Whatever your body size or shape, you can work with your healthcare provider to plan for a healthy pregnancy.

Plus-size women are at higher risk for certain health problems during pregnancy. But most plus-size pregnant women have healthy pregnancies, especially if they manage their weight gain, get regular prenatal care, and have a birthing plan in place for their labor and delivery.

Healthy pregnancy for plus-size women does not happen alone: women and providers need to work together to ensure the best outcomes. The first step is understanding your current health, body mass index (BMI), health history, and lifestyle (such as eating and physical activity habits) and how these factors can affect your pregnancy. Then you and your provider can work together to create a healthy pregnancy plan that meets your specific health needs. The plan may include meal planning, nutritional goals, physical activity changes, and ideas for reducing stress.

Your healthy pregnancy plan can also help set the stage for your long-term health. Continuing healthy behaviors after giving birth can provide life-long health benefits.

BMI is a ratio of height to weight (weight in kilograms divided by height in meters squared) that healthcare providers use to categorize someone’s weight status. Research shows that different weight statuses are associated with different health risks and benefits, including some related to pregnancy.

Healthcare providers use BMI as one piece in the overall puzzle of providing care. Your BMI is one factor in your healthy pregnancy plan, but it is not the only factor and not even the main factor. Your current health, health history, lifestyle and habits, and other information help your provider understand your pregnancy and your specific health risks. Your provider takes all of this information into account when working with you to create a healthy pregnancy plan that meets your specific needs.

Research shows that a BMI of 30 or higher before pregnancy is linked to higher risk of pregnancy complications.

Women with a pre-pregnancy BMI of 30 or higher are at higher risk for the following:

• Gestational diabetes: When a woman who did not have diabetes before pregnancy has problems with high blood sugar during pregnancy
• C-section: Surgical delivery of the baby
• Preeclampsia: Sudden increase in blood pressure after the 20th week of pregnancy
• Preterm birth: Birth before 37 weeks of pregnancy
• Miscarriage: Unexpected pregnancy loss before the 20th week of pregnancy
• Stillbirth: Death of a fetus at or after the 20th week of pregnancy

Getting early and regular prenatal care allows your provider to watch for signs of these conditions and possibly treat some of them before symptoms become serious. Your provider may also adjust the timing of or order different tests, such as earlier testing for gestational diabetes, based on your health and health risks.

In most cases, healthcare providers recommend against losing weight or trying to lose weight once you are pregnant. Doing so may affect the growth and development of the fetus. They may, however, recommend that you adjust your eating and physical activity habits, so you do not gain more weight than is recommended.

Yes. Babies whose mothers had a BMI of 30 or higher during pregnancy:

• Are at higher risk for metabolic syndrome, obesity, and asthma during childhood.
• May experience growth problems in the womb.
• Are at higher risk for certain birth defects, such as heart problems and neural tube defects.
• Are at higher risk for developmental problems, such as attention deficit/hyperactivity disorder.

How much a woman weighs when she gets pregnant and how much weight she gains during pregnancy can affect her health and that of her baby. Entering pregnancy with a normal body mass index (BMI) and gaining weight within the recommended levels during pregnancy are important ways to promote a healthy pregnancy.

The Institute of Medicine recommends the following ranges of weight gain during pregnancy for women in the United States:

• Those women who have underweight (BMI of less than 18.5) should gain 28 to 40 pounds.
• Those who have normal weight (BMI of 18.5 to 24.9) should gain 25 to 35 pounds.
• Those who have overweight (BMI of 25 to 29.9) should gain 15 to 25 pounds.
• Those who have obesity (BMI greater than 30) should limit weight gain to 11 to 20 pounds.

NICHD research shows that gaining more weight during pregnancy than recommended increases the risk for complications.

The institute’s Healthy Pregnancy for Every Body initiative encourages plus-size pregnant women and their healthcare providers to work together to promote healthy pregnancies and births. The effort explains that BMI is just one aspect of a healthy pregnancy plan, and should not be the sole focus of a plus-size pregnant woman’s care.

