Keep weight gain in check to avoid complications, advise doctors.

“Eating for two”— that’s a lie


On a regular day during her pregnancy six years ago, Kerine Tham had cheesecake for breakfast, several servings of hawker treats for lunch and dinner, as well as ice cream and durian in between meals.

“I was constantly hungry and thought I had to eat twice as much to grow a baby,” said the 27-year-old owner of a food-and-beverage business.

Just before she gave birth, Tham, who is 1.61m tall, tipped the scales at 90kg. She had put on 33kg, which was three times the weight her doctor had advised her to gain during her pregnancy.
Six months after giving birth to her 3.5kg baby, Tham was dismayed to find that she was still 20kg away from her pre-pregnancy weight.

How much more to eat?

Gaining weight is essential for a healthy pregnancy because an unborn baby is completely dependent on the mother for nutrients, said Dr Ting Hua Sieng, specialist in obstetrics and gynaecology at The Obstetrics and Gynaecology Centre, a Singapore Medical Group (SMG) clinic.

However, doctors said many local mothers tend to have the mistaken notion that they should “eat for two”. Dr Ting estimated that at least half of the pregnant mothers she saw had difficulty keeping their weight under control.

There is no need for women to increase their calorie intake during their first trimester, said Dr Ting.

Dr Kelly Loi, a fertility specialist at Mount Elizabeth Hospital, said an additional 300 calories a day — which translates to a small snack such as a cup of skimmed milk and one small sandwich or bun — is recommended during the second and third trimesters.

Said Dr Ting: “Family members may encourage the mother to take more high-calorie and rich food like tonic soups and meats. All these factors provide excuses for the mother to indulge,” said Dr Ting.

In addition, many Singaporean women continue to work long, stressful hours during their pregnancy. Their hectic lifestyles may result in poor dietary habits and a lack of exercise, which can cause excessive weight gain, said Dr Loi.

According to Dr Ting, women of normal pre-pregnancy weight are advised to put on an average of 11kg to 15kg during their entire pregnancy. Overweight women should gain 8kg to 12kg, while underweight women should aim for an additional 13kg to 18kg.

Dangers of excessive pregnancy weight gain

Dr Ting had a 100kg patient who gained 20kg during her pregnancy, despite repeated counselling sessions.

“[She] had backaches, problems maintaining good hygiene and eventually developed gestational diabetes, which required insulin injections. Her baby also grew too big, weighing almost 4kg at birth. She had to undergo an elective Caesarean section,” said Dr Ting.

Gestational diabetes and hypertension are serious pregnancy complications that can endanger both the mother’s and baby’s lives.

According to Dr Loi, studies conducted in the United Kingdom show that 20 to 30 per cent of maternal deaths occur in mothers who are obese, as a result of complications including blood clots in the vessels, heart disease, bleeding and severe infection.

Babies born to obese mothers may develop low blood sugar shortly after birth, which can lead to fits. They also tend to have more breathing problems, said Dr Ting.

Dr Loi added that these babies also face a higher risk of developing congenital abnormalities such as heart defects or spina bifida. In addition, they may face a higher chance of being stillbirth, complications at birth and/or develop chronic diseases later in life.

Post-delivery, obese mothers may experience a higher risk of succumbing to wound infections — whether from Caesarean section or vaginal delivery — as well as deep-vein thrombosis which can potentially be fatal if the blood clot travelled to the lungs, said Dr Ting.

Furthermore, breastfeeding problems may arise, due to the decreased milk production and difficulty in positioning the baby when breastfeeding.

Eat well, not more

To keep pregnancy weight in check, experts advised women to focus on the quality, not quantity, of their diet.

Dr Loi advised: “Cut back on fat, salt and sugar but increase the intake of wholegrains, fruits, vegetables, legumes and low-fat dairy products. Eat regular meals and avoid unhealthy snacks.”

Pregnant mums can also do gentle exercises such as walking, swimming, pilates and yoga. However, steer clear of high-impact exercises such as running, horse riding or weight lifting that may strain joints that are already loosened by pregnancy hormones, advised Dr Loi. Always check with a doctor before embarking on any exercise routine.

Ms Tham started a weight-loss programme six months after childbirth. She managed to lose 20kg in eight months through an intensive exercise routine and healthy diet, and is now back to her pre-pregnancy weight of 57kg.

“I have only one piece of advice for pregnant mums: Self-control. I won’t overindulge again for my next pregnancy,” said Ms Tham.

First published on Today on 15 April 2015.

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