UAE: Pregnant women ‘eating for two’ puts babies at risk

Pregnancy brings dramatic changes to a woman’s body, not least the inevitable weight gain as her baby and its placenta take up residency in the womb, alongside a healthy stash of amniotic fluid. Then there's all that extra blood and fat the body starts hoarding for pregnancy and breastfeeding. It's perfectly healthy, therefore, for women to put on a certain amount of weight during pregnancy. But with recent research highlighting worrying links between gestational weight gain and children’s health problems, as well as studies that show an increase in emotional eating for pregnant women experiencing stress during the pandemic, just how much weight can a woman put on and still maintain a healthy pregnancy?

A sensitive subject

For many women, pregnancy is a time to surrender her body to Mother Nature and embrace all the changes - weight gain included - even using pregnancy as an excuse to eat whatever she wants for the first time in her adult life (midnight chocolate cravings, anyone?). And, with morning sickness and extreme fatigue playing havoc with her hormones, who can blame a gal for seeking comfort in cake?

But although the old adage of ‘eating for two’ is still prevalent, the official health advice is very different. Rates of obesity amongst women of child‐bearing age in developed countries have increased steadily since the 1980s, and the public health concern regarding gestational weight gain has shifted from one of inadequate nutrition to one of excess weight gain.

It's something of a sensitive subject, especially here in the UAE, where the melting pot of cultures gives rise to mixed messages about what is considered a 'normal' amount of weight gain in pregnancy. What's more, pregnancy can be stressful enough as it is without the added anxiety of constant weight monitoring. So much so that in the UK mandatory weigh-ins for pregnant women were abolished in the 1990s as it was believed that the stress and anxiety it heaped on mothers outweighed any benefit.

Until recently, that is. In 2018 The Royal College of Midwives called for a return to regular weight monitoring following new research. The report, published in Diabetologia, the journal of the European Association for the Study of Diabetes, found a link between pregnancy weight gain and an increased risk of high blood pressure and poor blood sugar control. This echoes multiple studies that show a link between even a mild increase in glucose in pregnant women and an increased a risk of diabetes and obesity in off-spring. In fact, Australian health authorities have gone a step further as a result of new findings. A recent recommendation in the Medical Journal of Australia advocates monitoring the weight of pregnant women even more closely, and discussing weight, diet and fitness at all antenatal appointments.

While there are currently no such set guidelines in place in the UAE, women here are generally weighed routinely at each appointment.

"On average women should gain around 10 to 12kg during pregnancy, this is considered healthy as per the World Health Organisation guidelines," explains Hazel Leonard, lead midwife at UAE-based maternal support service Babies and Beyond. "However, some clinicians may vary their recommendations depending on individual health assessments and the mother's health needs.” She adds, "Weight is one way of assessing maternal wellbeing, so this is usually monitored at every appointment here in the UAE."

One eye on the scales

According to Dubai's Department of Health, obesity is one of the biggest health concerns facing women of childbearing age in the region. Coupled with the complications that can arise from unhealthy weight gain in pregnancy - preterm birth, gestational diabetes, increased risk of miscarriage, for example - it might seem prudent to keep one eye on the scales.

Cecile De Scally, midwife at UAE-based parental support service Malaak Mama & Baby Care warns of some of the further complications that can arise from excessive weight gain in pregnancy: "High blood pressure as a result of weight gain can cause damage to other organs, most often the kidneys, while the increased pressure on the heart can lead to cardiac problems. Weight gain can also cause sleep apnea, and make vaginal birth more difficult - resulting in the need for a C-section. Recovering from the C-section can also take longer as there is an increased risk of wound infections, and mobility problems can result in chest infections and deep vein thrombosis."

What's more, being overweight in pregnancy can also have an adverse effect on your baby, continues Cecile. "Your baby could be larger than average (a condition called fetal macrosomia) and have more body fat than normal. This increases the risk of blood sugar concerns in the first few days, which can continue into a possible metabolic syndrome and childhood obesity," explains Cecile. She adds, "Any birth defects are also harder to detect with an ultrasound if the mother is overweight."

New UAE study on eating habits in pregnancy

A study published in Nutrition Journal in April 2020 looked at the eating habits of pregnant women in the UAE and found that they tend to fall into two distinct camps: a ‘Diverse’ approach, in which the women increased their levels of fruits and vegetables and mixed dishes, and a ‘Western’ approach, in which they ate more sweets and fast foods. The latter pattern was associated with greater gestational weight gain – something which the researchers say is concerning. “The first one thousand days, including days spent in utero, are considered a critical and sensitive window in the lifespan, during which environmental exposures have a long-lasting impact on the baby’s growth and future health,” say the researchers. “Emerging evidence suggests that the quality and quantity of the mother’s nutrition during pregnancy is an important modifiable environmental factor that is associated, not only with growth and development of the fetus but also with the early programming of chronic diseases’ development later in life including hypertension, diabetes, cardiovascular disorders, obesity, as well as neuropsychological disorders.”

