Q: I’m pregnant with my first child, and I’m worried that pregnancy will permanently — and badly — affect my body and how much I weigh. Can you tell me what it will do?
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A: One of the biggest worries of my pregnant patients — after their concern about the well-being of their baby and the potential trauma of delivery — is post-pregnancy weight.
If you gain more than the recommended 20 to 25 pounds during pregnancy, or if you don’t lose the extra weight within six months of delivery, you are statistically likely to carry an extra 20 pounds, 10 years later. If you are overweight to begin with, that number is even higher. The six-month window for losing pregnancy weight seems to be critical.
During pregnancy, placental hormones increase your appetite and foster fat accumulation. This fat provides calories for the developing baby and later for the production of breast milk, which is 50 percent fat.
Once the baby is born, you must stop eating for two and start exercising. Most women can safely exercise — even swim — within four to six weeks. Obviously, if you have had an episiotomy, wait to get on a bicycle seat or exercise equipment that applies too much pressure until it has healed, usually within six weeks.
Breastfeeding expends about 500 calories a day (and is the healthiest way to nourish the baby for the first year). So breastfeeding will give you a weight advantage over bottle-feeding.
Breasts: That brings up another big concern — breast firmness. In general, firmness does diminish postpartum.
If you are breastfeeding, it is hard to assess what your breasts will look like when you stop. They will almost certainly become smaller. It is unclear whether breastfeeding — in addition to pregnancy — changes the contour of the breast or promotes droopiness.
Tummy: Then there is abdominal laxity (looseness). This depends on several factors — the size of the baby, how much weight you gained, whether you are prone to abdominal obesity.
This is another reason to lose weight in that six-month postpartum period. If you don’t, fat will stay in the abdominal area, possibly increasing your future risk for insulin resistance, diabetes and coronary disease.
The loss of abdominal elasticity and the presence of stretch marks depend on the degree of abdominal distention during the pregnancy. A big baby or multiple babies will take a greater toll.
As for that “poochy” abdominal roll that makes you look pregnant despite the fact that you now have a baby, it should go away with appropriate diet and exercise. For women who still retain belly fat after a year, liposuction or abdominoplasty are options — but only for those who don't want to bear more children.
Stretch marks: There is also a genetic component to stretch marks. They can arise from hormonal changes that occur fairly early in the pregnancy. If your mother or sister developed stretch marks, you are also likely to. Unfortunately, creams and moisturizers don’t prevent these marks. Postpartum stretch marks are usually permanent, though some data suggests that retinoids, or Vitamin-A-derivative creams or gels, soften their appearance. Laser treatments can also help.
Other effects: There are also other temporary bodily changes that accompany pregnancy. Increased pigmentation down the center of the abdomen creates a darkened “linea nigra.” It will fade.
Some women get varicose veins, caused by a combination of pregnancy hormones and pressure from the enlarged uterus and baby in the pelvis. The severity of these varicosities will decrease after the hormones and pressure are gone, but some degree of venous expansion usually remains. If this remains bothersome and you won't be having more children, you can consult a dermatologist or vein specialist about possible laser treatments or “collapsing” vein injections.
Women often notice hair loss within two to six months after giving birth. Handfuls of hair come out in their comb or brush as their hair follicles adapt to the fall in hormones. The hair will grow back.
Dr. Reichman’s Bottom Line: Re-establishing good eating and exercise habits in the six months after delivery is critical for your ultimate weight and health. There are some residual bodily changes from pregnancy, but these come with the territory and are definitely worth it.
Dr. Judith Reichman, the “Today” show's medical contributor on women's health, has practiced obstetrics and gynecology for more than 20 years. You will find many answers to your questions in her latest book, "Slow Your Clock Down: The Complete Guide to a Healthy, Younger You," published by William Morrow, a division of HarperCollins.