Calorie-counting mums-to-be put
babes at risk

Plus size pregnancies still the bigger problem.
It's time to talk to patients

By Carla Sparks

"I think we run into a problem when we talk about healthy weight," says Dr Hasselback, hinting that many people equate healthy with thin. "One thing that came across so clearly [in the report] was a lack of understanding among women." They were well informed about the risks of smoking, alcohol use and the importance of proper nutrition but drew blanks when it came to how much weight they should or shouldn't be putting on, he says.

SVELTE MOMMA
One of the more interesting findings that came out of the report was an increase in the number of low birth weight babies in the region. "We were looking at data over the last three years," explains Shelly Inglis-Allan, who worked on the report and is the project manager of the Interior's low birth weight prevention program. "Although, historically the incidence of low birth weight babies has gone down, we are starting to see that in the last few years it has been going up."

She thinks the trend has to do with more women worrying about putting on too many pounds during pregnancy. "By looking at some of the recent literature I think things like body image during pregnancy has an impact," says Ms Inglis. "I think women have always had an awareness around their changing bodies during pregnancy but now with an increased awareness around obesity there might be more of a concern." Some women are going as far as counting calories and exercising excessively, she adds.

PICKLES & ICE CREAM
But for most physicians the concern with women's weight during pregnancy is usually quite the opposite. "The problem is too much weight gain," says Dr Gregory Davies, the chair of maternal-fetal medicine at Queen's University. "Less weight gain [during pregnancy] is usually associated with a pre-existing eating disorder or sometimes poor nutrition due to drug use or the lack of income," he says but adds that these women only make up a small minority of patients in Canada.

Dr Davies believes a combination of bad food choices and lack of exercise are leading mums-to-be to balloon. "Our population doesn't have an appropriate diet," he says, "it's very high in carbohydrates, which leads to people being overweight." Plus-size pregnancies can increase a woman's risk of gestational diabetes and preeclampsia, and also make ultrasounds more difficult.

There are a few simple things that can be done. "You can refer to a dietician," says Dr Davies, "or you can look at the Society of Obstetricians and Gynecologists guidelines on exercise and pregnancy."

A WEIGHTY MESSAGE
Although the Interior Health report conflicts with what is perhaps the general trend of too much weight gain, the message remains the same: Women need to know how much weight is healthy and appropriate. "That's what we heard from our focus group and anecdotally," says Ms Inglis-Allan. "Women really wanted to know more from their doctors." Dr Hasselback adds that the major message to physicians is to sit down and have a discussion with patients. This is why Interior Health will be launching an awareness campaign later this spring, first targeted at physicians and then another for the general public.

But doctors looking to talk to their patients now can check out Health Canada's guidelines. The SOGC also recommends that "pregnant women should increase their caloric intake by about 100 calories per day in the 1st trimester, by 300 calories per day in the 2nd and 3rd trimester and 450 calories per day while breastfeeding." It's also important to question women about their diet during their initial visit. "The healthier a woman enters pregnancy the better the outcomes for both mother and baby," says Dr Davies.