You: Having a Baby: The Owner’s Manual to a Happy and Healthy Pregnancy. Michael Roizen F.

we consider those increases, though, we have to be clear about a few things. Those caloric amounts are guidelines that you’ll want to hit, understanding that daily amounts may vary a bit and that there are many times when, because of nausea or exhaustion, you won’t even get close to them. As long as you’re in the ballpark most of the time, that’s fine. Why? Because our end goal here is to make sure you maintain a healthy weight throughout your pregnancy for your own well-being and to provide the best environment for your child.

Of course, end goals do vary a bit, based on your prepregnancy size. While we’re not huge proponents of the scale in most circumstances,^* it is smart to use one during pregnancy to help track how you’re doing from week to week. Rather than count calorie for calorie, use your weight fluctuations (up or down) to help drive your decisions about how you eat. See the next page for what you should shoot for (only a third of women manage to stay within these guidelines, so it’s important to track your progress).

      In most cases, the extra weight gain will occur primarily in the second and third

      trimesters and the least in the first trimester. During the early part of pregnancy, most of the weight is in you, not the baby. For example, your body makes more blood so as to supply your baby with nutrients; the increase, about four to five pounds’ worth, is complete by early in the second trimester. By contrast, toward the end of pregnancy, it’s your baby who will be putting on the pounds, at a rate of about a half pound per week. Your weight will fluctuate, so you may not have the same weight gain from week to week; the important thing is to check yourself once or twice a week. Your weight gain should be steady; any huge increases or decreases may be a sign that something atypical is going on.

       It should go without saying that now is not the time to start thinking about a weight-loss program, though it is worth mentioning that where you deposit excess fat is still important. It’s much better to be able to store fat on your thighs; that’s because fat on the thighs is much richer in omega-3 fatty acids (which the baby needs), and fat on your belly can cause a state of insulin resistance. Your baby needs you to be the opposite (that’s called insulin sensitive), so that it can get as much energy from you as it can. While you can’t make a formal request to the genetic gods to ask where you’d like your fat to hang out, you can use this information to adjust your behaviors a bit. If, before pregnancy, you were apple shaped (with more of your excess weight in your waist than your thighs), try to counter the effects of this omental, or waist, fat. Since waist fat causes insulin resistance, we’d recommend that during pregnancy you aim to gain in the lower end of the range for your BMI to decrease your risk of further insulin resistance or its overt manifestation, gestational diabetes (more on page 94). In addition, gaining a higher proportion of the total weight early in pregnancy throws off the metabolic environment of your baby. It makes the fetus think that you are storing weight because a famine is coming and substantially increases the risk of preterm delivery.

      Factoid: Some women develop so much excess saliva during pregnancy that they look as if they belong in a baseball dugout rather than in a delivery room. In fact, they need to spit so much that they have to carry a spit cup around with them. They’re unable to swallow it because they produce so much and because it can also trigger nausea. Since these women lose so much bicarbonate in their saliva, it disrupts their acid-base balance. It seems that chewing gum, peppermint, and hard candy can help, as can a transdermal scopolamine patch.

      The ultimate goal, of course, is to make sure you gain enough weight to build the infrastructure you need to support your baby (placenta, uterus, breasts, and so on), but not so much that people are asking whether you’re heading to the hospital when you’re only five months along. Easier said than done, you say? There’s a reason for that.

      While you may fight many battles during pregnancy (over such things as crib style and middle names), there’s one battle in particular that has lifelong implications. It takes place deep inside your brain. In a nutshell, your body regulates the way you eat through the communication between two hunger-related hormones: leptin and ghrelin. If you’ve read some of our previous work on waist management, you may be familiar with them (you’ll also know that we really like nuts!), but we still think it’s worth a quick refresher course, so you can understand how hunger is controlled and, subsequently, learn how to manage it.

      Lovely leptin, a protein secreted by fat (yes, fat is more than a storage tissue; it is alive and secretes stuff like leptin), helps curb appetite; recent studies show that it may be a contributor to pregnancy-induced hypertension as well. Ghrelin, the gremlin of hormones, makes you want to eat by making your stomach growl for fulfillment. (See figure 3.1.) These two heavyweights are in a constant neurological battle, pushing, pulling, clawing at each other for victory. To the victor? The dominant message that your brain receives: either you’re hungry and want to chow down

      Figure 3.1 Fight for Food The two hormones most responsible for the battle over hunger: leptin (the superhero) and ghrelin (the evil Twinkie-loving villain). Unhealthy foods fail to calm ghrelin, putting you in a vicious cycle of hedonistic eating. If you can learn to increase leptin by eating healthy foods, you’ll score a knockout victory in the battle between your tummy and your tongue.

       What’s in Your Belly?

      When you tally up pregnancy weight, you may assume that most of that weight comes from the mass of the baby or perhaps from fat accumulated during a bonbon binge. Not so. Here’s how your added weight is approximately divided for a twenty-nine-pound weight gain:

      Baby: 7.5 pounds

      Placenta: 1.25 pounds

      Uterus: 2 pounds

      Amniotic fluid: 2 pounds

      Breasts: 1 pound

      Blood volume: 4–5 pounds

      Fat: 5 pounds

      Tissue fluid: 6 pounds

      Total: About 29 pounds

on a box of Cocoa Puffs,^* or you’re perfectly satisfied and would much rather spend your time walking around the block or dreaming about what life will be like trying to get spaghetti sauce out of the carpet.

      Contrary to what most people think, hunger isn’t influenced by willpower as much as by the messages that these hormones send to your brain. Ghrelin works in the short term: It sends out signals twice an hour, taunting and tempting you to gravitate toward the pantry. Leptin, though, works in the long term. If you can boost your leptin signals, you can ignore those ghrelin taunts—keeping your hunger (and thus your potential for dangerous pregnancy weight gain) in check.

      Factoid: Need more evidence that junk food is just that? And addictive? Researchers found that when you feed some rats good food and some rats good food plus junk food, the rats enjoying the junk food wind up consuming 40 percent more food by weight and 56 percent more calories. Even worse: Their pups develop an affinity for junk, eat more, and gain more weight during their lifetimes than normal pups. If you want fat kids, feed yourself junk during pregnancy.

      Factoid: One of the reasons you may be feeling a little hungry is because leptin, a hormone that controls hunger, is a little off during pregnancy. Receptors in the brain work to suppress chemicals that suppress your hunger—thus causing you to become more hungry—to ensure that you will eat enough to provide your baby more nutrients.

      Certainly it would be nice if we could reach our pinkie fingers into our ears, search around our