Maria, a young first-time mother-to-be ambled into my clinic, handing me the slip of paper on which her weight, blood pressure and test results for sugar and albumin (a type of protein) in her urine were recorded.
"Have I put on too much weight? Am I getting too fat?" she asked worriedly.
Putting on weight is one of the most feared consequences of pregnancy. Weight gain, stretch marks and the possibility that all these "extras" will stay after delivery fill many a woman with dread.
And many aspire to be like Catherine, the Duchess of Cambridge, who has sailed through pregnancy with aplomb and glamour.
Carrying a baby that needs space and nourishment is like growing a new organ.
The pregnant woman's body makes more blood, and her heart and lungs work harder to ensure the foetus gets adequate oxygen and nutrition.
The abdomen balloons and, often, the abdominal muscles have to separate to accommodate the growing foetus and womb.
Even a lovely "innie" belly button starts protruding.
Foetal growth is more rapid in the late second trimester and that is when stretch marks begin to appear.
The breasts grow larger and develop into milk-producing organs.
These changes - together with additional fat being stored as a reserve, water retention, and the development of the placenta and the fluid the foetus swims around in - all add up to the significant weight gain.
A recent study in KK Women's and Children's Hospital found that the amount of weight gain for a healthy pregnancy will vary according to one's body mass index (BMI).
If a woman is of normal weight, it may be 13kg, but if she is obese, 7kg may suffice.
Having a high BMI before pregnancy or putting on excessive weight during pregnancy is associated with higher risk of gestational diabetes, hypertension and requiring a caesarean section.
EATING HEALTHILY FOR BABY
In my clinic, Maria's husband blurted out: "She is always eating fried chicken and drinking cola."
She glared at him for letting her secret out.
I re-emphasised the importance of eating healthily, not excessively for the baby. I advised her to go for nutrient-dense food, including five portions of fruit and vegetables, and to have a balanced diet.
"Just because you crave something does not mean you need it. Once you eat it regularly, then this becomes a habit. Cultivate good eating habits. The one thing you have control over during pregnancy is your weight," I advised.
I encouraged her to do some exercise, such as walking or swimming, but could not help having a nagging suspicion that this would fall on deaf ears.
Many people have the misconception that once pregnant, a woman should avoid exercise altogether or risk having a miscarriage.
On the contrary, exercise can be done safely during pregnancy.
The important thing is not to exhaust yourself.
Studies have shown that women who keep active and fit cope better with pregnancy and have fewer problems during labour.
Finally, I tried to persuade Maria to adopt a healthy lifestyle by telling her that rapid weight gain increases the likelihood of stretch marks.
After that, the rate of her weight gain slowed, but the amount was still a bit too much for her petite frame.
Despite seeing the dietitian, she could not resist the temptation of accessible and affordable fast food.
I reassured her that even though she had failed to attain a desirable weight during pregnancy, the most important thing for her was to be healthy and she could still lose weight after delivery.
BREASTFEEDING BONUS
Generally, most of the weight gain in pregnancy - except the fat reserve meant to fuel breastfeeding - is lost soon after delivery.
The woman's body is remarkable in its capacity to "bounce" back from the strain of pregnancy, albeit never exactly to its original condition.
Six weeks after delivery, Maria strode in, looking almost like her usual svelte self, but just a little rounder, and with her chubby baby boy in her arms.
The surprise on my face must have been obvious because the moment she saw me, she said: "Breastfeeding lah!"
Breastfeeding burns about 500 kilocalories per day - equivalent to the amount used in an hour on the treadmill.
Breastfeeding also forges a close bond between mother and baby. This means that breastfeeding mothers often carry their babies close to them and tend to be active.
Besides providing complete nutrition and protection from infection, breastfeeding also helps keep the baby's weight healthy.
Breastfeeding for six months can reduce the risk of obesity up to 30 years down the road for the baby, a British study reported recently in the International Journal Of Obesity.
So the moral of the story is: do not wait till after birth to battle the fat. Eat healthily, keep active and breastfeed.
Dr Yong Tze Tein is a senior consultant at the department of obstetrics and gynaecology at Singapore General Hospital. She is also the president of the Association for Breastfeeding Advocacy (Singapore) and a member of the Baby Friendly Hospital Initiative Committee.
This story was first published in The Straits Times on Oct 10, 2013
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