The increase in weight occurring in pregnancy stems from several sources: first, fetal tissues—the baby, placenta, and amniotic fluid; second, the physiologic growth of specific organs, particularly the uterus, the breasts, and the blood circulating in the body. Finally there is the tendency of a pregnant woman to take up and retain within her tissues an additional quantity of water and also to accumulate an excessive amount of fat.
The normal weight gain during pregnancy varies from twenty to twenty-four pounds.
The additional six to ten pounds, depending on whether the total gain is twenty or twenty-four pounds, are retained tissue water and accumulated fat.
Pregnancy presents an ideal time for the perpetually thin girl to add a few extra pounds and for the chronically fat girl to subtract several. For the former the physician en- courages a total weight gain of thirty to thirty-five pounds, and for the latter a zero gain or even a loss of several pounds is safe and desirable. The rule is that at term the pregnant woman should weigh twenty pounds more than her ideal weight calculated on the basis of height, bony structure and age.
Why Should Weight Gain Be Restricted?
For the normal or obese woman there are several reasons, each in itself sufficient, why weight gain should not be excessive during pregnancy. First, it may impair health. A definite correlation exists between excessive weight gain during pregnancy, especially when rapid, and the development of high-blood-pressure complications. To be sure, there is some uncertainty as to whether the same condition which later causes the high blood pressure causes first abnormal and excessive weight gain, or whether the retention of tissue fluid, increased weight gain itself, predisposes to high blood pressure in late pregnancy. An additional health reason is the extra strain put on the heart by the necessity of pumping blood through excessive pounds of body weight—the heart being already burdened by the load pregnancy normally imposes on it. Pregnancy ordinarily makes for shortness of breath, but pregnancy plus excessive weight gain may cause actual difficulty in breathing.
In the second place, excessive weight gain makes the pregnant woman more clumsy and prone to stumble and fall. She gets so large she gets in her own way, and even rising from a chair becomes a task.
Finally, the pregnant woman ought to control weight within normal bounds for vanity’s sake alone. If she gains sensibly she will look far more attractive during pregnancy and when it is all over will soon be back to her prepregnant level. Many a young, attractive girl has permanently lost her figure by gaining forty pounds during pregnancy and then lacking sufficient will power to diet away the more than twenty excess pounds remaining.
What Is the Normal Rate of Weight Gain?
For the woman whose nonpregnant weight is normal for her height and build, a total gain of twenty pounds is ideal. She should not gain less; at the most she may gain five pounds more. The proper curve of weight gain is four pounds during the first three and a half months, and thereafter two pounds every three weeks. The curve is unlikely to be smooth; some weeks it may go up more rapidly than it should, and other weeks more slowly. A gain of one and one-half pounds a week is abnormal, and a gain of two pounds significant enough to report to your obstetrician immediately.
If you weigh at home, do so consistently in the morning, after voiding and before breakfast, while still unclothed. Weighing just after a meal may frighten you unnecessarily. When you go to your doctor for prenatal visits try to wear the same weight clothing each time, unless he weighs you draped only in a sheet; also, be uniform about the relation of the visit to eating, so that you are weighed each time either before or after lunch.
The fallacy that a pregnant woman should eat for two has been negated long ago. Actually, if you are accustomed to eat normally and sensibly, you should continue to eat about the same amount of food, or perhaps a little less, since you do not exercise as vigorously or work as hard in the latter months of gestation. The caloric value of your diet should be the same as that of a moderately active nonpregnant woman —a daily intake of 2500 to 2800 calories. Even though your total caloric intake will be approximately the same, the diet will be different, since during pregnancy your daily menu must emphasize proteins, vitamins, and minerals, and de-emphasize fats, carbohydrates, and starches.
If the prenatal diet is proper, many obstetricians and nutritionists see no need whatever for dietary supplements in the form of vitamins, iron, and other minerals. On the other hand, if for some reason there is doubt about the adequacy of the diet, dietary supplements can do no harm. There are more than a score of excellent preparations; among them are Prenatalins, Calcisalins, and Cyesicape. The usual dosage is one capsule or tablet three times a day.
