PREGNANCY AND OBESITY

“Doctor, I’m thinking about having a baby but I’m concerned that I’m too heavy.  Is this something I should worry about?”

The answer to this question is an unfortunate, yet definite, YES.  Saying weight loss is hard is an understatement. But if you are carrying too many pounds for your frame, returning your body to a healthy weight is one of the best things you can do for yourself and your baby.

These days, the statistics are staggering. Only about one-third of American woman are of a normal weight. One-third are overweight (BMI 25-30) and one-third are obese (BMI >30). As a result, our perceptions of “normal” weight have been dramatically skewed. Many health providers don’t even notice when a woman is overweight, but this carries many increased risks as well.

The consequences of obesity in non-pregnant women are well-known — diabetes, high blood pressure, stroke, certain cancers, joint problems and liver/gallbladder disease. And now, the health risks of obesity on pregnancy are clear as well:

Diabetes

An overweight mother is four times more likely to develop gestational diabetes. This can lead to extremely large infants who are more likely to have birth injuries or who will require cesarean delivery.

Preeclampsia

Obese mothers are twice as likely to have high blood pressure related to pregnancy. This can increase their chance of blood clots, stroke, and premature birth.

Higher chance of cesarean

When delivering a baby naturally, my medical partners and I like to say that it’s “all about the push.” Women who are carrying extra weight, especially in the mid-section, have less muscle tone and thus less strength with which to push their babies out. In addition, the extra fat deposits within the birth canal make it much more difficult for the baby to slip through.

Many patients ask what they can do to avoid a Cesarean delivery. Maintaining a healthy weight is high on the list. These statistics are staggering”

For women of normal weight, the chance of a Cesarean is 11%.

For overweight women, the chance is 18%.

For obese women, the chance is up to 43%!

In addition, obese women who have a cesarean have a higher risk of blood clots, bleeding, and infections after surgery.

Higher risk of birth defects

In obese women, the risk of spina bifida is twice that seen in normal-weight women.  The risk for cleft lip is 20% higher, for heart defects is 30% higher, and for hydrocephalus is 60% higher.

Inability to detect birth defects

Ultrasound is our best tool in obstetrics. Yet this technology is limited by the distance the sound waves need to travel. For overweight women, 3 or more inches of fat on the abdominal wall can limit the detail of what we can see. so subtle birth defects may go undetected.

Pregnancy symptoms

Even the more mundane symptoms and discomforts of pregnancy occur far  more often in obese mothers. These include heartburn, carpal tunnel syndrome, back pain, pelvic pressure, and headaches.

Public health officials are concerned that the maternal mortality rate in the United States has been on the rise in recent years. A major contributing factor is the increase in obesity. Of all maternal deaths, two-thirds are related to complications of obesity.

It is clear that one of the best things you can do prior to getting pregnant is getting your body to its healthiest weight. Calculate your BMI – many women are not even sure where they stand. Then talk to your doctor about a weight loss plan before putting yourself and your baby at unintended risk.

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