What to expect when you're expecting (23 page)

Not gaining enough weight during pregnancy can lead to a number of problems, including preterm delivery and a baby who is small for his or her gestational age.

Just being committed to conquering your eating disorder, so that you can start nurturing that beautiful little baby of yours, is a first and most important step. You’ll also need to understand the dynamics of weight gain in pregnancy. Keep in mind:

The pregnant shape is universally viewed as healthy and beautiful. Its roundness is normal, a sign that you’re growing a baby. Celebrate those curves! Embrace your pregnant self!

You’re supposed to gain weight during pregnancy. The right amount of pregnancy weight gain is vital to your baby’s growth and well-being as well as to your own health.

Weight gained at the right rate, on the right foods, will go to the right places (your baby and those essential baby by-products). If you stay within the recommended guidelines (which are higher for those who begin pregnancy significantly underweight), the weight won’t be that difficult to shed once the baby arrives. This strategy (a moderate amount of weight gained steadily on nutritious foods) will help ensure a speedier return to your prepregnancy shape postpartum and help ensure a healthier baby.

When you starve yourself, you starve your baby. Your baby depends on you for a steady shipment of nutrients. If you don’t eat, neither does your baby. If the nutrients you take in are purged (by vomiting, taking laxatives, or taking diuretics), your baby won’t have enough left to grow on.

Exercise can help you keep your weight gain reasonable, while guiding those extra pounds to the right places. But any exercise program you choose should be pregnancy appropriate (check it out with your practitioner first), and strenuous exercise (or too much exercise, which can burn too many calories or raise your temperature excessively) should be avoided.

All of the weight gain of pregnancy
won’t drop off in the first few days after delivery. With sensible eating, the average woman returns to close to—but does not hit—her prepregnancy weight about six weeks after delivery. Getting all the weight off and getting back into shape (which requires exercise) can take much longer. For this reason, many women with eating disorders find that negative feelings about their body image cause them to slip back into bingeing and purging or starving during the postpartum period. Because these unhealthy habits could interfere with your ability to recover from childbirth, to parent effectively, and to produce milk if you choose to breastfeed, it’s important that you continue professional counseling postpartum with someone experienced in the treatment of eating disorders.

The most important thing to keep in mind: Your baby’s well-being depends on your well-being during pregnancy. If you’re not well nourished, your baby won’t be, either. Positive reinforcement can definitely help, so try putting pictures of cute chubby babies on the fridge, in your office and car, anywhere you might need a reminder of the healthy eating you should be doing. Visualize the food you eat making its way to your baby (and your baby happily gobbling up the meals).

If you can’t seem to stop bingeing, vomiting, using diuretics or laxatives, or practicing semistarvation during pregnancy, discuss with your physician the possibility of hospitalization until you get your disorder under control.

“I’m 38 and pregnant with my first baby. I’ve read so much about the risks of pregnancy after 35 and wonder whether I should worry.”

Becoming pregnant after 35 puts you in good—and growing—company. While the pregnancy rate among women in their 20s has dropped slightly in recent decades, it has increased nearly 40 percent among women over 35. And though the number of babies born to women in their 40s remains relatively small, their ranks have also increased by a third in recent years.

If you’ve lived for more than 35 years, you’re probably aware that nothing in life is completely risk free. These days, pregnancy risks are very small to begin with, but they do increase slightly and gradually as you get older. However, the many benefits of starting a family at the time that’s right for you can far outweigh any small risks (all of which can be reduced anyway, thanks to medical advancements).

The major reproductive risk faced by a woman in your age group is that she might not become pregnant at all because of decreased fertility. Once you’ve overcome that and become pregnant (congratulations!), you also face a somewhat greater chance of having a
baby with Down syndrome. The incidence increases with mom’s age: 1 in 1,250 for 25-year-old mothers, about 3 in 1,000 for 30-year-old mothers, 1 in about 300 for 35-year-old mothers, and 1 in 35 for 45-year-old mothers (you’ll notice the risk gradually increases with age—it doesn’t just spike at 35). It’s speculated that this and other chromosomal abnormalities, though still relatively rare, are more common in older women because their eggs are older, too (every woman is born with a lifetime supply of eggs that age along with her), and have had more exposure to X-rays, drugs, infections, and so on. (It is now known, however, that the egg is not always responsible for such chromosomal abnormalities. An estimated minimum 25 percent of Down syndrome cases can be linked to a defect in an older father’s sperm.)

Is 35 the Magic Number?

Just because you’ve already clocked in 35 years doesn’t mean you’ll necessarily need more or different testing than your younger pregnant pals. In fact, screening tests are recommended for all women, regardless of how many birthdays they’ve celebrated—and only those whose screens show a possible elevated risk need to consider more invasive prenatal diagnosis.

A handful of other risks increase slightly with age. Being older, particularly over 40, means you might be more likely to develop high blood pressure (particularly if you’re overweight), diabetes, or cardiovascular disease during pregnancy—but all of these conditions are more common in older groups in general, and all are usually controllable. Older mothers-to-be are also more subject to miscarriage (because of their older eggs), preeclampsia, and preterm labor. Labor and delivery, on average, are longer and slightly more likely to be complicated, with C-section and other forms of assisted delivery (such as vacuum extraction) more common. In some older women, a decrease in muscle tone and joint flexibility may make labor a little tougher—but for many others, especially those who are in excellent physical shape thanks to regular exercise routines and healthy eating, this isn’t the case.

But in spite of these slightly increased risks, there’s lots of good news for expectant moms over 35, too. Today’s older mothers have more going for them than ever before. Though Down syndrome isn’t preventable, it can be identified in utero through a variety of screening and diagnostic tests. Even better news: Today’s essentially noninvasive first-trimester screenings (see
page 59
), which are recommended to all pregnant women regardless of age, are much more accurate than in the past, which means they screen out moms who don’t necessarily need to proceed to a more invasive diagnostic test (even moms-to-be over 35)—saving money and stress. Chronic conditions that are more common in older moms can be well controlled. Drugs and close medical supervision can sometimes forestall preterm labor. And medical breakthroughs continue to decrease risks in the birthing room.