First: Congratulations on your pregnancy!

Second: Remember that most plus-size women have healthy pregnancies and healthy babies.

Next: Be more informed!
Find a provider who treats you with respect and who you can trust. Talk with your healthcare provider about your current health, health history, lifestyle, and other factors that may affect your pregnancy. Work with your provider to create a healthy pregnancy plan.

Healthcare providers recommend that plus-size women considering pregnancy try to lose weight before they begin trying to get pregnant. Losing weight before pregnancy is one of the best ways to reduce weight-associated pregnancy risks. Losing even a few pounds can improve health outcomes.

Once you are pregnant, you and your provider will track your weight at each visit to check the growth of your fetus. If you are gaining less weight than current guidelines suggest, but the fetus is growing well, there may be no need to gain more weight. If the fetus is not growing well, you and your provider may need to change your diet and physical activity habits.

Getting Started

An appointment with a healthcare provider usually means you will get a lot of information in a very short time. You can prepare by doing a little work beforehand:

• Think about what questions to ask your provider. Write them down and take them to your appointment.
• Think honestly about your health history and current lifestyle. Understanding your health and possible health risks is the best way to plan for a healthy pregnancy.
• Think about your health goals for this pregnancy. Do you want to continue certain activities? Reduce stress? Adjust your nutrition? Knowing your goals will help you discuss them with your provider when creating your healthy pregnancy plan.

Use the following resources to prepare for upcoming healthcare visits.

Questions to Ask During Your First Medical Appointment

Start the conversation by asking your healthcare provider the following questions at your first appointment. Get a printer-friendly version of these questions (PDF 706 KB) with additional details about why the information is important.

• Does my health history put me at risk for any health problems during my pregnancy?
• Given my starting weight and medical history, how much weight should I gain during pregnancy?
• How can I create a healthy eating plan that is best for me and my baby?
• How much physical activity (and what types of activity) should I do during my pregnancy?
• Will my care plan change during my pregnancy? What tests and procedures will I need?

Create a Pregnancy Action Plan

The Pregnancy Action Plan contains questions to help moms-to-be set their pregnancy goals and plan steps to reach them. Sharing the action plan with your provider can help inform your pregnancy plan.

Be More Informed

Healthy pregnancies are for every body! Working with your provider to plan for a healthy pregnancy can also help manage problems and expectations. A healthy pregnancy plan includes many things, such as your current weight and body mass index (BMI), current health, past health, family health, and lifestyle factors. Your provider will consider all these factors and will work with you to create a plan that reduces your risks and increases your chances of healthy outcomes.

The first step to planning the best care for your pregnancy is completing this action plan. Use the following links to get the full action plan, which includes details about why the answers to these questions are important for your health. Then, bring your action plan to your next appointment to discuss it with your provider. You and your provider can use it to create a personalized healthy pregnancy plan.

What does a healthy pregnancy look like for me?

Think about what activities and habits are important to you and what goals you want to achieve during your pregnancy. For example, if you currently have an active lifestyle, your goal might be to keep doing the activities you enjoy throughout your pregnancy.

What concerns do I have about my pregnancy?

Some women may worry about possible complications, labor and delivery, or balancing family and work while pregnant. Think about your specific concerns and share them with your healthcare provider. Your provider may have resources that can help.

What do I want to do more of to help me reach my goals?

Pregnancy is a special time to focus on your health and taking care of yourself. Think of some ways to do this (such as take daily walks), and write down any questions you may want to discuss with your provider.

What do I want to do less of to help me reach my goals?

Taking care of yourself is often easier said than done. It may mean removing distractions or avoiding situations that interfere with your self-care. For example, to help reduce stress and strain, you may want to limit screen time by leaving your smart phone off after dinner until you go to bed.

