Gaining for two?

* Underweight: 28 to 40 pounds
* Normal: 25 to 35 pounds
* Overweight: 15 to 25 pounds
* Obese: 15 pounds

The guidelines' top priority is the health of the baby, and there are potential repercussions to gaining too much or too little. Putting on too much increases the risk of gestational diabetes (which, if not tightly controlled, can adversely affect the baby) and of labor complications. The baby may also be very large (more than ten pounds), putting him at increased risk of Type 2 diabetes. Women who gain too little weight are at risk of having a low-birth-weight or preterm baby, while outright dieting  -- especially Atkins-style  -- can produce compounds in the blood called ketones, which are toxic to a fetus.

How pregnancy weight gain affects a mom's health, though, isn't as well researched. Some experts think the standard 35-pound upper limit is too high, that gaining this much may contribute to obesity. Never before have women been advised to put on so much weight; prior to 1990, when these medical guidelines were developed, doctors usually advised a gain of between 20 and 28 pounds for women who start their pregnancy at a normal body weight.

A bigger problem: The guidelines are often ignored. "The range for normal-weight women  -- twenty-five to thirty-five pounds  -- looks pretty reasonable," says Barbara Abrams, a professor of epidemiology, maternal and child health, and public health nutrition at the University of California, Berkeley. "But only about one in three women who begin pregnancy at a normal weight stay within it. It's not that the guidelines are wrong. It's that we can't follow them."

"My obstetrician didn't give me any specific weight-gain advice," says Ellyn Ward. "He said, 'Don't worry about how much weight you gain  -- be concerned with eating healthy.'" She also had a routine meeting with a nurse who "went over the food groups," but it didn't make much difference. "It was helpful advice, but I didn't follow it. I had pretty bad eating habits, and I didn't really change my lifestyle," she says.

It's women who are already battling their weight who need the most support when they're expecting. "In the early months of pregnancy, many women are concerned with gaining too much," says Bonnie Berk, a nurse and the creator of Motherwell, a fitness program for pregnant and postpartum women based in Carlisle, Pennsylvania. "But as they become larger, they give up worrying about their weight and start eating indiscriminately. I see this often with women who tend to be on diets a lot. Once they're pregnant, it's like a license to eat."

Yet only a modest increase in calories is needed to sustain a healthy pregnancy  -- about 300 a day. That's as little as an extra apple and a yogurt, a turkey sandwich with lettuce and mustard on whole-wheat bread, a baked potato with a slice of cheese, or a milk shake made with low-fat ice cream. By contrast, a pint of superpremium chocolate-chip ice cream might have 700 calories.

"There's this belief that you should eat for two," says Kieffer. But that doesn't mean you need to eat twice as much as you did before. "What experts really mean is to eat better for your baby. It takes very little to add those calories to your diet, and they should come from healthy sources. Instead of having an iceberg-lettuce salad, start with dark greens like Romaine lettuce; try walnuts rather than cheese; substitute a slice of melon for pastry."

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