But convincing an exhausted, emotional woman in her third trimester to trade potato chips for baby carrots isn't easy. "I have great success getting women to quit smoking; eating less, not so much," admits Dr. Greenfield. Anna Maria Siega-Riz, a UNC professor of nutrition and epidemiology who helped develop the IOM's new report, says that many obstetricians don't even touch the topic at all. "Half of pregnant women say, 'I don't know how many pounds I should be gaining,'" says Dr. Siega-Riz. "Doctors definitely haven't been talking about it enough. If they had, we wouldn't have so many women gaining outside the recommended ranges."
Even if the IOM's message does get through, some women could take it the wrong way. "There is a risk the pendulum could swing too far the other way again," says Dr. Greenfield. "We don't want a 115-pound woman to gain 15 pounds because she hears that excessive weight gain is a problem while expecting. The focus should be on obese and overweight women." But Pamela Vireday, the founder of the website Plus-Size Pregnancy and a mother of four, worries that even these moms are at risk for unhappy—and potentially unhealthy—pregnancies if their providers push weight limitations too far. "It will create a climate of fear around eating and weight gain for women of size," she says. "More and more fat women will live in terror of eating during pregnancy, and follow restrictive and rigid practices, instead of common-sense, healthy eating regimens."
If you focus simply on healthy eating and moderate exercise, chances are good that you'll wind up keeping your pregnancy weight within IOM-approved ranges—without driving yourself crazy, says Suzanne Phelan, Ph.D., a kinesiology professor at California Polytechnic University who presented her research on pregnancy weight-loss interventions to the IOM. As for women who are focused on weight control or weight loss, however, the most successful techniques—charting your own weight gain, keeping a food journal, and using a pedometer to log your daily activity—require some vigilance. "Make no mistake: It's hard work," says Dr. Phelan. "You have to be motivated. But think of it as an opportunity: There are things you can do to change. And there's no better time to do it."