What specific steps can I take to work toward my goals?

Breaking down your goals into smaller steps can help you stay on track. Be sure to make them specific. Setting a date to get started can also help motivate you. For example, starting Monday, I will climb an extra two flights of stairs each day.

What information, tools, or resources do I need?

Set yourself up for success by being informed and prepared. For example, if improving your eating habits is a goal for you, ask your healthcare provider for advice or resources on healthy eating.

Who can help me reach my goals? What can they do?

Working with a healthcare provider you trust is important for a healthy pregnancy. Providers should treat you with respect and kindness. Make a list of the things you expect from a provider. If your current provider does not offer these qualities, ask to speak with another provider in the office or ask for a referral to another office.

Additional Tips

• Write down any additional questions you may have after completing the action plan. Ask your provider to review your questions with you as a way to work together to create a healthy pregnancy plan.
• You and your pregnancy are important. Do not be shy about asking questions or sharing concerns.
• After working together to create your healthy pregnancy plan, let your provider know if it would be helpful to review your plan or parts of the plan at each visit.

Once you're pregnant, early and regular prenatal care is important to keep yourself and your developing infant healthy.

During your first prenatal visit, your health care provider may talk to you about the following ways to help have a healthy pregnancy:

• Take folic acid.
• Do not use alcohol, tobacco, or drugs.
• Talk to your health care provider about medications.
• Avoid exposure to toxic substances.
• Follow a healthy diet.
• Eat a safe diet.
• Limit caffeine intake.
• Talk to your health care provider about physical activity.
• Maintain a healthy weight.
• Talk to your health care provider about your nutrition status, including vitamin B12 and iron levels.
• Get regular dental checkups.
• Prevent infections that can affect your pregnancy.

Begin or continue to get at least 400 micrograms of folic acid by taking vitamin supplements every day to reduce your child's risk of neural tube defects. In the United States, enriched grain products such as bread, cereal, pasta, and other grain-based foods are fortified with folic acid. A related form, called folate, occurs naturally in leafy, green vegetables and orange juice, but folate is not absorbed as well as folic acid. Also, it can be difficult to get all the folic acid you need from food alone. Most prenatal vitamins contain 400 micrograms of folic acid. If you have had a child with an NTD before, taking a larger daily dose of folic acid (4 mg) before and during early pregnancy can reduce the risk for recurrence in a subsequent pregnancy.

Drinking alcohol, smoking, and taking drugs during pregnancy can increase your child's risk for problems such as fetal alcohol spectrum disorders (FASDs), sudden infant death syndrome (SIDS), and other problems.

FASDs are a variety of effects on the fetus that result from the mother drinking alcohol during pregnancy. The effects range from mild to severe, and they include intellectual and developmental disabilities; behavior problems; abnormal facial features; and disorders of the heart, kidneys, bones, and hearing. FASDs last a lifetime although early intervention services can help improve a child's development. FASDs are completely preventable: If a woman does not drink alcohol while she is pregnant, her child will not have an FASD. Currently, research shows that there is no safe amount of alcohol to drink while pregnant. According to one recent study supported by the NIH, infants can suffer long-term developmental problems even with low levels of prenatal alcohol exposure.

Other research shows that smoking tobacco, smoking marijuana, exposure to second-hand smoke, and taking drugs during pregnancy can also harm the fetus and affect infant health. One study showed that smoking tobacco or marijuana and using illegal drugs doubled or even tripled the risk of stillbirth, fetal death after 20 weeks of pregnancy. Likewise, drinking alcohol, smoking tobacco, and exposure to second-hand smoke during pregnancy increases the risk of SIDS, the sudden, unexplained death of an infant younger than 1 year old. Research also shows that smoking marijuana during pregnancy can interfere with normal brain development in the fetus, possibly causing long-term problems.

