Eating for two is a common saying associated with pregnancy.
In a little over a decade, I feel like I’ve been pregnant too many times to count.
I’ve experienced enough pregnancies to know pregnancy hunger is no joke.
At the same time, pregnancy aversions, sickness, etc. are also no joke.
I experienced ravenous pregnancy appetites with some of my children, but also hyperemesis gravidarum (severe sickness and aversions) with others.
So you can imagine my relief after reading a study that finds gaining too much weight, and gaining too little weight, are both associated with serious complications and risks.
Just in case you couldn’t tell, that was sarcasm.
The pregnant-and-ravenously-hungry-at-9pm me doesn’t want to hear a double serving of chocolate chip cookies isn’t ideal.
And the me who’s pregnant and vomiting at 4am doesn’t want to hear not gaining enough weight can increase the risk of complications.
‘Eating For Two’ Comes With Serious Risks For Mama And Baby, Study Finds
So, why did I read these studies about eating for two?
And why write this article?
Because even if it’s hard to hear, and even if it’s hard to choose a healthier option when we’re hungry at 9pm, we all need evidence-based information to help us make the right choices for ourselves and our babies.
It would be nice to be able to eat whatever, and whenever, we want.
It would be good not to stress about our inability to eat enough.
But that’s just not how it works.
Realistically, it doesn’t even work that way outside of pregnancy, but that’s a whole other article.
Although I’d love to gloss over the information and not pass it on to you, I can’t.
Here’s what the study found:
How Is ‘Eating For Two’ Harmful For Mama And Baby?
Researchers in Hong Kong analysed 905 mother baby pairs and compared pregnancy weight gain with the Institute of Medicine’s (IOM) pregnancy weight gain recommendations.
They found children born to mothers who gained more than the IOM guidelines recommended were more likely to:
- Have high blood pressure
- Develop insulin resistance, which increases the risk of eventually developing type 2 diabetes
- Be predisposed to macrosomia (large size at birth)
- Have a higher than average BMI, increasing the risk of future diabetes, stroke, etc.
The risks to the mother include an increased risk of developing gestational diabetes, which increases her risk of some pregnancy and birth complications, such as:
- Complications associated with giving birth to a large (macrosomic) baby
- Pregnancy hypertension
It also involves a long-term increased risk of developing type 2 diabetes later in life.
Interestingly, some of the increased risks found in babies born to mothers who gained more than the recommended weight were also seen in infants born to mothers who gained too little weight.
Infants born to women gaining too little had an increased risk of insulin resistance and hypertension.
Even though each mother, baby and pregnancy is unique, this evidence suggests the IOM pregnancy weight gain guidelines support healthy pregnancy outcomes.
How Much Should Pregnant Women Eat?
Well, the ravenously hungry pregnant me says, ‘ I’ll eat as much as my appetite wants’.
The sick at 4am pregnant me says, ‘I’m not hungry, so stop pestering me to eat more’.
Unfortunately, evidence and risks don’t particularly care what my pregnancy appetite says.
Most professionals recommend eating an average 300 extra calories per day during pregnancy.
That means usually a bit less in the first trimester – around 200 calories – and closer to 400 in the third trimester.
Lead researcher, Professor Wing Hung Tam, cautions against bringing back mandatory pregnancy weigh-ins.
It is important, however, to educate pregnant women about the role of nutrition and weight gain during pregnancy.
“What’s more important is that ‘eating for two’ could be harmful. A pregnancy requires an extra 300 kcal per day.
“What a pregnant mothers need is a balanced diet, meeting such requirements with adequate micronutrients.
“They also need to have moderate exercise to avoid putting on excessive weight,” Tam said.
So, unfortunately, we shouldn’t double our caloric intake and ‘eat for two’ while pregnant, even with our ravenous pregnancy cravings.
We should stick to around 300 extra calories per day from food sources with adequate micronutrients, and also remain physically active.
The former ravenous pregnant me wouldn’t have appreciated this advice while downing my second bowl of noodles at 7pm.
Neither would the not eating enough sick pregnant me.
However – and certainly this is anecdotal, and doesn’t replace the research results mentioned – after one pregnancy where I gained less than recommended, I went on to experience health problems related to insulin resistance.
Our pregnant bodies are vulnerable to side effects when we cannot, or choose not, to eat healthily.
The good news? For most women, there are many ways to reduce the risk of gaining too much or too little, or of developing gestational diabetes.
What Should Pregnant Women Eat?
My simplest answer: you’re an adult and you should make your own choices about what you eat.
The long answer is: what you do choose to eat can be a benefit in your pregnancy or it can increase your risks in pregnancy.
Having evidence-based information to make informed decisions is part of making your own choices about what to eat.
Reproductive health specialist, Dr. Andrew Orr, has plenty of experience running a reproductive health clinic.
Based on this, he says he’s seen an increase in excess pregnancy weight gain and gestational diabetes due to higher carbohydrate diets and a lack of protein.
For women at risk of, or already diagnosed with, gestational diabetes (GD), or for anyone aiming for optimal pregnancy health, Dr. Orr recommends:
- Watching your diet. “You need to follow a strict, low GI diet. The best diet to follow is a grain-free diet such as the paleo/primal/zone diet. This way you are cutting out the inflammatory foods that spike your blood sugars and then spike your insulin”. He recommends a high protein intake, especially by consuming nuts. He also recommends healthy oils and fats, such as coconut and olive oil.
- Getting involved in physical activity. Research has found a healthy diet, combined with physical activity during pregnancy, reduces the risk of developing GD by 83%.
You can read Gestational Diabetes | Diet and Symptoms to learn more.
Regardless of your risk level, pregnant women need adequate intake of many macro and micronutrients.
I also believe pregnant women should eat to satisfy their hunger.
Now isn’t the time to let yourself starve; just make healthy choices when you are hungry.
You needn’t completely deprive yourself of anything that is good, obsessively count calories, or weigh yourself in fear.
However, you should be intentional about eating to the best of your ability.
These foods might help you feel satiated while providing good nutrition.
They should be incorporated into your diet while you’re pregnant.
- Avocado and other healthy fats like eggs and butter
- Nuts and seeds
- Healthy oils – for example, using olive oil in salad dressing, or cooking with healthy oils
- Low mercury fish and other sources of omega-3s and protein
- If you’re on a plant-based diet, chia seeds, flax seeds, seaweed, and nuts are great sources of omega-3s
- Leafy greens
Be sure to read 5 Yummy, Healthy Foods Every Pregnant Woman Needs To Eat to learn more.
I’m Pregnant And All I Crave Are Carbs. What Can I Do?
If you’re pregnant and craving carbs, this article probably seems completely irritating and useless.
The ravenously hungry pregnant me agrees.
Unfortunately, indiscriminate consumption of every carb around (been there) isn’t without risk.
In my own experience, I’ve found not letting myself get too hungry helped dramatically.
Have a handful of nuts to nibble on in the morning, instead of crackers. It keeps some nausea and carb cravings at bay.
Eating before I became ravenous helped me avoid indulging every craving.
These two articles offer a bit more advice on preventing an over-indulgence in carbs: