I had put off TTCing for 3 yrs bcoz I thought I needed to lose weight first.I didn't want to gain too much on top what I already have.And I knew the risks of that.Then I found that time was running out for me,so I wondered if I can do low carbing in pregnancy.To my surprise I found several forums where women actually did exactly that.But further research revealed another important study.I was even more amazed why this study did not get the publicity it deserved.I feel like I wasted so many yrs to TTC.Only if someone had told me about this before.that is my whole reason for starting this thread.So that anyone like me might be able to make use of this info.the foll: article has appeared on this forum (in one of the archive files),but i am re-posting it here.
Many obese women are told to hold off being pregnant,but what if they cannot reach their goals and time runs out on them?There is hope for such a situation....read on.
Obesity risks
Birth brings more difficulties. The fetuses of obese women are often too large to fit through the birth canal; their mothers are about twice as likely as normal-weight women to need a Caesarean section. Longer surgical instruments are required, as are extra-wide operating-room tables, reinforced to support hundreds of additional pounds.
To head off such problems, patients at the bariatric obstetric clinic at St. Louis University in Missouri are counseled not to put on any pounds at all during pregnancy, and are even encouraged to lose weight. Dr. Raul Artal, the chairman of the ob-gyn department and the clinic’s director, acknowledges that the notion of weight loss during pregnancy can be startling. “It goes against everything we were taught in medical school, everything we’ve always told our patients,” he says. Some scientists warn that we still know little about the potential dangers of this approach. Emerging evidence, however, suggests that obese women who maintain or lose weight during pregnancy experience significantly fewer complications and deliver healthier babies.
We know that children have sensitive vulnerabilities that are quite distinct from adults. Their exposure to chemicals in our environment is more potentially damaging than the same exposure at a later age. It is important to realize that the diet a woman eats during her pregnancy and even before her pregnancy effects the adult health of her future offspring. For example, a recent study shows a strong association in children who develop brain tumors with the mother’s consumption of hotdogs during pregnancy.1 Scientific evidence suggests that cigarette smoking during pregnancy is associated with testicular cancer in sons thirty-five to fifty years later.2 We may get away with risky behaviors when we imbibe in our later years, but when we gamble with our children, the stakes are much higher and the damage more profound.
Many rumors surround the effects of breastfeeding on women’s bodies, from saggy breasts to stretch marks, but breastfeeding is a foolproof way to lose weight, according to Dr Artal. “Breastfeeding is probably one of the main interventions postpartum that not only benefits the newborn but also the mother,” he says. On average, women who breastfeed can burn up to an extra 600 calories per day.
Dr Artal recommends feasting on nutrient-dense foods, such as vegetables, lean meats and complex carbohydrates.
The conventional wisdom holds that a mom shouldn't be losing weight while pregnant because there is an implicit assumption that the mother would be restricting calories; she would be semi-starving herself, therefore she would be starving the fetus, which would obviously be a problem, for both mother and fetus.
Pregnancy has its perks — taking it easy and indulging in cravings like gorging on ice cream.
But those long-cherished traditions are challenged at one St. Louis clinic, where overweight pregnant women are maintaining and even losing weight through a closely supervised diet and exercise program.
"The assumption was that no woman should lose weight during pregnancy," said Dr. Raul Artal, director of the SLUCare Pregnancy Bariatric Clinic, one of just a few in the country dedicated to treating overweight mothers-to-be. "Over the years I noticed that obese women that didn't gain weight do better in pregnancy."
It's estimated that 50 percent of women are overweight when they get pregnant and go on to gain even more during pregnancy. Obesity during pregnancy is known to raise the risk of gestational diabetes, high blood pressure, sleep apnea and gallbladder disease.
For the babies, the risks are higher for stillbirth, premature delivery and birth defects such as spina bifida. Babies of overweight moms also tend to be heavier at birth, with half needing to be delivered via C-section.
And studies increasingly show that children of obese mothers are more likely to become obese themselves.
Concern for their babies helps make pregnant women especially motivated to change unhealthy behavior.
"We look at pregnancy as an opportune time to intervene to get maximum cooperation and impact," Artal said. "What we have demonstrated is that changing the lifestyle is not only safe but also desirable."