The Daily Essentials of Your Diet 1. Milk, one quart daily (four glasses) or a lesser amount, with cheese supplying the deficit If you gain too rapidly, your doctor may require that you drink skim milk or fat-free buttermilk. You get equal credit for the milk you drink and pour over cereal and the milk used in the preparations of custards, pudding, cocoa, and milk soup. A one-and-one-quarter-inch cube of American cheese equals a glass of milk. It may be utilized plain or in recipes such as a Welsh rabbit. Cottage cheese is a less satisfactory substitute for milk since it is relatively low in calcium. Occasionally a cottage-cheese salad or a slice of cottage-cheese cake may replace a glass or two of milk.
Calcium tablets are not an entirely satisfactory substitute for milk, since so frequently they are excreted unabsorbed in the stool. However, if by chance the woman just cannot drink milk, even when it is disguised, chemical calcium is better than no calcium at all. Dical-D tablets or capsules, seven and a half grains each, are a satisfactory preparation. Six to eight a day should be taken. 2. Leafy green and yellow vegetables, one or more serv ings daily. As rich sources of vitamins A, B, and C, and iron, as well as other essential minerals, the green and yellow vegetables are second in rank in the list of food necessities for the pregnant woman.
The more common green vegetables are asparagus, green beans, lima beans, broccoli, Brussels sprouts, green cabbage, chard, endive, kale, leaf lettuce, okra, green peas, peppers (green and red), spinach, turnip greens, watercress.
Broccoli, chard, kale, spinach, and turnip greens are specially healthful, since they are the richest in iron.
The best yellow vegetables are carrots, pumpkins, and yellow squash.
Vegetables should be used while very fresh. If they are cooked, the cooking should be brief and as little water used as feasible. Protracted heating destroys vitamins, so that ten to fifteen minutes in boiling water should be the maximum for most vegetables. The water may be saved and used as a stock for soups, since it contains abundant minerals and vitamins of value. Canned or frozen vegetables may be substituted for the fresh; their vitamin content is frequently higher than those home-cooked.
Salads are splendid food. In their preparation, use fresh vegetables. Also, prepare the salad just before it is eaten, since chopped and grated vegetables and fruits quickly lose their vitamin content on exposure to air. 3. Citrus fruits, tomatoes, and other foods rich in vitamin
C, two or more servings daily. Among the fruits are canta loupes, grapefruit, grapefruit juice, kumquats, lemons, limes, muskmelons, oranges, orange juice, pineapples, strawberries,’ tangerines, tomatoes, and tomato juice. Vegetables especially rich in vitamin C are cabbage (slaw), salad greens, green peppers, and turnips. Both the fruits and vegetables must be eaten uncooked and unpreserved. Canned or frozen juices are satisfactory substitutes for the fresh juices. If calories must be serioulsy rationed, be certain the canned orange juice you buy is of the unsweetened variety. 4. Meat, poultry, fish, and eggs, one or more servings daily.
One egg—or, better yet, two—should be included in the daily menu, since the yolks are rich sources of iron, vitamins, and tissue-building proteins. Meat, especially beef, is a perfect food for the pregnant woman. It bestows more nutritive value when not overcooked; broiled or baked meats have less caloric value and are easier to digest than those fried.
Liver and oysters contain a particular blood-building substance, and one or the other should be eaten at least once a week.
Poultry, fish, and other sea foods are also good sources of animal protein, but not the equal of beef. Fatty meats such as pork and sausage, as well as salted meats, should be eaten in moderation if at all. 5. Breads and cereals, four or more servings a day. Use whole-wheat, dark rye, or enriched breads. Approved cereals for the pregnant woman are oatmeal, whole cornmeal, rye, barley, whole-wheat-enriched or restored cereals.
The germ and shell of the wheat kernel are rich in iron, protein, and the two essential vitamins, B and E. Since the latter is especially vital to successful reproduction,is laid on the ingestion of whole-wheat breads and cereals in preference to products made of milled, unenriched flour.
As nuts are also rich in vitamin E, a handful can at times be substituted for the daily whole-wheat requirements. 6. Potatoes, other vegetables, and fruits, two or more serv- ings daily.