According to the CDC, most women take at least one medication during pregnancy. The majority of medications have not been specifically studied for use in pregnancy. Talk to your health care provider about over-the-counter and prescription medications and herbal and vitamin supplements. Certain medications to treat acne and epilepsy and some dietary or herbal supplements can harm the fetus during pregnancy.

Taking prescription pain medications, specifically opioids, during pregnancy can pose serious risks to the fetus. Taking these medications during pregnancy doubles or even triples the risk for stillbirth. If taken regularly during pregnancy, the baby may go through withdrawal after birth, a situation called neonatal abstinence syndrome (NAS). Babies with NAS face a variety of symptoms and problems, some of them severe. The best way to protect your baby from these problems is to stop taking these medications during pregnancy.

During pregnancy, exposure to radiation, pesticides, some metals, and certain chemicals can cause birth defects, premature birth, and miscarriage. If you're not sure if something might be harmful to you or your fetus, avoid contact with it until you check with your health care provider.

If you work in a job on a farm, a dry cleaner, a factory, a nail or hair salon, you might be around or come into contact with potentially harmful substances. Talk to your health care provider and your employer about how you can protect yourself before and during pregnancy. You may need extra protection at work or a change in your job duties to stay safe.

A few examples of exposures that are known to be toxic to the developing fetus are:

Lead: Lead is a metal that may be present in house paint, dust, and garden soil. Any home built before 1978 may have lead paint. Exposure can occur when removing paint in old buildings (or if the paint is peeling) and working in some jobs (for example, manufacturing automotive batteries). Lead is also present in some well water and in water that travels through lead pipes. High levels of lead during pregnancy can cause miscarriage, stillbirth, low birth weight, and premature delivery, as well as learning and behavior problems for the child. Women who had exposure to lead in the past should have1 their blood levels checked before and during pregnancy. Call the National Lead Information Center for information about how to prevent exposure to lead at: 800-424-LEAD.

Radiation: Radiation is energy that travels through space. It can be in the form of X-rays, radio waves, heat, or light, or it can come from "radioactive" materials like dust, metals, or liquids that give off energy called radioactivity. Low exposures to radiation from natural sources (such as from the sun) or from microwave ovens or routine medical X-rays are generally not harmful. Because the fetus is inside the mother, it is partially protected from radiation's effects. Pregnant women or women who might be pregnant should make sure their dentists and doctors are aware of this so appropriate precautions can be taken with medical scans (X-rays or CT scans) or treatments that involve radiation. Pregnant women who may be exposed to radiation in the workplace should speak with their employer and health care provider to make sure the environment is safe during their pregnancy. Nuclear or radiation accidents, while rare, can cause high radiation exposures that are extremely dangerous, especially to the developing fetus.

Solvents: Solvents are chemicals that dissolve other substances. Solvents include alcohols, degreasers, and paint thinners. Some solvents give off fumes or can be absorbed through the skin and can cause severe health problems. During pregnancy, being in contact with solvents, especially if you work with them, can be harmful. Solvents may lead to miscarriage, slow the growth of the fetus, or cause preterm birth and birth defects. Pregnant women who may be exposed to solvents in the workplace should speak with their employer and health care provider to make sure the environment is safe during their pregnancy. Whenever you use solvents, be sure to do so in a well-ventilated area, wear safety clothes (such as gloves and a face mask), and avoid eating and drinking in the work area.

Many chemicals are commonly found in the blood and body fluids of pregnant women and their infants. However, much remains unknown about the effects of fetal exposure to chemicals. It's best to be cautious about chemical exposure when you are planning to get pregnant or if you are pregnant. Talk to your health care provider if you live or work in or near a toxic environment.

Choose a variety of fruits, vegetables, whole grains, and low-fat dairy products to help ensure the developing fetus gets all the nutrients it needs. Make sure you also drink plenty of water.

Avoid certain foods such as raw fish, undercooked meat, deli meat, and unpasteurized cheeses (for example, certain types of feta, bleu cheese, and Mexican-style soft cheeses). Always check the label to make sure the cheese is pasteurized.