The goal for the patients is to come out 25 pounds lighter after delivery than they were pre-pregnancy. That means the mother must keep her weight steady for nine months after factoring in the gain for the baby's weight, extra fluids and other pregnancy-related pounds.
The idea of losing weight during pregnancy is not an easy sell, Artal said. Some balk at the notion that a baby can grow even as the mother shrinks.
But "the baby is a parasite," Artal said. "There is always preferential transfer of nutrients to the baby even under the most adverse conditions."
Kim Rurack's twin boys were born strong and healthy five months ago after she lost about 30 pounds while pregnant.Rurack followed the clinic's low-carb diet and exercise plan throughout the pregnancy."Of course I was motivated because I wanted healthy babies," said Rurack, 38, of Belleville. "I was eating what I knew was good for me and them."None of Rurack's pre-pregnancy clothes fit when she came home from the hospital a total of 60 pounds lighter.
"Afterwards, I felt like a completely different person," she said. "You look like you lost weight overnight almost."
Women who enroll in the clinic must have a body-mass index of 35 or above, which qualifies them as obese. For example, a 5-foot-5-inch woman who weighs 210 pounds would be eligible.
The patients come once a week to the clinic at St. Mary's Medical Center in Richmond Heights, where they meet with a nutritionist to review their eating and workout schedule. The pregnancies are considered high-risk, so the women receive more frequent ultrasounds to monitor their babies' growth.
Dieting during pregnancy has long been thought to be dangerous for the baby. Weight Watchers, for example, bans pregnant women from its program.
But the notion of pregnant moms needing to "eat for two" is a myth, Artal said. Women require just 300 extra calories a day in the later stages of pregnancy, according to the American Dietetic Association.
Women on the clinic's program typically eat 2,000 to 2,500 calories a day.
"We are talking about normal diets sufficient to sustain a normal-weight person," Artal said.
The increase in obesity in the U.S. has raised questions about the standard amount of weight a woman should gain during pregnancy. Because many women gain too much or don't lose the weight after giving birth, it's thought that pregnancy has contributed to the obesity epidemic.
The Institute of Medicine, a national nonprofit group that develops guidelines for health, currently recommends that women of normal weight gain 25 to 35 pounds during pregnancy, overweight women gain between 15 and 25 and obese women gain at least 15.
But those guidelines were written nearly 20 years ago with the goal of reducing the number of low-birthweight infants. Now, the institute is reviewing the guidelines and could make changes as soon as the spring.
Artal hopes it approves lower numbers, particularly for obese mothers.
"Fifteen pounds is 15 pounds too many in my opinion," he said.
EXERCISE BENEFITS
As one of the first advocates of exercise for pregnant women, Artal has long been at the forefront of challenging conventional norms for pregnancy and health.
It took him 20 years to convince doctors and patients that exercise in pregnancy was safe, he said, and expects it could take another 20 years before people believe that overweight pregnant women can drop pounds and still deliver normal, healthy babies.
His most recent research should help his cause.
A study of 120,000 Missouri women found that overweight and obese women who gained less than 15 pounds during pregnancy had lower rates of C-sections, high blood pressure and large babies. Artal and his colleagues previously found that exercise during pregnancy cuts the risk of gestational diabetes in half.
At 27 weeks pregnant, Penny Cooley shows no signs of diabetes. She developed gestational diabetes during her first pregnancy four years ago. And after having trouble losing weight from that pregnancy, Cooley eventually developed type II diabetes.
"You think you can eat whatever you want and you can gain as much weight, but in the end it is so much harder to lose all that weight," said Cooley, 23, of Collinsville. "I wouldn't have to do this if I would have lost the weight and exercised and buckled down."
Now Cooley has lost 4 pounds in her second pregnancy under the care of Artal. She said she was shocked by the idea of not gaining weight during pregnancy but excited to give it a try.
Each week Cooley goes over her progress with a nutritionist. They review her daily menus and exercise routine, which typically involves long walks, plus housework and playing outside with her young son and their puppy.
Instead of ordering out for the chicken wings she craves, Cooley makes them at home, baked in the oven. She has substituted turkey burgers for hamburgers, and carries sugar-free gum and candy.
At a recent appointment, Cooley's blood sugar levels were normal.
"I want to be a good example for my son and my little one on the way to eat healthy and everything," she said. "My children deserve to have me in their life as long as possible."
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