If you’re among the roughly 75% of people who are overweight in the United States or among the approximately 40% who are obese,[1] rest assured that the odds are in your favor of having a safe pregnancy and delivering a completely healthy baby. 

Still, carrying more weight than is medically recommended while you’re expecting can put you at higher risk for certain pregnancy complications, including preterm birth, preeclampsia and hypertension.

But there’s good news: By working with your doctor, you can learn more about what you can do to increase your chances of having a healthy pregnancy.

Understanding your BMI  

Learning your body mass index (BMI) and how it’s calculated is a good first step to figuring out how much weight you should aim to gain during pregnancy, along with your recommended caloric intake. Your BMI is an approximation of body fat based on height and weight.[2]

Body max index is not a perfect formula — it doesn’t take into account a person’s muscle mass and weight distribution (apple- vs. pear-shaped), for example. In recent years, BMI has become increasingly controversial. Many experts find it to be a flawed system, pointing out that there are a host of factors aside from BMI that contribute to your overall health.

However, the American College for Obstetricians and Gynecologists (ACOG) and the Centers for Disease Control and Prevention (CDC) still use BMI to quantify pregnancy weight gain, so your health care provider will likely do it at your first appointment. During that visit, they'll also confirm which of the following categories you fit into:

  • Underweight: a BMI that’s less than 18.5
  • Normal: a BMI of 18.5 to 24.9
  • Overweight: a BMI of 25 to 29.9
  • Obese: a BMI that’s greater than 30

Once you know your BMI, you’ll have a better idea of how much weight you’ll need to gain to best reduce your risk of pregnancy complications and protect your own health. ACOG recommends the following based on your pre-pregnancy BMI, but you and your doctor should discuss what’s appropriate for you.[3]

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8 Things to Know About Weight Gain During Pregnancy
Gaining Too Much Weight During Pregnancy: 7 Tips to Get Back on Track
Not Gaining Enough Weight During Pregnancy: 5 Tips to Get Back on Track
  • Overweight: Aim to gain 15 to 25 pounds throughout pregnancy, with just over half a pound per week in the last trimester. 
  • Obese: Aim to gain 11 to 20 pounds throughout pregnancy, with half a pound a week in the last trimester.
  • Pregnant with twins: Aim to gain 31 to 50 pounds if you’re overweight and 25 to 42 pounds if you’re obese.

What happens at your first prenatal appointment 

It’s a good idea to schedule your first doctor’s appointment as soon as your pregnancy test comes back positive. The earlier you can get your first ultrasound, the better. This will help date your pregnancy and give you a sense of when your baby will be due.

If you’re overweight, it may be a little tougher to date your pregnancy accurately for two reasons. First, you may be more likely to have irregular periods. And second, it may be harder to measure your baby using an ultrasound, which is the traditional way practitioners estimate gestational age. 

Your doctor may also test you for gestational diabetes (GD) early on because being overweight increases your risk. If you test positive, you’ll need to monitor your blood sugar at home. If not, your doctor will check your blood pressure and look for protein in your urine at every checkup — and you’ll likely receive a second test later in pregnancy.[4]

At this point, it’s also smart to consider the relationship you have with your practitioner and their willingness to support your healthy living goals. If you think you’re experiencing weight bias, make a change. You deserve the best possible care — so get recommendations and note that if you switch OB/GYNs, try to do so in the first trimester if possible, since some doctors may not accept patients later on.

Risks and complications of being overweight and pregnant

First and foremost, know that it is possible to have a healthy pregnancy if you’re overweight or obese. However, you and your baby are at a higher risk of some conditions and complications that are important for you and your practitioner to look out for, including:[5]

  • Macrosomia. This condition results in a larger-than-normal baby at birth.
  • C-section delivery. Cesareans are more common if you’re obese, and the surgery and recovery can be more complicated.
  • Preterm birth. A baby born before 37 weeks of gestation is considered preterm.
  • Gestational diabetes. Gestational diabetes is a type of diabetes that appears only in pregnancy. It affects up to 9% of expecting women. 
  • Hypertension. Hypertension is another name for high blood pressure. A systolic reading at or above 140 or a diastolic reading at or above 90 is considered high blood pressure during pregnancy. 
  • Preeclampsia. This condition is characterized by a sudden onset of high blood pressure, and it can be serious if left untreated. Your practitioner will check for signs of preeclampsia at every appointment, but let them know immediately if you’re experiencing severe swelling (called edema) that doesn’t go away, headaches, vision changes or a headache that doesn’t respond to Tylenol.
  • Obstructive sleep apnea. These abnormal pauses in breathing while you’re asleep can make you feel tired during the day and cause other complications. 
  • Birth defects. Fetal brain and heart defects are possible, including neural tube defects.

While you’re pregnant, you may find that it’s difficult for your practitioner to measure the fetus’ size and position and harder for you to feel those first kicks. Pregnancy weight gain can also amplify symptoms like backaches, varicose veins, swelling and heartburn.

Daunted? Don’t be. There’s plenty you and your practitioner can do to minimize the risks to you and your baby and ease discomfort. 

And it’s not all about the scale — it’s about implementing healthy habits, like getting regular exercise, eating fruits and vegetables, and logging better sleep. Eliminating all pregnancy risks that are within your control, such as drinking and smoking, is particularly important. Ask your doctor for tips too.

Is it okay to lose weight during pregnancy?

