Plus size and pregnant


If life were fair, pregnancy should be that one time in a woman’s life when she could eat as many bars of chocolate as she wanted without worrying about weight gain. But life isn’t, and the last remaining area of weight nonchalance is under attack. New studies are finding that being obese and pregnant can be very risky indeed – both to mother and baby.

Even though doctors allow women a (stingy-ish) 12-kilogram increase over the span of pregnancy, they throw another spanner in the works – this guideline is for women with a healthy BMI only. The plus-sized among us need to gain less weight (about 6kg) in order to safeguard our own health and that of our baby – and that’s no lightweight matter.

How much did you weigh at the start of your pregnancy? Divide your mass in kilograms at the time you became pregnant by your height in metres squared (say, 70kg / {1.7m x 1.7m} = 24.22). If your answer is under 18.5, you are underweight. Normal weight ranges between BMIs of 18.5 and 24.9.

Overweight is considered a reading of between 25 and 29.9, and you are obese if your reading is greater than 30.

It’s at that 30-plus point where the trouble starts. And with a full 70 percent of South African women overweight or obese (according to the South African National Health and Nutritional and Examination Survey, which reported its results in August last year), that’s a hefty load of trouble for a lot of us.

Read: What you need to know about pregnancy weight gain

But it's just a bit of flab... or is it?

Being overweight at the start of your pregnancy is not ideal for many reasons. We already know that obesity is linked to a far greater risk of contracting lifestyle diseases such as diabetes, high blood pressure and heart disease.

But adding pregnancy into the mix complicates matters significantly. Women who were overweight at the start of their pregnancy are at a higher risk of contracting gestational diabetes (diabetes which starts as a result of pregnancy), hypertension (high blood pressure) and pre-eclampsia (which is marked by high blood pressure and protein in the urine and is dangerous to mother and baby).

To monitor all these potentially serious conditions, you can expect to undergo more regular blood and urine tests over the course of your pregnancy.

Increased risks

Obese women also face increased risk of developing urinary tract infections during pregnancy, and postpartum infections, according to the Mayo Clinic in the United States. There is also an increased risks of thrombosis (blood clots), or of developing sleep apnoea (where you stop breathing in your sleep for short periods).

If you’re obese, you’re more likely to have an overdue delivery date, be carrying a high-birth-weight baby, and have your labour induced. Epidurals may be harder to administer, and assisted deliveries (where instruments such as ventouse or forceps are used) and c-sections are also more common in obese women. “Obesity also increases the risk of miscarriage and stillbirth,” warns the Mayo Clinic.

But now, a study published last year by the Journal of the American Medical Association has found that the greater a woman’s weight, the higher the chance that she will have an extremely premature delivery. The study tracked 1.6 million deliveries in Sweden between 1992 and 2010.

Read: Calculate your BMI

At the top of the scale, women with a BMI of over 40 (which is very overweight indeed, and only represents a small percentage of overweight women), were more than three times more likely to deliver extremely prematurely than a woman with a healthy BMI.

Clearly the first prize is to embark on pregnancy at a healthy BMI – and if you are not yet pregnant, you have an opportunity now to manage your weight before you conceive. But if the deed has been done and you’re already with child, you needn’t feel helpless or despondent.

Despite all these dire warnings, most plus-size pregnancies progress just fine. An increased risk is just that – an increased risk, not an increased reality.

Take care of your health

No matter at what weight you started your pregnancy, you still have a chance to take charge of your health, and that of your baby. Chat to your doctor and follow these tips:


Try to limit your weight gain during pregnancy to what your doctor advises. Do not, however, set out on your own to diet or lose weight during pregnancy – that can be dangerous because you can lose out on nutrients.

“In consultation with a registered dietician it is safe to lose weight during pregnancy, especially if you are obese,” says dietician Nicqui Grant.

“But losing weight should not be a primary focus and it must be done under supervision,” she says. Rather follow a healthy eating plan, preferably one that a dietician has worked out for you – or look one up online for free.


Commit to every gynaecologist or clinic appointment and follow the doctor’s, sister’s or midwife’s advice religiously. Educate yourself on the potential risks in your pregnancy, know the signs and symptoms of trouble and be prepared and able to act quickly if the warning bells do ring.

Read: A to Z of a healthy pregnancy


If your lifestyle has been completely sedentary, start a mild to moderate exercise regime, but check with your doctor first. Start with 15 consecutive minutes of gentle exercise such as walking three times a week and work up to 30 minutes up to five to seven times a week.

Do not become so out of breath that you cannot talk while exercising – you don’t want to put unnecessary strain on your heart or get too hot.

“It is very important not to overheat as this can have negative effects on the foetus,” says Nicqui. “You can regulate your own body temperature by sweating but the foetus cannot.”

Remember, the aim is to counteract some health risks, such as to bring down your blood pressure or increase your heart health, not to lose weight.


Be flexible with your birth expectations. It’s really not worth insisting on a home birth if you know you are at higher risk of delivery complications.

A hospital has access to medical care and pain relief options and you may well be advised to choose that safer setting. Always put the safety of your baby first.

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