Why is Prenatal Care Important? And How to Navigate Weight Stigma

Why is prenatal care important? As I learned about two years ago when I was pregnant with my son, the quality of that care matters just as much as receiving it. “You need to buy a scale” were some of the first words out of my new gynecologist’s mouth before I even conceived him. I had told my doctor I didn’t know my weight but that I did know and trust my body. Instead of inquiring more, he judged my explanation and insisted I start weighing myself. Little did he know, I spent several years of my life living as a prisoner to scales with an eating disorder and banned scales from my life more than a decade ago as an important part of my recovery, and my reclamation to my life and body.

At the earliest stage of a pregnancy preceded by miscarriage—one of the most vulnerable and scariest times of my life—my doctor was telling me to get a scale and weigh myself often. Like so many others, he is steeped in our weight-obsessed healthcare system, and I realized he wasn’t trying to harm me with his bold recommendation. However, if I didn’t have more than 10 years of recovery behind me and know my boundaries before this conversation, it could’ve sent me down a dangerous spiral, and potentially hurt myself and my baby.

How diet culture impacts prenatal care

Throughout my pregnancy, I’ve encountered several messages rooted in diet culture, which is a belief system valuing thinness above everything, and weight stigma, or bias against people because of body size. For example, every mainstream resource I read about prenatal nutrition or health encourages eating enough and a balance of food groups and gaining enough weight (which I appreciate as an eating disorder dietitian), but the author always throws in a caveat, like “but be sure eat only ‘healthy’ foods” and “but don’t gain too much weight.”

When asking, “why is prenatal care important?” it’s worth remembering that quality prenatal care should support both physical and mental health rather than reinforce shame, fear, or harmful beliefs about body size. It's often encouraged that larger bodied women be even more rigid with food and focused on weight. Research shows such weight stigma is what harms people living in larger bodies—not their weight. Regardless, weight stigma shows up in all areas of healthcare, and research also shows it can prevent people from seeking medical treatment and receiving adequate, humane care.

As a thin white woman, I have it relatively easy, and I’ve imagined several times how it would be if I didn’t have such privilege—unfortunately, I know it would be much worse.

(Disclaimer) While fatphobia is a commonly used term, it’s not necessarily accurate when it comes to describing weight stigma in prenatal healthcare, because healthcare providers aren’t necessarily afraid of larger bodied folks, yet many of them have anti-fat beliefs and discriminate against them.

How weight stigma shows up in prenatal care

Prenatal care helps monitor the health of both parent and baby, identify potential complications early, and provide guidance throughout pregnancy. However, when weight stigma enters the picture, it can interfere with the supportive care pregnant people deserve. In fact, a 2020 study of pregnant and postpartum women showed nearly one in five experienced weight stigma in healthcare settings, with obstetricians (OBs) as the most commonly cited source.

There’s a significant focus on weight for expecting mothers, according to Dr. Anna Whelan, MD, FACOG, a maternal-fetal medicine subspecialist and assistant professor of obstetrics and gynecology at University of Massachusetts Chan Medical School. “Pregnant people are told based on their initial BMI how much weight they ‘should’ gain,” she says, “[and] people are often admonished if they gain ‘above’ their recommended goals and told they are harming their child.”

Around 200 years ago, a Belgian mathematician created the BMI (a basic calculation measuring body fat based on height and weight) to quickly measure "obesity" of the general (largely white and male) population—not to determine a person’s health. It wrongly became one of the most common ways to assess a person's "health” and make diagnoses by the 1970s. “I've had clients denied fertility treatment because of their BMI [and] larger-bodied clients told they are ‘too high risk’ by OBs and referred out,” says clinical psychologist Emma Basch, PsyD. “I've had clients receive infantilizing nutrition information from ‘concerned’ providers who assume they don't eat healthily or exercise [based on their BMI], and one client whose provider used fear tactics saying she was going to harm her pregnancy if she didn't lose weight with no data to back this up.”

Unsurprisingly, widely accepted pregnancy weight gain guidelines are based on BMI.

What actually determines health in pregnancy?

Effective prenatal care focuses on meaningful health markers, individualized support, and evidence-based monitoring rather than assumptions based solely on weight. And when it comes to gaining weight in pregnancy, there's no perfect amount. "Healthy weight gain during pregnancy is nuanced and complex,” according to reproductive dietitian Rachelle Mallik, MA, RDN, who defines it as “the amount someone gains [while] regularly engaging in health-promoting behaviors in a way that is realistic and accessible to the individual.” Mallik means practices like eating regular meals and snacks, incorporating a balance of food groups (including carbohydrates, fiber, protein, and fat), generally honoring hunger and fullness cues, moving your body regularly, getting decent sleep, and going to prenatal visits.