Pregnancy is not the time to lose weight even if you were overweight or obese before conceiving, according to ACOG. But losing even a small amount of weight before you conceive can up your odds of a safer pregnancy. Most importantly, talk to your doctor about the best amount of weight gain for you, which might differ from what ACOG recommends based on your BMI.

Maintaining a healthy diet

The foods you eat are also what your baby needs to develop, so maintaining a wholesome diet is one of the most important ways to have a healthy pregnancy. You’ll need foods that are good sources of vitamins, minerals and protein. 

These tips can help get you on the healthiest eating path possible:[6]

  • Check out MyPlate.gov. This site from the U.S. Department of Agriculture (USDA) offers a customized personal fitness and nutrition program based solely on your needs and can complement your doctor’s recommendations.
  • Talk to a registered dietitian. A nutritional professional can help you create a meal plan each week and give suggestions on which foods you should prioritize. By seeing someone regularly, you’ll likely feel more accountable for your food choices. Most dietitians ask that you log what you eat.
  • Drink plenty of water. Research has shown that 1 in 4 Americans consume at least 200 calories daily from sugary drinks. Simply replacing soda and other sugary beverages like juice with water is a great place to start.[7]
  • Fill up on fiber. Fiber-rich foods — including yellow and green veggies, fruit and whole grains like brown rice and whole wheat bread — will make you feel full. Bonus: They ease many pregnancy complaints like constipation, hemorrhoids and bloating.
  • Go low-glycemic. Eat plenty of lean meat and poultry, vegetables and fruits (especially the dark green, red or orange kinds), along with healthy fats (like salmon and avocados) — all of which are low-glycemic. Unlike higher-glycemic foods like white bread, rice and potatoes, low-glycemic foods don’t spike your blood sugar levels as much.
  • Stock your kitchen. Fill your pantry and fridge with plenty of nutrient-dense pregnancy foods. This makes opting for healthy meals a lot easier.
  • Make smart substitutions. Look for more places to add veggies, fruits and other good-for-you foods to your meals — like piling berries on your morning yogurt, ordering your sandwich with extra spinach, or dipping baby carrots into hummus for your afternoon snack.
  • Keep a food diary. Recording your breakfast, lunch, dinner and snacks every day may help you stay on track, especially since you might have to eat more frequent but smaller meals. Six mini-meals a day are often recommended for pregnant women instead of three large meals, since this also helps combat nausea.
  • Take your prenatal vitamin. It can be challenging to get all the nutrients you need, but a prenatal vitamin provides some extra insurance. This vital pill contains vitamin D and folic acid, two critical nutrients for healthy fetal development.
  • Avoid appetite suppressants. Pills and beverages that claim to suppress your appetite can be dangerous during pregnancy, so keep them off the menu. Even after you deliver, always check with your practitioner before taking any OTC or prescription appetite suppressants.
  • Don’t beat yourself up. No single food or meal can ruin your eating plan, so go easy on yourself. It can be especially hard to fill up on certain foods when you have pregnancy aversions or nausea. There will be more opportunities to make healthy choices. 

Getting or staying active

If you weren’t active before, pregnancy is excellent motivation to get moving — and there are multiple benefits to be gained. Exercising during these nine months:

  • Decreases constipation and swelling
  • Helps ease back pain
  • Increases your energy
  • Makes you feel more positive (thanks to endorphins released during physical activity)
  • Promotes better sleep
  • Prepares your body for labor by increasing your muscle tone, strengthening your core and boosting your endurance (all of which will come in handy when you’re pushing!)

Start with five minutes of exercise every day, and add five minutes every week until you build up to the recommended 30 minutes per day (unless your doctor recommends otherwise). 

Good exercise options include:

Even little bursts of extra movement throughout the day can help you hit your goal. A few ideas:

  • Take the stairs instead of the elevator. 
  • Get off the bus or subway one stop early and walk the rest of the way.
  • Park at the farthest spot from the grocery store.
  • Spend half your lunch hour eating and the other half walking around the neighborhood.
  • Find a quiet spot during the day for a few prenatal yoga poses. 

Sleeping better

A good night’s sleep helps your body stay healthy and may reduce your risk of certain pregnancy complications. 

If you think you might have obstructive sleep apnea, be sure to tell your doctor, since the condition may also increase your risk of developing conditions like gestational diabetes, preeclampsia and hypertension. Your practitioner may recommend:

  • Using pillows to prop yourself up into a more upright position
  • A mouthpiece to keep your airways open while you sleep
  • Continuous positive airway pressure or CPAP, which is a face mask hooked up to a small machine that blows air continuously at a set pressure 

Staying motivated when you're overweight and pregnant

It can be difficult to stay motivated, especially when you’re just getting started with a new diet and fitness plan when you’re pregnant. Fortunately, there are lots of little steps that can make your new lifestyle easier:

  • Join a support group. Some groups are geared specifically toward overweight pregnant women. Your local hospital or OB/GYN may offer groups where you can make friends with other women and get support.
  • Involve your family. Your partner, family and friends can not only provide extra motivation, but involving them in your goals helps everyone stay healthier.
  • Work out with a friend. Taking a walk or a class together offers extra incentive to get out the door — plus it makes any activity more fun.
  • Take a prenatal class. In workout classes such as prenatal yoga, you’re around other women who share your same goal (a healthy baby!), which can be inspiring.
  • Give yourself an extra incentive. Save your favorite music, TV shows or podcasts and indulge during your workout sessions.

While these changes during pregnancy may at first seem overwhelming, remember that your doctor is there to help you. The same goes for your partner, friends and family. And always keep in mind the ultimate motivator: delivering a healthy bundle of joy.