In preparation for her first pregnancy, Susan Clinton decided to get in shape. The Ottawa accountant had always led a fairly active lifestyle, but before conceiving, she staged a last healthful hurrah, training for and completing her first half-marathon. When she crossed the finish line, she was in the best shape of her life. Finally she deemed herself ready—and healthy enough—to grow a baby.
“I expected to be the poster child for an easy pregnancy. I somehow had this visual that I’d just glow. But that was not the case.”
With every passing day of her pregnancy, Clinton found herself getting further and further away from her goal of a stress-free nine months. Her healthy habits fell by the wayside. “I was sick through the whole thing. When I’m pregnant, I have a hangover-type feeling. My body wants comfort foods: carbohydrates, ice cream. It was as if a different body took over, and I was living in someone else’s.” By the time she gave birth to her 10-pound son, Clinton had gained 85 pounds—three times the amount she had initially planned.
Little did Clinton know, she was right on trend. Pregnant Canadians are gaining more weight than ever before, according to a series of recently published studies, and the impact is hurting more than our waistlines. It’s putting our babies, who are also heavier than ever before, at a serious disadvantage: They are more likely to struggle with weight issues for the rest of their lives.
In Clinton’s case, she had no idea of those risks, or how to minimize them. When she learned how much she was gaining, she says she was “gobsmacked. I felt horrible.” Adding to Clinton’s misery was her sense of powerlessness—she wasn’t sure what she could have done differently while pregnant to manage her weight gain. “If someone had told me how many calories I should consume in a day, I would have done it,” she says. Clinton says her doctor seemed to take comfort in the fact that she gained a lot of weight and didn’t seem worried. When she looked online for advice, she found herself lost in a whirl of inconsistent information. Ultimately, she gave in to her body’s cravings.
Within three months of delivering her son, though, Clinton was running again. She joined Weight Watchers and managed to shed all of her extra baby weight. When her son was a little more than a year old, she got pregnant again.
“This time, though, I had the healthy eating habits in place. I had decided that gaining too much weight was my fault the first time around, and the second pregnancy was going to go much better,” Clinton says. And it did, until Clinton was barred from Weight Watchers when she revealed she was expecting. (It’s Weight Watchers’s policy that women are not allowed to participate during pregnancy.) “When they wouldn’t let me continue to attend meetings, I just had a real feeling of helplessness…kind of like sending an alcoholic back to the bar,” Clinton says. “You’re ravenous, and you know you do actually have to consume more calories. For me it was the Wild West.” By the time she delivered her second baby, a 12-pound boy, she’d gained 72 pounds.
Questions around how much weight expectant moms ought to gain—and how closely healthcare practitioners should monitor this—are among the most sensitive in pregnancy. While medical guidelines for healthy weight gain do exist—both Health Canada and the Institute of Medicine make recommendations according to body mass index—they are rarely discussed by healthcare practitioners and aren’t often posted in doctors’ offices. (Online, you can check out Health Canada's easy-to-use pregnancy weight-gain calculator.) In general, a healthy pregnancy weight gain is two to four pounds total during the first trimester, and then about one pound a week during the second and third trimesters. The average pregnant woman needs about 300 more calories per day than when she’s not pregnant, but they should be healthy calories.
Culturally, however, we’re taught that pregnancy isn’t the time to fret over a few extra pounds. On the contrary, we should relish the permission to indulge in extra helpings, high-calorie foods (“the baby needs that cookie”) and skip the gym in favour of putting our feet up to ward off swollen ankles and exhaustion. Growing a human is, after all, tough work. While adapting to this mindset, we’re also fascinated by the topic of post-pregnancy weight loss. Many of us keep one eye on magazine covers plastered with celebrity moms claiming they slipped into their pre-pregnancy jeans just after their baby was delivered; we click on links offering tips for pregnancy-safe workouts as if they’ll help us build up some sort of post-pregnancy weight loss currency. In this era, to be pregnant is to be steeped in the conflicting pressures to gain ample weight but get it off quickly.
For doctors, the subject of weight gain is often dreaded, says Helena Piccinini-Vallis, a family doctor and a clinical investigator at Dalhousie University in Halifax. “Conversations around weight are particularly sensitive. When a physician feels that he or she has to raise the issue, there’s that initial sense of ‘Oh, my God, how is the patient going to receive it?’”
While doctors commonly find it “easy” to address the issue of not gaining enough weight during pregnancy, “traditionally, if someone gained too much, it’s not addressed,” Piccinini-Vallis says. The reason? “Some physicians don’t even know there are guidelines out there. Patients always have the sense that because we’re physicians we know everything about nutrition and physical activity. Nothing could be further from the truth.” Doctors also worry about offending their patients and discouraging them from continuing prenatal care. “It’s really tough to go against a woman’s grandmother and mother who are telling her ‘Take it easy, you’re in a delicate state, eat as much as you want.’”
