Kim Carney / MSNBC.com
By Jane Weaver Health editor
msnbc.com
updated 7/13/2005 12:54:39 PM ET 2005-07-13T16:54:39

Michelle Marti, 34, of Stamford, Conn., has always been weight-conscious. Now that she's pregnant with her first child, it's been a challenge for her to avoid becoming obsessed with her expanding body.

Just entering her second trimester, Marti walks about 40 minutes every day and lifts weights twice a week. She's careful about every bite she eats and avoids junk food.

At 12 weeks, she's gained just 3 pounds but worries that her clothes are already getting too tight.

"It's weird because I don't feel 'pregnant,' I just feel bloated and fat," says Marti, who struggled with an eating disorder in her teens and 20s. "I feel like I’ve gained a lot more than that."

Another mom-to-be, Alison Thoe, 28, of Brunswick, Maine, is determined not to gain the 40 pounds she put on during her first pregnancy — mostly the result of daily visits to Dairy Queen, she admits. Early in her third trimester, she's put on just 8.5 pounds, slightly below average, a feat accomplished by jogging three days a week and carefully monitoring her diet.

"With this pregnancy, I am very strict with my calorie intake and no Dairy Queen!" says Thoe, whose pre-pregnancy weight was 133 pounds.

Whether women are caught up in the social pressure to be glamour mamas even when expecting a child (thank you supermodel Heidi Klum), or afraid that packing on the pounds will lead to health risks for both baby and mom, more expectant mothers are struggling to control their weight.

"I ... feel like a giant fat blob'
According to these women, being pregnant is OK. Being fat isn't.

"You hear about women gaining 60 pounds while pregnant," says Marti. "I don't want to do that."

Internet message boards geared to pregnant moms are filled with posts from anxious women bemoaning their changing bodies.

"I KNOW I shouldn't feel this way but I do. I am 32 weeks and up 30 lbs and feel like a giant fat blob. It seems like a lot of weight to have gained!" writes a Chicago mom-to-be at Urbanbaby.com, a Web site for parents.

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"Before I got pregnant I was under the false illusion that neurotic behavior about food, exercise and weight didn't exist in pregnant women. Unfortunately, I am still neurotic and it sounds like many others are as well," writes another Urbanbaby poster.

Heidi Murkoff, author of "What to Eat When You're Expecting," isn't surprised at the current angst over bulging bellies.

"With skinny women on magazine covers everywhere, the prospect of putting on that much weight is terrifying to pregnant women," she says. "But if you’re starving yourself, you’re starving your baby. Your baby is what you eat."

For Sara Muller, 33, of New York, controlling the pounds while pregnant involved regular visits to the gym and sticking to "healthier carbs" in her diet.

"I was very conscientious about my weight before I was pregnant, didn’t want to use pregnancy as a free pass to eat whatever I want," the first-time mom says. "There's a concern that despite your efforts to eat well and work out, you don’t know how high your weight is going to go."

In general, women who restrict their calories during pregnancy tend to be more affluent and educated, according to a study by the American Dietetic Association. They are also more anxious, stressed and "less uplifted about their pregnancies."

Obesity is biggest problem
Yet while some women pursue the "perfect bump" by restricting how much they eat, the reality is that many pregnant women are gaining way too much weight, a side effect of the nation's obesity problem, say doctors. More than half of American women between ages 25 and 55 are overweight or obese, according to recent data from the Centers for Disease Control and Prevention's National Health and Nutrition Examination Survey.

An estimated 40 percent of pregnant women have "super-sized pregnancies," in which they're gaining more than the recommended amount of weight, says Dr. Christine Olson, professor of the department of nutritional science at Cornell University in Ithaca, N.Y.

"Women say they are concerned about weight during pregnancy, but when you look at the scales and you look at the proportion of women that gain too much, in some groups, it's the majority," she says.

So how much weight should a woman gain during pregnancy?

The recommended weight gain is based on her pre-pregnancy body mass index (BMI), which compares weight to height. The Institute of Medicine recommends that women of normal weight should gain between 25 to 35 pounds and underweight women should gain 28 to 40 pounds. Overweight women should limit their increase to 15 to 25 pounds and obese women should gain about 15 pounds.

Among women who gain more than the recommended amount, several studies have found significantly higher odds of being overweight a year after delivery. A Cornell University study of nearly 600 rural, white women in upstate New York found that 25 percent of the mothers who gained more than the recommended amount during pregnancy were at least 10 pounds heavier a year after giving birth.

In 2002, a separate study of 775 mothers by the Gundersen Lutheran Health System, a healthcare network in La Crosse, Wis., found that only 34 percent were back to pre-pregnancy weight six months later.

"Excess weight gain and failure to lose weight after pregnancy are important and identifiable predictors of long-term obesity," writes Dr. Brenda L. Rooney, medical director of community and preventive care services for Gundersen and lead author of the study.

Gaining too much weight can pose serious health problems for both mothers and their babies. Hefty moms-to-be run the risk of developing gestational diabetes, preeclampsia and having complications during delivery. Babies born to overweight mothers are more likely to be premature or have birth defects. A 2003 study published in the journal Pediatrics found that the babies of obese and overweight women faced greater risks of heart abnormalities or other birth defects like cleft palate.

Although national birth weights for single babies have changed little in the last few decades, according to the American College of Obstetricians and Gynecologists, some doctors say that excessive weight gain during pregnancy is leading to larger babies and an increased number of Caesarean sections. In 2002, C-sections accounted for a record high 26 percent of all births, according to ACOG.

"I'm harping all day to tell people to eat less in pregnancy," says Dr. Jacques Moritz, director of gynecology at Roosevelt Hospital in New York. "The biggest problem for me in obstetrics is large babies."

Watch the ice cream
Some women who have dieted all their lives may be relieved when they get pregnant, thinking it's finally OK to stop counting calories. But the reality, experts say, is that women need only an additional 100 calories a day during the first trimester and an average of 300 extra calories during the second and third trimesters.

"That isn’t much food," says Olson. "It’s a big glass of orange juice or skim milk and a peanut butter sandwich."

While some women may dream about downing 300 calories of ice cream, Murkoff cautions that the quality of an expectant mom's diet is especially important because of the extra nutritional needs of the baby.

"If you’re really serious about keeping weight within the recommended guidelines, you’ll have to be really efficient in your food choices," such as low-fat dairy, lean sources of protein and plenty of whole grains, fruits and vegetables, she says.

Even though doctors are concerned that women stay within the weight guidelines and not pack it on nor restrict too much, the issue of how to monitor a woman's weight during pregnancy is controversial.

In England, women are weighed only at the beginning and end of the pregnancy, with medical experts citing the lack of evidence that monitoring weight promotes healthier births.

But Olson disagrees. "Maybe weight in pregnancy is not a sensitive predictor of infant birth weight, but in a population where obesity is rampant, we need to monitor weight gain of pregnant women from the perspective of promoting long-term healthy weights in women," she says.

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