A Body-Positive Pregnancy Guide for People of Size

As you approach a pregnancy in a higher weight category, your focus (understandably) may be on the health of your growing baby. But your health matters, too, and it can be adversely affected by weight-related complications.

Possibly the most well-known risk in a higher-weight pregnancy is that of developing gestational diabetes. This preggo-specific condition causes high blood sugar that needs to be controlled through diet or medications (and usually goes away after the bun is released from your proverbial oven).

The connection between overweight and gestational diabetes is real: Research from 2010 found that nearly half of all gestational diabetes cases could be attributed to overweight and obesity. According to the American College of Obstetricians and Gynecologists (ACOG), having gestational diabetes also ups your risk of a cesarean delivery.

Rates of miscarriage and stillbirth also go up with higher maternal weight. The ACOG states that “The higher the woman’s BMI, the greater the risk of stillbirth” and notes that women with obesity have an increased risk of miscarriage.

Research has established, too, that extra weight makes you more likely to have preeclampsia — a fancy word for high blood pressure in pregnancy that can cause swelling and damage vital organs like the liver and kidneys.

Finally, getting pregnant may simply mean you’ll have more aches and pains, like the all-too-common back pain that tends to crop up as pregnancy progresses.

Since these health risks aren’t insignificant, it’s important to discuss them with your doctor before getting pregnant, if possible.

Related: Pregnancy stretches for your back, hips, and legs

Just as your weight can make a difference to your health in pregnancy, it can affect baby’s well-being, too. Not surprisingly, one major concern is the size of your baby in utero (and on the way out).

Since gestational diabetes often leads to higher birth weight, if you have this complication, you may end up with a larger baby. While chubbier babies are, of course, adorable, their size can make their exit more precarious; high birth weight babies may actually get injured during vaginal delivery.

Another consideration for baby’s health is the possibility of a preterm birth. A large Swedish study found that people with overweight and obesity were at higher risk of delivering too early. Babies delivered preterm are more likely to have problems with a number of organ systems, including (but not limited to) the heart, lungs, brain, and gastrointestinal tract.

Learning the risks of pregnancy for yourself and baby may feel a bit overwhelming. Thankfully, there are steps women of size can take to reduce the chances of landing with weight-related complications.

Your first — and best — line of defense? Start early.

“It’s best to plan at least 6 months ahead of actually getting pregnant so you can be your healthiest self before carrying your most vulnerable passenger,” says Sherry A. Ross, MD, an OB-GYN and women’s health expert at Providence St. John’s Health Center in Santa Monica, California.

Ross encourages working with your doctor and/or a dietitian to get into your best pregnancy shape through diet and exercise.

If losing weight pre-baby wasn’t in the cards and you’re already “on the nest,” healthy food choices and increased activity are still best bets for maintaining a healthy weight — and, therefore, a healthier pregnancy.

“Well-controlled weight gain during pregnancy is key,” says Jamie Lipeles, DO, founder of Marina OB/GYN in Marina Del Rey, California. “The most important steps a [woman with extra weight] can take to avoid all the mentioned risks are diet and exercise.”

And don’t forget to stick with your prenatal vitamins. “In addition to a well-balanced diet, I encourage my patients to begin taking prenatal vitamins and additional folic acid prior to getting pregnant,” says Lipeles. (Of course, keep taking them while you’re pregnant, too!)

Related: The 11 best prenatal vitamins for a healthy pregnancy

And now for the million-dollar question: Just how much weight should you gain over 9 months if you’re a person of size? According to the CDC, for a single-child pregnancy, a woman who is overweight should aim to gain 15 to 25 pounds. Those with obesity should gain 11 to 20 pounds.

Ross emphasizes that a slow start is usually best when it comes to weight gain in your pregnancy. Over the course of your three trimesters, she explains how this might look: “You should gain about 2 to 4 pounds during your first 3 months of pregnancy and a half pound a week for the remainder of your pregnancy.”

The baby bump is the most obvious visual indicator of pregnancy — anticipated by family members, photographed for Instagram, and proclaimed by tabloids about celebrity pregnancies. But for women of size, this particular outward sign of pregnancy may or may not be “a thing.”

“A [woman who is overweight] may never show during pregnancy,” says Ross. “There are so many variables taken into consideration when she is pregnant, especially her starting weight and how much she gains during the pregnancy.”

But don’t dismay! Eventually your bump is likely to pop. “Usually by the last couple months of pregnancy, the abdominal area grows in such a way to expose the pregnancy, regardless of [size],” Ross notes.

According to Lipeles, the appearance of your baby bump may also depend on your body shape — for example, whether you’re more of a so-called “apple” or “pear.”

“[Women of larger size] with a pear-shaped body can expect to show only slightly later in the pregnancy than other women. Pear-shaped women [of larger size] will likely show between 16 and 20 weeks,” he estimates.

“In contrast, some women will have a different weight distribution and body type, referred to as apple-shaped body. The apple-shaped woman [of larger size] can expect to show between 20 and 24 weeks of pregnancy.”

Sometimes, you may be feeling physically great and emotionally pumped about meeting your sweet little bundle — only to have a family member or stranger at the grocery store make an insensitive remark about your weight and your pregnancy. Ouch. (Or perhaps a comment comes when you were already feeling low — double-ouch.)

When others speak unkind words, try to remember that your weight isn’t anyone else’s business. The only people who have a right to discuss your size are you, your doctor, and anyone else you choose to allow in the conversation.

If negative comments continue to bring you down, try a simple visualization for resilience, such as imagining yourself surrounded by a shield of armor that protects you against hurtful words.

While you’re at it, don’t forget to document (and celebrate) your successes! Taking time to acknowledge your progress — whether going to the gym twice in a week or passing your gestational diabetes test with flying colors — can build the positive sense of self that will help you brush off other people’s demeaning comments.

We’ve covered a lot of ground, but you may be left with one question: Can your pregnancy be a healthy pregnancy? Though overweight and obesity do bring increased risks, in the end, you have some control over the answer.

“Pregnancy is a great excuse to live a healthy lifestyle,” says Lipeles. “Most often, pregnancy encourages women to learn about diet and exercise and live the healthiest lifestyle they have ever lived! For a woman [who is overweight], this new healthy lifestyle will yield a happy, healthy pregnancy.”