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Plus-Sized and Pregnant

Seven steps to a healthy nine months (and beyond).

Photo: Thinkstock

When you're pregnant and overweight, it's easy to let yourself ride the guilt train, big time. After all, everywhere you turn, some magazine's telling you how dangerous your weight is for baby or how you should have dropped the weight before getting pregnant. (Sound familiar?) And while it's definitely true that your weight can put you at risk for certain complications like gestational diabetes and preeclampsia, trust us -- even though it's ideal to work towards a BMI of 18.5 to 24.9, a higher BMI doesn'tmean you're necessarily doomed to a rough pregnancy. It just means you need to be extra-aware of what to look out for. So for all the plus-sized mamas out there who may be stressing right now: chill. We've got your basic guide to having a healthy, guilt-free, and totally kick-ass pregnancy -- a few extra pounds and all.

STEP 1: FIND THE RIGHT DOCTOR

Okay, so it goes without saying that it's beyond important to have a doctor who makes you feel comfortable -- but in this case, it's especially important to choose a doc you're comfortable enough to talk openly with about your weight (without feeling judged). If you feel like your provider talks down to you, makes you feel uncomfortable, or worse, doesn't address your weight at all, it's time to find a new practice.

STEP 2: KNOW YOUR RISKS

Though gestational diabetes (GD) and preeclampsia get the most notoriety among all of the risks associated with being overweight and pregnant, there are (sorry to say) many more you'll want to be aware of. According to Dr. Ashley S. Roman, MD, MPH, Maternal Fetal Medicine Specialist at the New York University School of Medicine, women who enter pregnancy with a high BMI also have a higher risk of miscarriage, preterm labor, high blood pressure, certain birth defects, postpartum hemorrhage, postpartum blood clots, postpartum pneumonia, postpartum depression, c-section wound infection, having a large baby, having a baby that gets stuck on the way out, and having a c-section. [PAUSE. DEEP BREATH.] Now remember that you aren't a statistic. You’re you. And now that you know those risks, you can work on lowering them. Talk to your doctor about things you can do to help, like keeping tabs on your blood pressure, taking extra folic acid, and generally taking good care of yourself.

STEP 3: EAT RIGHT & EXERCISE

Cliché? Maybe. But this is your primary defense against all those risks we just spewed at you. A healthy, well-balanced diet and regular moderate exercise are extra, extra-important during pregnancy -- plus-sized or not. So keep your focus on maintaining a balanced diet, taking your prenatals, getting plenty of fluid, and keeping active. Dr. Roman stresses that it's also crucial to get up and moving ASAP after delivery in order to lower health risks. Plus, this will help shed those pregnancy pounds and set you on a path towards a lower BMI before any future pregnancies. (Need a new workout routine? Try our pregnancy workout plan now.)

STEP 4: WATCH THE SCALE

Don't weigh yourself every day (it'll just drive you nuts), but do keep tabs on your pregnancy weight gain. The American Congress of Obstetricians and Gynecologists (ACOG) recommends that patients with a BMI of 25 to 29.9 gain 15 to 25 pounds, and that moms-to-be with a BMI over 30 (considered obese) limit weight gain to 11 to 20 pounds. For women with a BMI over 40, they actually mention that modest weight loss "may be recommended," with close supervision by your doctor. So steer clear of fad diets and never take diet pills. In fact, as a rule of thumb, don't "diet" at all without your doc’s approval.

STEP 5: NETWORK

Remember: You aren’t alone. In fact, over 60 percent of the US population is overweight (BMI 25+). Seek out other plus-sized mamas in your community and online (our message boards are a good place to start). Women who have been in your shoes are probably the best people to talk to and can offer loads of support and helpful tips -- like where to shop for plus-sized maternity clothes, which can be pretty darn elusive. (Our pick? Try Old Navy.)

STEP 6: KEEP SOME TRICKS UP YOUR SLEEVE

Here's the lowdown on a few things you might not expect:

• Ask for a bigger blood pressure cuff if you need one, and ask if they'll write it on your chart so you don't have to ask every time.
• If your veins are tough to find (for drawing blood or placing an IV), try holding something warm against your arm for a few minutes before a nurse comes at you with a needle. (ThermaCare HeatWraps work well.)
• Epis can be tougher to place in larger women, as can intubation, if it becomes necessary. Ask your doc about setting up a consultation with the anesthesiologist to assess your airways and plan for accessing your epidural space to make for a smoother delivery day.
• Studies show that overweight women tend to be in active labor over an hour longer than usual. So if your doc suggests a c-section due to a "stalled labor," make sure he isn't comparing you to smaller moms. You might be progressing normally for your size.
• Dealing with a c-section incision can be more difficult for overweight women because it can be harder to get to the incision area. If you have a cesarean, talk to your doc about how to care for your incision to keep it dry and help it heal so you don't wind up with an infection.

STEP 7: ENJOY

This is the most important part! Give yourself permission to be excited about your growing belly, and accept the fact that yes, you are a gorgeous, glowing mama-to-be.

Are you a plus-sized mom? What are your best tips for other overweight mamas-to-be?

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Nutrition During Pregnancy