In Secrets of Feeding a Healthy Family, I observed that ''Until we recover eating as one of life's great pleasures, it simply is not going to turn out well.'' Nowhere is that more apparent than when we consider current pressure to restrict food intake and,limit weight gain during pregnancy.

We have been this way before. Back in the sixties, when I started my dietetics career in an private outpatient medical group practice, obstetricians were vehement about combating what they viewed as excessive weight gain during pregnancy. Their rigid guidelines allowed women whose weights were judged to be normal to gain 15 lb; those judged overweight were told to gain none. Doctors were absolutely convinced of the rightness of these guidelines, based on their clinical impressions (contradicted by numerous research studies then available) that excessive weight gain caused preeclampsia and difficult delivery. Women were shamed and scolded, and one of doctors even threatened not to deliver his patients if they gained too much weight. Women worried constantly about eating and weight and dreaded their prenatal appointments. Most tried to go hungry all month and many stopped eating and even drinking on the day prior to weigh-in. In short, many perfectly happy pregnancies were spoiled by obsession with eating and weight gain.

That all changed with the 1970 National Research Council statement,¹ which encouraged, and supported with persuasive clinical outcome data, letting women eat as much as they were hungry for and gaining weight accordingly during pregnancy. The monograph predicted a weight gain of 20 to 25 lb and correlated this natural weight gain with the best outcome for both mother and child. In response to that report, we began encouraging our patients to eat in accordance with their hunger, appetite and satiety. Women gained more weight than before, and we supported it (with the exception of one nurse who persisted in sucking in her breath when patients gained and praising them when they failed to).

Three years later, our clinical research showed that our patients before 1970 gained, on the average, eight pounds less than those after 1970, 15.9 versus 24.2 pounds. Babies born to mothers who gained more weight were heavier by 159 grams�over five ounces. There were six mothers before 1970 who gained less than ten pounds, and their babies weighed over 11 ounces less than the average babies.²

The five-ounce weight difference between the pre-1970 and post-1970 babies doesn't sound like much, and neither group had low birth weights. To understand the practical significance of this difference, consider that infants born after the extremely short rations of the WWII Rotterdam blockade were 300 g. (10 oz) smaller than average.³

From my perspective, the moral of the story is ''don't try to outsmart Mother Nature.'' Supporting mothers in eating as much as they need and accepting their weight gain has the best chance of producing a healthy baby. The moral of the story is not, however, that low weight gain will produce a small baby, high gain a big baby. While the trends existed in our population and in other studies, we can't predict for individuals. According to the Institute of Medicine, which published the current recommendations on nutrition during pregnancy, ''The low birth weight of an infant born to a mother who gained only 11 lb. cannot be a confidently attributed to her low gestational weight gain, nor can the high birth weight of a baby whose mother gained 55 lb be attributed to high gestational weight gain.''⁴

Unfortunately, those bad-old-days attitudes about restricting weight gain during pregnancy are coming back. Now health and nutrition policy, medical practice and societal vehemence about weight exert the very pressures on weight gain during pregnancy that came from those pre-1970 norms in obstetrical practice. Current concern is focused around high obstetrical weight gains, particularly those of women considered to be overweight, delivering a large baby�one who by definition weighs 9.9 lb or more,or increasing post-pregnancy weight retention in the mother and the fetus.⁵

The next four newsletters will address weight-gain issues in pregnancy. Family Meals Focus# 16 addresses today�s weight-gain standards and the dilemmas those standards create for pregnant women. Family Meals Focus #17 discusses the negative impact on nutritional behavior from creating such weight-gain dilemmas. Family Meals Focus #18 wraps up the pregnancy discussion by proposing a practical and moderate approach to prenatal eating management and weight gain that doesn't do harm, that is positive and rewarding for pregnant women, and that has a higher likelihood of being successful. Finally, Family Meals Focus # 19 addresses infant birth weight and lifetime health patterns.

Reference List

1. Committee on Maternal Nutrition F&NB. Maternal Nutrition and the Course of Pregnancy. Washington, DC: National Research Council; 1970.

2. Gormican A, Satter EM, Valentine J. Relationships of maternal weight gain, pre-pregnancy weight, and infant birth-weight. J Am Diet Assoc. 1980;77:662-667.

3. Stein Z, Susser M. The Dutch famine, 1944-1945, and the reproductive process. II. Interrelations of caloric rations and six indices at birth. Pediatr Res. 1975;9:76-83.

4. Food and Nutrition Board IoM. Nutrition During Pregnancy. Washington, D.C.: National Academy Press; 1990.

5. Abrams B, Altman SL, Pickett KE. Pregnancy weight gain: still controversial. Am J Clin Nutr. 2000;71:1233S-41S.

Family Meals Focus by Ellyn Satter, MS, RD, LCSW, BCD. discusses trends, research and clinical issues in eating and feeding and interprets other research from a feeding-dynamics, eating-competence perspective. For past issues of Family Meals Focus, click here.

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