What to expect when you're expecting (66 page)

If the symptoms continue for longer than two weeks, speak to your practitioner about your depression (he or she may want to test you for a thyroid condition since that can trigger depression) or ask for a referral to a therapist who can offer supportive psychotherapy. Getting the right help is important. Depression can keep you from taking optimum care of yourself and your baby, now and after delivery. In fact, depression during pregnancy can increase risks for complications—much as depression can adversely affect your health when you’re not pregnant. Deciding whether antidepressant medication will be part of the treatment plan will require sitting down with your practitioner (and therapist) to weigh possible risks against possible benefits (see
page 518
for a discussion of antidepressants during pregnancy).

Panic Attacks

Pregnancy can be a time of high anxiety, especially for those who are expecting for the first time (and consequently don’t know what to expect). And a certain amount of worry is normal, and probably unavoidable. But what about when that worry turns to panic?

If you’ve had panic attacks in the past, you’re probably all too aware of the symptoms (and most women who have panic attacks during pregnancy have had them before). They’re characterized by intense fear or discomfort accompanied by an accelerated heart rate, sweating, trembling, shortness of breath, feeling of choking, chest pain, nausea or abdominal distress, dizziness, numbness or tingling, or chills or hot flashes that appear seemingly out of the blue. They can be incredibly unsettling, of course, particularly when they strike for the first time. But happily, though they definitely affect you, there is no reason to believe that panic attacks affect the development of your baby in any way.

Still, if you do experience such an attack, tell your practitioner. Therapy is always the first choice during pregnancy (and other times, too). But if medications are necessary to ensure your well-being (and your baby’s—if anxiety is keeping you from eating or sleeping or otherwise taking care of your precious cargo), your practitioner, together with a qualified therapist, can work with you to decide which medication offers the most benefits for the fewest risks (and how low a dose you can take and still derive those benefits). If you’ve been on a medication for panic attacks, anxiety, or depression prepregnancy, a change or an adjustment of dose might be necessary, too.

While medication is one solution to extreme anxiety, it certainly isn’t the only one. There are many nondrug alternatives that can be used instead of or in conjunction with traditional therapy. These include eating well and regularly (including plenty of omega-3 fatty acids in your diet may be especially helpful); avoiding sugar and caffeine (caffeine, in particular, can trigger anxiety); getting regular exercise; and learning meditation and other relaxation techniques (prenatal yoga can be incredibly calming). Talking your anxieties over with other expectant moms can also provide enormous relief.

Consult your practitioner, too, before turning to any alternative treatments. Over-the-counter supplements, such as SAM-e and St. John’s wort, touted for their mood-elevating properties, have not been studied enough to consider them safe for use in pregnancy. But other CAM therapies (see
page 85
) might help, and bright light therapy (which increases levels of the mood-regulating hormone serotonin in the brain) cuts depressive symptoms during pregnancy in half. Eating foods rich in omega-3 fatty acids lowers the risk of depression during pregnancy and possibly during the postpartum period as well. You can also ask your practitioner about taking a pregnancy-safe omega-3 supplement.

Being depressed during pregnancy does put you at somewhat greater risk of postpartum depression. The good news is that getting the right treatment during pregnancy—and/or right after delivery—can help prevent postpartum depression. Ask your practitioner about this.

Weight Gain During Pregnancy

Put two pregnant women together anywhere—in a doctor’s waiting room, on an elevator, at a business meeting—and the questions are certain to start flying. “When are you due?” “Have you felt the baby kicking yet?” “Have you been feeling sick?” And perhaps the most commonly posed of all: “How much weight have you gained?”

Everybody expects to gain weight while they’re pregnant (and after spending half a lifetime dieting, lots of women actually look forward to it). And, in fact, gaining the right amount of weight is vital when you’re growing a baby. But what is the right amount of weight? How much is too much? How much is too little? How fast should you gain it all? And will you be able to lose it all once your baby’s delivered? (Answer: yes—if you gain the right amount of weight at the right rate on the right type of foods.)

If there were ever a legitimate reason to pile on the pounds, pregnancy is it. After all, when you grow a baby, you’ve got to do some growing, too. But piling on too many pounds can spell problems for you, your baby, and your pregnancy. Ditto if you pile on too few pounds.

What’s the perfect pregnancy weight gain formula? Actually, since every pregnant woman—and every pregnant body—is different, that formula can vary a lot. Just how many pounds you should aim on adding during your 40 weeks of baby growing will depend on how many pounds you were packing before you became pregnant.

Your practitioner will recommend the weight gain target that’s right for you and your pregnancy situation (and that’s the guideline to follow, no matter what you read here). Generally, weight gain recommendations are based on your prepregnancy BMI (a measurement of body fat calculated by multiplying your weight in pounds by 703, then dividing by your height in inches squared; see
What to Expect: Eating Well When You’re Expecting
for a chart). If your BMI is average (between 18.5 and 26), you’ll probably be advised to gain between 25 and 35 pounds, the standard recommendation for the average-weight pregnant woman. If you start out pregnancy overweight (BMI between 26 and 29), your goal will be somewhat scaled back—to somewhere between 15 and 25 pounds. If you’re obese (with a BMI greater than 29), you’ll likely be told to tally a total of between 11 and 20 pounds, or perhaps even less than that. Super skinny (with a BMI of less than 18.5)? Chances are your target will be higher than average—upward of 28 to 40 pounds. For moms providing room and board for more than one, extra babies require extra pounds (see
page 407
).