The pandemic has also introduced some further challenges; with reduced doctor visits, it may be harder to stay abreast of your own pregnancy weight gain in a healthy way, while Chinese research has also noticed a pattern of emotional eating related to COVID-19 stress in pregnant women, which has exacerbated gestational weight gain amongst some.

It's a scary picture, but addressing the issue head-on, as Australian authorities have, comes with the added consideration of the mother's mental health. After all, pregnancy during a pandemic is a stressful enough time without worrying whether that extra helping of chips is going to wreak havoc on you and your baby's health.

The flip side

The flip side of the argument is the stress that such stringent attention to weight can cause for pregnant women – and anxiety during pregnancy can also be harmful for her growing baby.

For Molly Richards*, a UAE-based writer and mother of two who has a history of an eating disorder, the constant weighing and pressure surrounding her weight while she was pregnant triggered her into some old, unhealthy patterns of thought. “When I went to have my anomaly scan at 20 weeks, I was disgusted that the results included a calculation of my BMI using my current pregnancy weight. I had put on the correct number of kilos for my pregnancy stage, but this tipped me into the ‘overweight’ category for BMI. The judgement implicit in this really made me feel triggered and stressed and I can imagine could easily be upsetting for many women.”

Nadia Brooker, counselling psychologist at The Priory Wellbeing Centre, Dubai warns against meticulously monitoring pregnancy weight gain, and says diet tools like food diaries should be off limits when you are with child. "These behaviours are not appropriate for any woman during pregnancy (apart from standard testing by a doctor/midwife to ensure the baby is growing). Any obsessional weighing or even food diaries is of concern and could be a sign of a pre-existing eating disorder, thus it is important that expectant mothers seek professional support. Moreover, this can be a stressful time for people who have a diagnosed history of an eating disorder, as weight gain and body changes can trigger 'old' eating disorder cognitions, thus ongoing support and monitoring is highly recommended."

Women who have struggled with body image pre-pregnancy should be extra vigilant not to fall into a weight-watching trap, adds Nadia. "Should there have been a confirmed eating disorder or significant body image concerns pre-pregnancy, these mums need to be extra mindful and continue to access support during and post-pregnancy. There are also risks concerned with the baby - dieting during pregnancy is dangerous for the growing child. If the mum has a history of an eating disorder, she may need postnatal support if body image remains an issue. The health of the mother post-birth needs close monitoring to ensure she can adequately care for the needs of the newborn child."

Striking a balance

The key, says Hazel, is in an open and trusting relationship with your midwife or doctor. "Some mothers may find regular weigh-ins stressful, which is why it is important to build a positive and trusting relationship with your healthcare provider. By doing so, appropriate education and information can be shared freely, helping to reduce stress for mothers. Should mothers find that the monitoring of weight is leading to high levels of stress, this should be discussed so that a referral to appropriate healthcare providers can be made, such as a dietician, counsellor or maternal support group."

Cecile also advocates a moderate approach. "Stress in a mother directly impacts the foetus, which can affect the baby's growth as well as cause a preterm birth. When we weigh too often this can be equally bad as not monitoring weight when needed. There needs to be a balance where the woman is observed and guided appropriately. If a pregnant mother has concerns about her weight, whether over or underweight, she requires proper guidance on nutrition and safe levels of exercise."

It's worth remembering that every pregnancy is different, and how your body responds to pregnancy will vary from woman to woman. "Some women will retain water, so their weight gain will not necessarily be diet-related. It's important to guide a mother through any health concerns, keeping her mental state in mind," says Cecile. "It's worth noting that the concern a mother will have for her baby can be overwhelming and affect how she gives birth."

Above all, self-care is paramount. Nadia says this includes: "Good nutrition, ample rest/sleep, moderate to gentle exercise (depending on pre-pregnancy levels) and keeping stress levels to a minimum, generally. If you have other children to care for, ask your husband or nanny for help around childcare tasks, cooking, shopping etc. in the latter stages of pregnancy to allow more time for rest and relaxation. It can also be very helpful to talk about your worries or concerns - chances are you aren't alone and it's very helpful to feel validated and heard. Spend time doing things that you enjoy, but first and foremost look after yourself and take any health concerns seriously, no matter how minor you may think they are."

*Name changed **Stats from the UK's National Health Service