The following vegetables and fruits also contain valuable minerals and vitamins, but they have greater carbohydrate content, and therefore a higher caloric value, than the vegetables already listed. However, they introduce variety into the diet and because of their bulk appease the appetite.
Vegetables: Artichokes, cauliflower, corn, cucumbers, eggplant, head lettuce, mushrooms, onions, parsnips, potatoes, white and sweet, radishes, sauerkraut, summer squash, turnips.
Fruits: Apples, apricots, avocados, bananas, berries, cherries, dates, figs, grapes, peaches, pears, plums, prunes, watermelons. 7. Butter or fortified margarine. Butter is rich in vitamin’
A, but since this vitamin is amply supplied in several of the foods previously listed, butter is not essential to the well- rounded diet during pregnancy. If weight gain is normal, two pats of butter a day (one inch by one inch by one-fourth inch) should be spread on bread or toast or used in cooking. 8. Salt in moderation is permissible in the first half of pregnancy, but it should be used sparingly, if at all, in the second half. If there is a tendency to rapid weight gain or an elevation of blood pressure, salt or any other sources of sodium, such as bicarbonate of soda for indigestion, must be rigidly excluded. Other condiments can be used during pregnancy as the patient’s appetite dictates.
Fluid Intake during Pregnancy
Adequate fluid intake is just as essential to health during pregnancy as adequate caloric intake. The minimum amount of fluid necessary is 2 quarts or 8 full glasses a day. Anything which one can pour from glass to glass is counted as fluid, and equal credit is given for soup, coffee, fruit juice, milk, and water.
Special Dietary Problems
The commonest dietetic problem in pregnancy is the consistent and regular gaining of too much weight. What can be done about it?
First and foremost, exert your will power. If your will power needs a crutch in the form of drugs to diminish appetite, most physicians will permit you one 10-milligram Dexedrine Spansule daily after breakfast, or Preludin tablets (25 to 75 milligrams daily), which may ‘hop you u’p’ a little.
Second, examine your conscience for dietetic sins. What non-essential foods have you been eating or drinking, perhaps as snacks between meals? Eliminate all ginger ale, Coca-Cola, beer, cocktails, chocolate bars, doughnuts, pies, cakes, and all between-meal rations except milk. Restrict your brjead to two pieces and eliminate butter. Cut out free salt at the table since salt by mouth increases the fluids retained by the tissues and therefore elevates the weight. You may use a non-sodium substitute like Co-salt or Neocurtisal with complete safety. Eliminating salt includes cutting out potato chips, pretzels, salt fish, and salted meats.
If these remedial measures are insufficient, skim the milk you use for drinking and cooking, cut out all fried foods, substitute a salad dressing made of mineral oil for mayonnaise and conventionally prepared dressings, and use saccharin or sucrol for sweetening in place of sugar. Choose lean meats rather than fatty meats. Eat fresh fruits in place of canned or preserved fruits.
If following these suggestions does not check your abnormal weight ga^n, also eliminate all salt used in the preparation of your food. Try skipping lunch and substitute ‘skimmed milk with a few unsalted crackers.
Finally, eliminate your breakfast cereal and all desserts except fruit
If you have gained very rapidly—several pounds a week —and your tissues, by being swollen and puffy, show evidence of abnormal water retention, your doctor, no doubt in addition to eliminating salt at the table and in cooking, may see fit to place you on a salt-poor diet This becomes particularly urgent if your blood pressure has shown any tendency to become elevated.
Under these conditions all soups are taboo, except un-salted, fat-free chicken or beef broth.
No smoked, pickled, cured, frozen, or canned meat, fish, or poultry is permitted. In addition, bacon, bologna, chipped beef, corned beef, frankfurters, pastrami, pork in every form9 sausage, and tongue are put on the condemned list The meats, poultry, and fish which may be eaten are: lean beef and lamb, liver, veal, chicken, turkey, codfish, flounder, halibut oysters, salmon, scallops, sole, and whitefish.
Unsalted butter must replace salted butter, and skimmed milk whole milk. The only cheese allowed is unsalted cottage cheese. Both sweet and sour cream must be eliminated. The eating of unsalted bread is permissible—but no other breads nor any crackers.