The moment Christie Maruka, 46, found out she was pregnant, she came up with a plan to eat healthy foods and exercise so she wouldn’t gain too much weight.
Like many other health-conscious women, Maruka, who lives in Wall, New Jersey, worried about developing gestational diabetes and other pregnancy complications that can occur with pregnancy weight gain.
As a fashion stylist and wardrobe consultant, she also feared something her clients had warned her about for years: not losing the baby weight.
“My image is very important to me,” Maruka said. “I wasn’t going to buy a whole new wardrobe in a different size.”
Over the course of her pregnancy until she delivered in June 2003, Maruka, gained a total of 20 pounds, which at her pre-pregnancy weight of 116 (she’s 5’3”), is five pounds below the Institute of Medicine’s recommendations for pregnancy weight gain.
She cut out all junk food and loaded up on vegetables and high-protein, low-carbohydrate meals and snacks.
“In order to combat morning sickness, dizziness or weakness, I would eat every three hours around the clock until I went to bed,” she said.
Once a week, she would allow herself a slice of pizza and would only indulge in a half a slice of cake on special occasions.
Maruka exercised for 90 minutes, six days a week— a combination of using the elliptical, weight lifting, outdoor biking and roller blading. At 9 p.m. every night, she’d take a 60-minute walk.
Although Maruka thought her pregnancy was healthy, as she got closer to 40 weeks, her doctor expressed concerns. The baby was measuring at just four pounds, so he suggested she cut back on her exercise routine.
But Maruka wasn’t worried and anticipated that the baby would weigh about five pounds. She continued to hit the gym.
“I wanted to be in good shape after I gave birth,” she recalls.
Who doesn’t gain enough?
The Centers for Disease Control and Prevention (CDC) estimates that 47 percent of women gain too much weight during pregnancy.
Yet experts agree that in our celebrity-obsessed culture where stars are back in their bikinis two weeks after giving birth, women who cut calories, over-exercise, weigh themselves daily and become obsessed with gaining weight during pregnancy are a real phenomenon.
In fact, 48 percent of pregnant women admit to cutting calories, restricting entire food groups and over-exercising, according to a 2012 survey by SELF magazine and CafeMom.com.
A 2015 study in the journal Obstetrics and Gynecology found that nearly 21 percent of women do not gain the recommended amount of weight during pregnancy.
“We know that pregnancy means weight gain. And in our culture, weight gain is always [seen as] a bad thing,” said Rebecca Scritchfield, a registered dietitian nutritionist and a health and happiness expert in Washington, D.C.
Pregnant women who watch their weight are even glorified for how great they look, which only reinforces the idea that they shouldn’t be gaining weight, said Kelley Kitley, a licensed clinical social worker in Chicago, Ill. who specializes in pre- and post-natal anxiety and depression.
Although most women understand the risks associated with gaining too much weight during pregnancy, for some the fear takes control of their lives.
“There’s so much negativity that drives this fear that then drives them to make these potentially harmful choices,” Scritchfield said.
Plus, some OB-GYNs who have the right intentions but aren’t “psychologically savvy” can compound the problem if a woman has gained too much weight and may even instruct her not to gain any more, Kitley said. Although some women may take it with a grain of salt, “the ones that maybe had anxiety disorders or were body-image conscious before are really struggling with it,” she said.
Women who are hyper-focused on their weight might actually fear having a baby and how their lives will change.
“Pregnancy is so out of control [and] the food and exercise is really a coping mechanism,” Kitley said.
Health risks to mom and baby
When a woman is pregnant, she faces a higher risk of bone and muscle loss, vitamin and mineral deficiencies, and anemia, not to mention fatigue and weakness.
If a mother isn’t eating enough or is over-exercising, the baby is at risk for intrauterine growth restriction (IUGR), a condition in which the baby doesn’t grow normally and has a low birth weight, said Dr. Daniel Roshan, an OB-GYN and director of ROSH Maternal-Fetal Medicine in New York City.
IUGR is usually caused by problems with the placenta, or other complications and can lead to problems during delivery and the need for a cesarean section. Small babies may need to be monitored in the NICU and can have trouble breathing, feeding and have low Apgar scores. They may also have problems with brain development and intellectual disabilities, Roshan said.
A study out of the U.K. found that women who don’t eat enough calories during pregnancy actually increase their baby’s risk for obesity later on in life.
Even more alarming is a study in the American Journal of Public Health which found that babies born to women who didn’t gain enough weight during pregnancy were more likely to die in the first year of life, compared to those women who gained more.
Stay focused on health, not weight
Two and half weeks after she gave birth, Maruka was back in the gym lifting weights, despite the recommendation to wait six weeks. Her son weighed 5 pounds, 7 ounces, which is considered a low birth weight. According to Roshan, who did not treat Maruka, the ideal birth weight is between 7 and 7.5 pounds
According to the National Institutes of Health, some low birth weight babies may be more at risk for certain health problems, such as developing infections early in life, or delayed motor and social development.
Even though she ignored her doctor’s warnings— potentially putting her baby at risk— Maruka said she’s proud of how she maintained what she considered to be a healthy weight during her pregnancy.
"My baby was a perfect weight for me being that I am a petite person and I was praying I wouldn't have to push out a eight or more pound baby,” Maruka said, adding that her son had the same birth weight as she did.
Experts say instead of placing too much emphasis on calories, workouts and the scale, pregnant women should eat well-balanced meals and snacks, listen to their hunger cues and exercise, but never to exhaustion. If they’re worried about weight gain, Scritchfield advised approaching it with “sense of calm and trust.”
"Rather than looking at your weight gain every day or even every week, you look at the patterns... [When] you look at patterns with your doctor that's based on flexibility and not fear, you'll see that most people gain within the range of what's recommended without trying to intervene and control it,” she said.
It’s also important to realize that pregnancy is unpredictable, so when morning sickness, cravings, hormonal fluctuations and energy levels interfere, be flexible and stay calm.
“When fear ends up driving the car, you end up making irrational choices that cause more stress, which is not good for you or the baby,” Scritchfield said.