It’s one thing to set an ideal weight gain goal; it’s another thing to get there. That’s because ideals aren’t always completely compatible with reality. Piling on the right number of pounds isn’t just about piling the right amount of food on your plate. There are other factors at work, too. Your metabolism,
your genes, your level of activity, your pregnancy symptoms (the heartburn and nausea that make eating too much like hard work; those cravings for high-calorie foods that make gaining too much too easy)—all play a role in helping you (or keeping you from) packing on the perfect pregnancy poundage. With that in mind, keep an eye on the scale to ensure that you’re reaching your weight gain target.

Slow and steady doesn’t only win the race—it’s a winner when it comes to pregnancy weight gain, too. A gradual weight gain is best for your body and your baby’s body. In fact, the rate at which weight is gained is as important as the total number of pounds you gain. That’s because your baby needs a steady supply of nutrients and calories during his or her stay in your womb—deliveries that come in fits and spurts won’t cut it once your little one starts doing some significant growing (as will happen during the second and third trimesters). A well-paced weight gain will also do your body good, allowing it to gradually adjust to the increased poundage (and the physical strains that come with it). Gradual gain also allows for gradual skin stretching (think fewer stretch marks). Need more convincing? Pounds put on at a slow and steady rate will come off more easily when the time comes (after you’ve delivered and you’re anxious to get back to your prepregnancy shape).

Does steady mean spreading out those 30 pounds or so evenly over 40 weeks? No—even if that were a possible plan, it wouldn’t be the best one. During the first trimester, your baby is only the size of a few poppy seeds, which means that eating for two doesn’t require extra eating at all, and only a minimum of weight gain. A good goal for trimester 1 is between 2 and 4
pounds—though many women don’t end up gaining any at all or even losing a few (thanks to nausea and vomiting), and some gain somewhat more (often because their queasiness is comforted only by starchy, high-calorie foods), and that’s fine, too. For those who start slowly, it should be easy to play weight gain catch-up during the next six months (especially once food starts tasting and smelling good again); for those who begin gangbusters, watching the scale a little more closely in the second and third trimester will keep their total close to target.

Why More (or Less) Weight Gain Isn’t More

What do you have to lose by gaining too much weight when you’re expecting? Packing on too many pounds can present a variety of problems in your pregnancy. More padding can make assessing and measuring your baby more difficult, and added pounds can add to pregnancy discomforts (from backache and varicose veins to fatigue and heartburn). Gaining too much weight can also increase your risk of preterm labor, of developing gestational diabetes or hypertension, of ending up with an oversize baby that may be too large to deliver vaginally, of postcesarean complications, of a host of problems for your newborn, and of having more trouble with breastfeeding. Not surprisingly, too, those extra pounds may be extra hard to shed postpartum—and, in fact, many women who gain too much weight during pregnancy end up never shedding them all.

Gaining too little weight can also be a losing proposition during pregnancy, and in some cases it can be more dangerous than gaining too much. Babies whose mothers gain under 20 pounds are more likely to be premature, small for their gestational age, and to suffer growth restriction in the uterus. (The exception: very overweight women, who can safely gain less than 20 pounds under close medical supervision.)

Breakdown of Your Weight Gain

(All weights are approximate)

During the second trimester, your baby starts to grow in earnest—and so should you. Your weight gain should pick up to an average rate of about 1 to 1½ pounds per week during months 4 through 6 (totaling 12 to 14 pounds).

During your final trimester, baby’s weight gain will pick up steam, but yours may start to taper off to about a pound a week (for a net gain of about 8 to 10 pounds). Some women find their weight holding steady—or even dropping a pound or two—during the ninth month when ever-tighter abdominal quarters can make finding room for food a struggle.

How closely will you be able to follow this rate of gain formula? Realistically, not that closely. There will be weeks when your appetite will rule and your self-control will waver, and it’ll be a rocky road (by the half-gallon) to your weight gain total. And there will be weeks when eating will seem too much of an effort (especially when tummy troubles send whatever you eat right back up). Not to worry or stress over the scale. As long as your overall gain is on target and your rate averages out to that model formula (a half pound one week, 2 pounds the next, 1 the following, and so on), you’re right on track.

So for best weight gain results, keep your eye on the scale, since what you don’t know can throw your weight gain way off target. Weigh yourself (at the same time of day, wearing the same amount of clothes, on the same scale) once a week (more often and you’ll drive yourself crazy with day-to-day fluid fluctuations). If once a week is too much (because you’re scale-phobic),.
twice a month should do the trick. Waiting until your monthly prenatal is fine, too—though keep in mind that a lot can happen in a month (as in 10 pounds) or not happen (as in no pounds), making it harder for you to stay on track.

Weight Gain Red Flags

If you gain more than 3 pounds in any one week in the second trimester, or if you gain more than 2 pounds in any week in the third trimester, especially if it doesn’t seem to be related to overeating or excessive intake of sodium, check with your practitioner. Check, too, if you gain no weight for more than two weeks in a row during the fourth to eighth months.