Some pregnant women are concerned about the amount of fish they can safely consume. Certain fish contain methylmercury, when certain bacteria cause a chemical change in metallic mercury. Methylmercury is found in foods that fish eat, and it remains in the fish's body after it is eaten. Methylmercury in fish eaten by pregnant women can harm a fetus's developing nervous system.

According to the U.S. Food and Drug Administration (FDA), pregnant women can eat up to 12 ounces a week of fish and shellfish that have low levels of methylmercury (salmon, canned light tuna, and shrimp). Albacore ("white") tuna has more methylmercury than canned light tuna; pregnant women should consume 6 ounces or less in a week. Avoid fish with high levels of methylmercury (swordfish, king mackerel, and shark).

Some studies suggest that too much caffeine can increase the risk of miscarriage. Talk to your health care provider about the amount of caffeine you get from coffee, tea, or soda. Your health care provider might suggest a limit of 200 milligrams (the amount in about one 12-ounce cup of coffee) per day. Keep in mind, though, that some of the foods you eat, including chocolate, also contain caffeine and contribute to the total amount you consume each day.

Most women can continue regular levels of physical activity throughout pregnancy. Regular physical activity can help you feel better, sleep better, and prepare your body for birth. After your child is born, it can help get you back to your pre-pregnancy shape more quickly. Talk to your health care provider about the amount and type of physical activity that is right for you.

Gaining too much or too little weight during pregnancy increases the risk of problems for both the mother and the infant. Following a healthy diet and getting regular physical activity can help you stay within the recommended weight gain guidelines set by the Institute of Medicine.

The amount of weight you should gain during pregnancy depends on your pre-pregnancy weight and body mass index (BMI), which is your weight in kilograms divided by the square of your height in meters (kg/m). The following guidelines are for women who are pregnant with one fetus. The recommendations are different if you are pregnant with more than one fetus (such as twins).

• Women who are underweight (BMI less than 18.5) should gain between 28 and 40 pounds.
• Women at a normal weight (BMI between 18.5 and 24.9) should gain between 25 and 35 pounds.
• Overweight women (BMI 25 to 29.9) should gain between 15 and 25 pounds.
• Obese women (BMI more than 30) should gain between 11 and 20 pounds.

In a recent NICHD study of more than 8,000 pregnant women, 73% gained more than the recommended amount of weight. The study found that excessive weight gain during pregnancy increases the risk for gestational high blood pressure, cesarean section, and large-for-gestational-age infants.

Talk to your health care provider about the right amount of weight gain for you based on your pre-pregnancy weight.

Iron-deficiency anemia—when the body doesn't have enough iron—is common during pregnancy and is associated with preterm birth and low birth weight. Your health care provider may screen you for iron-deficiency anemia and, if you have it, may recommend iron supplements. Your health care provider may also recommend a vitamin B12 supplement if you are a vegan. (Vegetarians normally get enough vitamin B12 by eating eggs and dairy products.)

Your gums are more likely to become inflamed or infected because of hormonal changes and increased blood flow during pregnancy. Make sure you tell your dentist if you think you could be pregnant, but keeping up your regularly scheduled checkups is important. Some women may fear getting dental work during pregnancy, but a 2006 study and 2011 follow-up study showed no increase in preterm births or other adverse outcomes for pregnant women who received dental care.

Certain infections can affect pregnancy or the developing fetus. It's important to take steps to prevent such infections or get medical treatment before or during pregnancy.

Vaccinations can protect against many infections that can affect the mother's health, the pregnancy, the fetus, and even her newborn child. Some vaccines need to be given before pregnancy, so it's a good idea to review your vaccination history with your health care provider as part of your pre-pregnancy care. The Centers for Disease Control and Prevention provides recommendations about timing of vaccinations to help ensure a healthy pregnancy.