However, obese women are more likely to experience pregnancy complications such as miscarriage, gestational diabetes, high blood pressure and pre-eclampsia, premature birth, emergency C-sections and stillbirth. New research is also tying mothers’ excessive gestational weight gain to obesity rates in children. A study published last year in the journal Contemporary Clinical Research pointed out that pregnant Canadians now gain more weight than ever: 15 kg or 33 lb., on average, up from the 10 kg or 22 lb. that was considered average four decades ago. We’re also giving birth to the heaviest babies in Canadian history.
Kristi Adamo, the paper’s lead author, a professor of paediatrics and a research scientist with the Healthy Active Living and Obesity Research Group (HALO) at the Children’s Hospital of Eastern Ontario Research Institute in Ottawa, explains that a baby’s experience in the womb is critical to his or her long-term health. “That nine-month period of time is when all of the organs and brain develop. If you provide a suboptimal environment, the baby isn’t destined for disaster, but it sets her up for a more challenging situation outside of the womb. It’ll be an uphill battle,” Adamo says.
A huge number of Canadian children are already experiencing that struggle. More than 30 percent of children are overweight or obese and struggling with related complications: Type 2 diabetes, early onset puberty and, later on, their own obesity-related fertility problems, to name a few. Children born to mothers who exceed guidelines for gestational weight gain—even by a smidge—are four times more likely to be overweight by preschool. They’re also more likely to remain overweight by age 12, which puts them at risk of struggling with their weight into adulthood.
It’s with an eye to helping the next generation avoid this uphill battle that Adamo and her colleagues have been working on a set of custom tools designed to help pregnant women chart a healthier course. While one of those will help guide doctors through conversations with expectant moms on healthy behaviours and weight gain, the crown jewel of the set is a smartphone app designed to give moms-to-be a personalized weight management system. The app, SmartMoms-Canada, is currently undergoing tests in the US with Adamo’s American counterparts, who are funded by the National Institute of Health. It blends both calorie-counting and physical activity advice based on each user’s pre-pregnancy body mass index, weight-gain trajectory and stage of pregnancy.
For those already turning the page at the idea of a calorie-counting app—pregnancy is already chock full of confusing do’s and don’ts at a time when surplus energy is scarce—Adamo, a mother of two, asks you to hear her out.
“We are not fat bullies. We’re trying to help Canadian women and the next generations. I absolutely recognize the challenges, particularly in the first trimester when women might be suffering from nausea and food aversions, and they’re exhausted. The message that needs to get through is that every little bit counts,” she says. “We’re not asking women to train for a marathon. We’re asking them to do the things they should be doing anyway, when they’re not pregnant. That might simply be walking. We have to recognize that pregnancy is not an excuse to throw all healthful behaviours out the window.”
The app may take longer to debut in Canada than in the US. Funding for its Canadian customization has been approved by the Public Health Agency of Canada, but there’s a hitch: The grant requires Adamo and her colleagues to find a private-sector partner to fund the second half of the two-million-dollar project. Their goal is to create the first medically evaluated app of its kind (meaning doctors would be comfortable recommending it to patients) in hopes that it might one day be covered by the healthcare system.
“This is something that should be available to everyone,” Adamo says. “Today’s women expect continuous feedback and decision-making help in the moment—it can’t wait until your next OB appointment.”
In Susan Clinton’s mind, having personalized guidance at her fingertips in the grocery store and for her daily food choices would have transformed her pregnancies, and possibly her family. She and her husband had initially hoped to have four children, but they amended plans after her third pregnancy, which resulted in a 75-pound weight gain and her biggest baby yet—a 15-pound boy.
“At the end of the third pregnancy it was like, clearly, I can’t do this again,” says Clinton. Even though she managed to return each time to her pre-baby weight, she became more desperate for advice on how to eat right, and angrier that she couldn’t find a support system, like Weight Watchers, designed for expecting women. “In each pregnancy, I reached a point where I gave up,” she says. “If that sense of losing control hadn’t taken over, I bet I wouldn’t have gained that much.”
Clinton is convinced that had she had more guidance, her babies would have been born smaller and perhaps healthier. While no major, long-lasting health problems have occurred so far, Clinton was deemed “high-risk” before giving birth, all three times, by C-section (which carries its own risks). Clinton’s sons, who are now six, 10 and 12 years old, are at a higher risk for obesity. For now, their active lifestyles are keeping them at a normal weight for their ages, she says. But she does worry. “They are not obese children. Whether they’ll have issues when they slow down, I don’t know.”
A version of this article originally appeared in the September 2014 print issue with the headline "Gaining on us," p. 41-4.