According to health experts, pregnancy in underweight women presents unique considerations and challenges that require special attention and care since being underweight during pregnancy can potentially increase the risk of complications for both the mother and the baby. Underweight women may have lower nutrient stores and a higher likelihood of inadequate weight gain during pregnancy hence, it is crucial for underweight women to work closely with healthcare professionals to ensure proper nutrition and weight management throughout pregnancy.
In an interview with HT Lifestyle, Dr Srividhya Guddetti Reddy, Obstetrics and Gynaecology at Rainbow Children’s Hospital in Bangalore’s Marathahalli, explained, “Body fat predicts reproductive health in women as sex hormones are synthesized from cholesterol. Either of the extremities in body fat percentage poses menstrual disorders and fertility issues. Most of the underweight (BMI < 18.5 kg/m2) have irregular or no menses and difficulty conceiving. A poor micronutrient environment may hamper the egg quality resulting in early miscarriages and congenital anomalies. They are more prone to have anemia, low birth weight babies, spontaneous and iatrogenic preterm labour and lactation failure in postpartum. As their immune system is weak they are open to infections which further complicates the pregnancy.”
She revealed, “Causes for being underweight could be nutritional deprivation, eating disorders like anorexia, bulimia nervosa, irritable bowel syndrome, depression, hyperthyroidism, tuberculosis, Type I diabetes, or any underlying immunocompromised medical conditions. At times it can be genetic without any underlying disease. Low birth weight Babies born to underweight mothers are prone to coronary artery diseases, Type 2 diabetes later in their life. This can be explained by Barker’s hypothesis of the fetal origin of adult disease where in nutrient deprivation in early fetal life results in permanent changes in glucose-insulin metabolism.”
Dr Srividhya Guddetti Reddy elaborated, “Hyperemesis in the first trimester of pregnancy can further cause weight loss and electrolyte imbalance. More fetal surveillance in view of low-birth-weight babies is needed in them. The best thing to do is to address underweight starts pre-pregnancy by emphasizing the importance of diet, encouraging food fortification measures, deworming, and prenatal vitamin supplementation.”
Care in pregnancy for underweight women:
Dr Srividhya Guddetti Reddy recommended –
- Correction of underlying medical disorders
- Awareness to overcome food taboos
- Small frequent meals
- High protein food like eggs, meat, fish, paneer, sprouts
- Extra fat and calorie intake is allowed in them when compared to normal BMI
- Fibre-rich diet
- Eating a rainbow diet to ensure adequate vitamins and minerals supplementation
- Focusing on psychological issues to overcome depression and anxiety
- Consultation with the dietician with set targets of weight gain during each visit
- Supplements to correct the diagnosed vitamin and mineral deficiencies from the very early pregnancy
- Support from partner, caregivers, and family
- Close fetal surveillance
Most of the time pregnancy in underweight can result in normal outcomes if timely intervention is done. According to Dr Poornima Kinila, Consultant – Obstetrics and Gynecology and Infertility at Aster RV Hospital, gaining a few pounds before getting pregnant can be helpful if you are underweight. She shared, “This is predominantly essential if your pre-pregnancy diet was not nutritionally adequate. A certified dietitian can suggest nutrient-dense, high-calorie food options to help underweight pregnant women achieve their weight goals.”
She suggested the following tips for encouraging steady weight gain while pregnant:
• Eat small, frequent meals, especially if you are suffering from morning sickness.
• Avoid meal skipping.
• Always eat breakfast.
• Snack on nutrient-dense, high-calorie snacks, such as nuts; whole-grain crackers with cheese, nut butter, hummus, or avocado, sliced fruit spread with nut butter; sandwiches on whole-grain bread; creamy soups; steel-cut oats with fresh fruit; and chopped nuts.
• Consume high-calorie drinks like smoothies made of full-fat milk or milk alternative with added protein powder.
• Most importantly, if you have any questions or concerns, work with a registered dietitian to assure you are getting adequate amounts of macro and micronutrients.
- Underweight women should target to add about 400 calories per day in the second trimester and 400 to 600 in the third trimester.
- We suggest women to take prenatal vitamin before and during pregnancy. Daily consumption of certain nutrients such as folate (folic acid), calcium, and iron needs increase during pregnancy. These nutrients are essential for the healthy growth and development of your baby.
- The right way to get adequate nutrition is to eat a variety of fruits, vegetables, and whole grains; calcium-rich foods, such as milk, almond milk, Greek or plain yogurt; protein sources like beans, eggs, fish and chicken; and healthy fats like fatty fish, nuts, seeds and oil.
Bringing his expertise to the same, Dr Gaurav Pawale, Obstetrician and Gynecologist at Apollo Clinic in Pune’s Wanowrie, said, “First and foremost, if you are underweight and pregnant, right away consult your doctor and understand the dietary requirements on how much weight gain is required to promote and continue a healthy pregnancy.” He advised –
- Consult a dietician after your gynae consultation and plan a diet accordingly.
- Women with BMI less than 18.5kg/m² are considered underweight pregnant women.
- Understand the risks of being underweight while pregnant. Increased risk of miscarriages, low birth weight babies, fetal growth retardation etc.
- Small frequent meals (at least 4-5 meals/day) every few hours
- Don’t skip your meals
- High calorie diet, rich in proteins, carbs vitamins, minerals & fats.
- Folic acid, iron, calcium supplements
- Diet rich green leavy vegetables, protein shakes, smoothies and drinking plenty of water to keep hydrated.
- Exercise especially walking and yoga.
- Track your pregnancy weight regularly and maintain a chart for the same.
- Understand the calorie intake, about 400-600 calories/day are required during the 2nd and 3rd trimester of pregnancy.
- Ideal weight gain during pregnancy should be between 12-18 kgs.
- Most importantly please follow a strict dietary routine and do not skip or change the routine.
