Recommended Weight Gain during Pregnancy: Comparing the American and French Guidelines
How much weight should you gain during pregnancy to maximize your and your baby’s health?
Weight gain guidelines during pregnancy can be frustratingly nonspecific, and there is conflicting advice everywhere. Many doctors don’t even counsel patients on safe prenatal weight gain! Nine months is a long time, and if you’re like me and can easily scarf down a pint of Ben and Jerry’s in one couch potato sitting, you may crave a structured plan to help stay on track for a healthy gain throughout pregnancy. Since I’ve now been pregnant in two countries I wanted to put together all of what I’ve learned about how much to gain, and at what rate to gain it.
I’ve heard some crazy myths about French pregnancies and one that I wanted to clarify is that French weight gain guidelines are drastically different than American guidelines. From my experience that is not true. For a normal weight woman throughout pregnancy, the American medical guideline is to gain 25 – 35 pounds; the French medical guideline is to gain 12- 15 kg, which translates to roughly 26 – 33 pounds, which is basically the same goal. What I have noticed in both countries is that providers and published guidelines often will not give you a monthly breakdown of weight gain recommendations, so I’ve put together a detailed compilation of advice from obstetricians and medical texts:
As you can see the overall weight gain recommendations are similar but the French and Americans recommend spacing the gain out in a slightly different way. Please note that these are more of guidelines to keep you on track rather than rigid goals. In both countries it is expected that you will vary from this timetable on a weekly and monthly basis. From personal experience the American attitude that more weight should be gained in the 2nd trimester seems more natural because that is when your appetite reaches crazy monster levels to nourish that quickly growing baby. By contrast during the morning sickness ridden first trimester your baby is tiny with fewer caloric requirements, and during the 3rd trimester there is an increasingly small amount of abdominal real estate making it difficult to eat heartily and pack on the pounds.
So here’s the lowdown on French versus American weight gain trends:
The recommended guidelines that doctors are adopting in their practices are similar. The real difference is that French women actually tend to stay within these limits, and therefore gain less than their American counterparts. In fact many French women stay at the lower end or slightly below these limits. By contrast, at least half of American women are gaining excessively (5)! Some of this may be due a lack of knowledge of the guidelines, or ingrained cultural attitudes. One study showed that if a woman expected to gain excessive amounts of weight during pregnancy, there was a strong possibility that she would. What caused the women in this study to believe they would gain more weight? Starting out overweight in pregnancy and receiving contradictory or incorrect advice from friends and family seemed to predispose women to gaining excessive amounts of weight(6).
The French, by contrast, are not only by the book, but they all seem to be on the exact same page. French ladies are aware of the guidelines, and follow them religiously. There is a real preoccupation in French culture with returning to your pre-pregnancy weight after you deliver, and a strong sense that gaining excessively can not only cause the baby to be large, but will also make it difficult for you to lose weight postpartum. Culturally it is frowned upon to surpass the recommendations: one woman I met admitted to me that she had gained a whole 17 kg! That’s 4.4 pounds over the recommended amount. Most Americans wouldn’t think much of such a small amount, but she was clearly worried and embarrassed about it. The French mantra is on n’a pas à manger deux fois plus! This means, don’t eat for two! And they take it seriously.
These cultural differences impact how medical practitioners approach their patients. For both of my pregnancies my weight gain has been similar and within the recommended range, but my doctors reacted differently to my weight gain pattern. My American provider tended to continually caution me on not gaining too much. In fact, when I started gaining weight quickly after a long period of morning sickness she became instantly worried about gestational diabetes and advised me to restrict my diet. My French provider is quite the opposite: she is more worried about me not gaining enough weight and even became suspicious that I was smoking when morning sickness prevented me from gaining anything in the first trimester. I think this is a reflection of the types of weight gain trends they are seeing in their respective patient populations.
For more information on how French women stay on track to a healthy prenatal weight gain, see these related articles:
(5) Weight Gain During Pregnancy: Reexamining the Guidelines, by National Research Council, Institute of Medicine, Board on Children, Youth, and Families.
(6) Association of Gestational Weight Gain Expectations and Advice on Actual Weight Gain. Krukowski et al. Obstetrics and Gynecology. Vol. 129, No. 1, January 2017.