Cierra can easily recall the many times she felt judged for gaining 55 pounds during her first pregnancy — once, her family commented about her weight gain at her grandmother’s funeral. Things weren’t much easier the second time she got pregnant. When Cierra was diagnosed with gestational diabetes, she says a healthcare provider was quick to place blame, saying she received the diagnosis because of her pre-pregnancy weight. Cierra, who asked that her full name not be used to protect her privacy, describes leaving the appointment feeling like a failure.
“Weight is often a big issue for people, but then there’s really this emphasis put on it during pregnancy and it just becomes that much more magnified, and it feels so overwhelming,” she says.
Cierra isn’t alone. Research has shown many women find it challenging when they gain weight during pregnancy. Dr. Angela Incollingo Rodriguez says people often assume that because weight gain is a natural part of being pregnant, women aren’t stigmatized for it. But her research has found just the opposite: nearly two-thirds of pregnant and postpartum women experience some form of weight stigma.
“Women of all weight categories who are pregnant experience weight stigma, it’s not just women in larger bodies or women who are considered to be living with obesity,” says Incollingo Rodriguez, an assistant professor of psychological and cognitive sciences at Worcester Polytechnic Institute in Massachusetts.
Incollingo Rodriguez’s work has shown that women are subject to comments about their weight from many different groups — including healthcare providers, family and friends — from the time they try to conceive until they’re postpartum. And it turns out experiencing weight stigma can have negative effects on health.
“Experiencing pregnancy-related weight stigma is related to gaining more weight over pregnancy and having a harder time losing it postpartum,” she says. “It also predicts postpartum depression, it predicts unhealthy and maladaptive eating behaviours, and I even just had a paper come out showing that being concerned about weight stigma during pregnancy was a predictor of gestational diabetes.”
Most women will gain weight during pregnancy — there’s the baby itself, increased breast tissue, the placenta and increased blood volume. Health Canada recommends pregnancy weight gain targets based on the body mass index a woman has when her pregnancy begins. Obstetrician Dr. Laura Gaudet says these targets exist because too much or too little weight gain can potentially cause complications for mom and baby. The former is associated with a higher risk of gestational diabetes and needing a C-section for delivery. Not gaining enough weight is associated with babies being born preterm.
Gaudet says starting the conversation around weight in an open and sensitive way early on in pregnancy is important, especially if there are any signs a woman might be concerned. But the challenge is making sure women are informed without becoming too focused on the scale. Many women — even the ones who weigh in on target — can find putting on pregnancy weight overwhelming. Gaudet says the last thing she wants is someone restricting their diet following a weigh-in, because nutritional balance is important for fetal development.
According to Dr. Kara Nerenberg, it’s important for health care practitioners to be aware that weight is a concern for many pregnant women, and to also remind them that healthy pregnancies are about much more than weight — they’re also about getting enough exercise, sleep and limiting stress.
“We need to discuss with women what we’re targeting over the whole pregnancy, and saying there will be weeks where you gain more weight than others, and that we’re not really worried about week-to-week variations but more month to month and over time,” says Nerenberg, an obstetric medicine specialist at Foothills Medical Centre in Calgary. “Healthcare providers need to set that up in a supportive way and if women do get worried, we need to be better at acknowledging that and talking women through it. There’s a lot of emphasis put on weight gain during pregnancy and there’s often a lot of emotions associated with it.”
Nerenberg says there are many myths around pregnancy weight gain and that a lot of healthcare practitioners still don’t discuss it appropriately — or at all — with their patients. A similar conclusion was drawn from a study out of the University of Alberta, where most women who participated felt their health care provider did not do a good job of discussing weight gain with them. Several said their weight was only mentioned once they had gained beyond their target, which brought on emotions such as guilt, blame and feeling out of control.
Incollingo Rodriguez’s says both healthcare providers and society have a role to play in moving the conversation away from weight and towards supporting all women to feel good during pregnancy.
“Pregnant women are this uniquely captive audience who are really seeking advice,” she says. “It’s a great opportunity for health promotion. So instead of focusing on weight, why not shift the conversation to what are all the things you can do to be as healthy as possible.”
Incollingo Rodriguez adds that commenting on a woman’s weight while pregnant, even if it’s intended to be complimentary, can be harmful.
“In day-to-day life you almost never comment on someone’s body, and you certainly don’t say how big a person looks and you probably wouldn’t touch them, and then when someone is pregnant all of a sudden people think it’s okay,” she says. “I think most of the time the intent is ignorant and not intended to be unkind, but it makes a woman so much more aware of her body when of course she already is.”
As for Cierra, she is enjoying time with her one month old son, and says she’s learning to be less harsh with herself when it comes to her body, and hopes other women will do the same.
“The scale is overwhelming and scary, and it seems to define us in all ways of life, but give yourself grace,” she says. “You are growing a whole entire human and you’re nurturing a whole tiny human, so just be gentle and kind to yourself.”
This story is part of Healthing’s series, The Shape of Us.