Dr. Whelan says some of her larger-bodied patients’ other providers tested them for gestational diabetes two or three times, because they wouldn’t believe they didn’t have it. “People in larger bodies are told they’re going to get gestational diabetes and preeclampsia, [and] while there is an increased risk, the majority of people in larger bodies will have healthy pregnancies,” she explains. “Those that do get gestational diabetes often feel that they have failed, however, [it’s] caused by placental hormones and individuals have no control over this.”

Instead of focusing on her patients’ weight and BMI, Dr. Whelan says she looks at vital signs, like blood pressure and heart rate, along with lab values. “Weight is not a good marker for health and shouldn’t be used solely to assess risks of complications in patient,” she adds. In fact, research has shown second-time larger-bodied mothers without underlying health conditions, like pre-existing diabetes or high blood pressure, may have lower risk of birth complications than first-time thin moms.

Why weight stigma affects women of color even more

Weight stigma disproportionately impacts women of color trying to conceive or while pregnant, which is “due to intersecting factors such as racism, socioeconomic disparities, and cultural norms,” says therapist Kira Denney, MS, LCPC-S, LPC, NCC. “These women may face additional layers of discrimination and pressure to conform to society’s narrow beauty and health standards.”

Also, research shows mistreatment by healthcare providers (including being scolded and ignored) is more likely to be experienced by women of color than white women during pregnancy and childbirth in the U.S. “Stereotypes experienced by individuals at higher weights, such as lack of education, laziness, and poverty, are experienced at exponentially higher rates by patients of color than by white patients at similar body weights,” Dr. Whelan explains. “Maternal mortality rates for black women are three to four times higher than for white women, [and] rates of preeclampsia are higher among individuals of color due to systemic racism and intergenerational trauma experienced by these populations.”

According to psychologist Linda Baggett, PhD, women of color are harmed by both sexism and racism in medical care. “The harm multiplies, as they are having to navigate anti-fat bias, weight stigma, systemic medical racism, and gender bias, and the ways in which these systems of oppression intersect,” she explains. “A fat black woman, [for example,] is going to be dealing with this on both fronts.”

Why this tyle of care is not helpful

At its best, prenatal care should empower people with information, compassion, and appropriate medical support—not leave them feeling judged, blamed, or dismissed.

Weight stigma in prenatal care undoubtedly impacts larger-bodied folks the most. “Although diet culture and weight stigma harms everyone, patients in larger bodies or higher BMI categories experience more stigma based on their body size because of how these BMI categories are pathologized and assumptions that are made about health based on weight,” Mallik says. Here are some reasons why weight stigma and diet culture-based prenatal care can unhelpful:

It can cause shame

Dr. Whelan says such hyper-focus on weight can lead to shame and even dangerous consequences for mother and baby. “Instead of approaching prenatal care as a collaborative effort between patient and provider, it puts focus on the health of the pregnancy as something that is entirely affected by body weight and thus if there is a complication individuals feel that it is a personal failing,” she explains. “Weight stigma can lead to individual’s concerns being attributed to their weight and may lead to ignoring warning signs or symptoms of problems. For example, larger individuals may be told that they don’t feel their baby move because of their body size, however, this is not the case and decreased fetal movement should be investigated carefully as it can be a warning sign for fetal health.” Research confirms that effects of weight stigma during pregnancy include decreased reproductive healthcare quality, mental health symptoms, poorer health behaviors, and adverse pregnancy outcomes.

It can lead to disordered eating or relapse

Plus, conversations rooted in weight stigma and diet culture can lead to disordered behaviors with food and exercise, such as cutting calories and excessively exercising to try and control their weight—in a time when calories and being gentle with our bodies is more important than ever. In fact, one study shows pregnant women experiencing weight stigma reported increased unhealthy dieting and emotional eating behaviors. Interestingly, another study shows an association between weight stigma and excessive pregnancy weight gain and retention of weight gain, along with increased depressive symptoms.

Such conversations also put those with a history of an eating disorder at risk of relapse. “I've had clients in recovery who are in smaller bodies feel pressure to track their food, change their diet, and have been triggered by doctors who insist on weighing them at all appointments,” Dr. Basch adds.

Additionally, being at an unhealthily low weight can lead to amenorrhea, or loss of periods and infertility, and there are harmful side effects during pregnancy, including miscarriage, premature birth, fetal growth and development problems, and low birth weight.

