirth. However, it does not affect the health and growth of the baby directly. The baby’s health is affected if health issues crop up in the would-be mother. The most common cause of excess weight gain during pregnancy is eating food that is high in calories and lack of exercise. There is no fixed diet for a pregnant woman and as such, she can eat whatever and in whichever quantity she wants. But healthy eating is good and beneficial, which includes less fatty and sugary food and more fresh green vegetables, fruits, healthy meat, and milk products. Simple exercises are done up to limit of endurance during pregnancy, prevent excess weight gain. They also keep the body healthy, joints supple and facilitate a smooth delivery. The greatest advantage of a regular exercise is it helps to lose the extra weight gained after childbirth. Alcohol should be avoided as apart from supplying extra calories, it is harmful to the pregnant mother and foetus in multiple ways. It is also important to exclude other medical problems like diabetes, hypothyroidism, and heart failure, causing weight gain, as these can affect both the mother and child.  A very rapid weight gain with nausea, dizziness, and other symptoms can be a sign of eclampsia of pregnancy, an emergency condition which if untreated can be fatal.    

            Dr. Rachna   Pande is a specialist in internal medicine.