What prenatal care should be about

According to Dr. Whelan, there’s a link between higher body weight and conditions like gestational diabetes and preeclampsia, but it’s not “causal,” meaning having a higher body weight doesn’t cause or mean all larger-bodied people will develop such issues. “There are other factors, such as prior history, underlying medical conditions, genetics, and placental factors which increase the risk of these complications.” Instead of focusing on weight, she says “the best way to decrease risks is to focus on close monitoring and optimizing health including pre-pregnancy blood pressure and blood sugar.”

Regular prenatal care helps identify potential health conditions, monitor blood pressure, review family health history, and screen for medical conditions such as polycystic ovary syndrome that may affect pregnancy outcomes. Regular prenatal visits also provide important information about folic acid supplementation, healthy lifestyle habits, and other health topics that support a healthy pregnancy. Consistent prenatal visits can help reduce the risk of complications associated with low birth weight, low birth, preterm birth, congenital anomalies, and neonatal health concerns. A health care provider can use regular prenatal assessments to identify hihg risk pregnancies and recommend appropriate care.

How to safely navigate prenatal care—and deal with any harmful practices

Here are several approaches I recommended both as a mother and a weight-inclusive registered dietitian:

Consider learning how to eat intuitively while pregnant.

Intuitive eating is a framework that helps you improve connection to and communication with your body’s requests (hunger) and boundaries (fullness). It guides you to challenge diet and weight beliefs, look at your emotional relationship to food and ways of coping, honor your body’s natural state, embrace joyful movement, get satisfied at meals and snacks, and honor your health. In my pregnancy, my intuitive eating practice came in handy, especially in the first trimester when extreme nausea diminished the variety of foods I could tolerate, and in the third trimester, when my energy (calorie) needs were higher than they are pre-pregnancy. Instead of trying to force myself to eat salads in the name of “health’ although the thought of one made me ill, I trusted my body to tell me what it could tolerate those first three months (which was mostly carb sources like rice, pretzels, and fruit, or proteins like peanut butter, chicken, and yogurt).

As I prepared to give birth, I let my body tell me how much it needs at each meal and snack (and it’s naturally more than usual), instead of unnecessarily counting every calorie. Of course, there are food limitations (like avoiding raw fish) and prenatal supplement requirements, which is part of a prenatal intuitive eating practice.

In listening to my body’s needs with movement, I noticed it was wanting gentler forms of exercise (like walking over running) and I can trust that’s what’s best for me and my baby in this pregnancy, instead of worrying about it not being enough or what others are doing. “Focus on nourishing your body and the growing baby rather than obsessing over weight gain [and] body changes,” Denney says. “Challenge harmful messages about ‘ideal’ pregnancy bodies and allow for space to celebrate the diversity of maternal experiences.” If you’re attempting intuitive eating for the first time while pregnant or feel you need more guidance, consider working with a non-diet registered dietitian with prenatal experience. Check out our blog post on eating intuitively during pregnancy.

Find a new care team if necessary. 

Nurse midwife Lucy Chapin, CNM, recommends scanning the initial paperwork you fill out. “Does it make you feel shame or fear or overly focus on weight? Check in with yourself after each appointment—did your care provider focus intently on weight or weight-related concerns?” If you are left feeling fearful or ashamed, chances are high boundaries or changes are in order.

If you’re feeling like you need to a team overhaul, consider finding new, weight-inclusive providers. A good place to start is searching the Health at Every Size (HAES) provider directory, this size-friendly doctor website, and this fat-friendly health professionals list. “If there are limited available providers where you live, seek out a HAES-aligned doula, [and] whether you are using an OB, midwife or a family practice physician, make sure that provider gives personalized and individualized care,” Chapin says. “Find a care team who gives you whole person support, and not care that is centered around your BMI.” If you don’t have a weight-inclusive prenatal therapist or dietitian, consider adding one or both to your team, to help support your mental health, nutrition, and body image throughout pregnancy.

Set boundaries with your providers when necessary.

“You don’t have to be weighed at each visit or you can choose to be weighed and not see your weight,” Dr. Whelan says. I chose Dr. Whelan’s latter suggestion—at my first midwife visit, I requested that she blindly weigh me, and that she only confirms I’m gaining weight as the pregnancy progresses, because that’s what felt important to me.

“Let your healthcare team know that focusing on your weight is triggering and that you'd rather not discuss it unless medically necessary,” Mallik suggests. “If you have a history of or active eating disorder, please discuss monitoring your weight with your healthcare provider.”

Speak up at your appointments. 

“Make sure you understand the recommendations your provider makes and if you don’t understand push your provider to explain them in a different way,” Dr. Whelan recommends. “Talk frankly with your provider about your concerns regarding weight and size. [and] make a list of your questions to ask your provider at each visit.”

Specifically, Mallik suggests asking, "’What treatment options would you recommend for someone with this condition in a smaller body?’ If that feels too confrontational, ask ‘What treatment options can you recommend besides weight loss or weight management?’”

Surround yourself with people that support you.

Part of feeling safe during pregnancy goes beyond your providers and there’s no better time to be picky about with whom you share your prenatal experience and (often diminished) energy and time. Be sure to surround yourself with people that feel emotionally safe and support your choices throughout pregnancy, including how you care for your body. Baggett says bringing such a support person to prenatal visits can also be helpful, especially when navigating potentially triggering conversations. 

Follow people online that align with a weight-inclusive and holistic approach to prenatal care.

“I would strongly encourage expecting mothers to connect with resources that specifically address weight stigma in prenatal care, are fat positive, and evidence based,” Baggett says. Her favorites are Nicola Salmon (@fatpositivefertility) and Jen McClellan (@plussizebirth and @plusmommy). “this is a time when social media algorithms get out of control—I can't tell you how many stigmatizing posts show up in my feed now that I'm pregnant, and they prey on pregnant mom's fears of having a healthy baby,” she adds. She recommends hiding or unfollowing triggering posts and curating your feed with weight-inclusive prenatal accounts.

Understand your autonomy. 

We’re conditioned to believe to do everything our healthcare providers say, but if something is emotionally unsafe for you (like getting a scale was for me), you can choose to decline such recommendations (as long, of course, it’s not putting you our your baby in danger). The second my doctor told me to get a scale, I knew that I wouldn’t, to protect my mental health and recovery—and ultimately, my baby. Basch adds an important point—it’s easier to decline recommendations “if you are in a smaller body [and] hold thin privilege, and do not hold a marginalized identity.”

Additionally, when I take in prenatal information, I always remind myself of my choice about what I take in and in what I leave out. For example, I use a prenatal app that I love, primarily for strength-training, which happens to include blogs and videos on topics like weight gain and nutrition that I skip, because the authors use diet culture and weight-stigmatizing language. Take what you need and feels healthy for you and leave the rest.

Ultimately, when we ask, “why is prenatal care important?” we should remember that prenatal care is about far more than weight or numbers on a chart. It should help people make informed decisions, feel supported throughout pregnancy, and access care that promotes their overall well-being.

Prenatal Care: FAQs

Now, I'm sharing answers to some of the most common questions we get from clients, friends, and family members when it comes to prenatal care:

Why is prenatal care important?

Prenatal care is important because it helps protect the health of both the pregnant person and the baby. Regular prenatal visits allow a health care provider to monitor blood pressure, track fetal development, and catch potential complications early.

Why is prenatal and postnatal care important?

Prenatal and postnatal care are important because they support the health of both parent and baby before and after birth. Together, they reduce the risk of complications such as preterm birth, low birth weight, and postpartum health issues, while ensuring ongoing guidance from a health care provider for a healthy pregnancy, safe delivery, and smoother recovery after birth.

Why are prenatal vitamins important?

Prenatal vitamins are important because they help fill nutritional gaps during pregnancy and support the healthy development of the baby. They typically include key nutrients like folic acid, iron, calcium, and vitamin D, which are essential for brain development, red blood cell production, and bone health.

Why are prenatal vitamins important while breastfeeding?

Prenatal vitamins are important when breastfeeding because they help support both the parent’s recovery after birth and the baby’s ongoing nutrition through breast milk. They provide key nutrients like folic acid, iron, calcium, iodine, and vitamin D, which can be harder to get in adequate amounts during this time.

Are prenatal vitamins important in third trimester?

Yes, prenatal vitamins are important in the third trimester because the baby is rapidly growing and developing, especially the brain and bones. Nutrients like iron, calcium, vitamin D, and folic acid continue to support fetal growth and help prevent deficiencies in the pregnant person.

Reach out if you need help.

If it feels hard to navigate prenatal care, reach out for professional help and we'd be happy to help you in your process. Feel free to explore our nutrition counseling, body image counseling, and eating disorder counseling services. If it feels right, get in touch with us via our contact page—we'd love to support you.

In true health, 

Caroline