For years, physicians have been discussing the importance of maintaining a healthy weight. While there are numerous risks associated with obesity for adults, becoming pregnant while obese presents a distinct and significant set of problems. In obese women, there is not only potential harm to the mother but to the unborn child, as well. In this article, I will discuss the impact of obesity on pregnancy and options for obese women who are or want to become pregnant.
Morbid obesity is defined as having a BMI (Body Mass Index) of 35 or greater, typically starting at about 75 pounds overweight. Obesity during pregnancy puts a mother at risk of several serious health problems. The most common are gestational diabetes and sleep apnea. Gestational diabetes is diabetes that is first diagnosed during pregnancy. Obese women are screened for gestational diabetes early and throughout pregnancy. This condition can increase the risk of needing a Cesarean delivery. Women who have had gestational diabetes also have a higher risk of developing diabetes in the future, as do their children.
Another more serious disorder is preeclampsia. This is a high blood pressure disorder that can occur during or after pregnancy. It is a serious illness that affects a woman’s entire body – the kidneys and liver may fail. Preeclampsia can lead to seizures and in rare cases, stroke can occur. Severe cases need emergency treatment to avoid these complications. The baby may need to be delivered early.
It is important to know that the risks of morbid obesity are not limited to the mother. Obesity can also increase the risk of problems for the unborn child during pregnancy. Multiple studies have shown that obese women have an increased risk of pregnancy loss (miscarriage) compared with women of normal weight. Babies born to obese women have an increased risk of birth defects, such as heart defects and neural tube defects (defects of the brain, spine or spinal cord).
Babies carried by obese mothers can develop fetal macrosomia. In this condition, the baby is larger than normal, which can increase the risk of the baby being injured during birth. For example, the baby’s shoulder can become “stuck” during delivery. Macrosomia also increases the need for Cesarean delivery. Infants born with too much body fat have a greater chance of being obese later in life.
If you plan to be or are already expecting, working with your physician to develop nutritional and exercise plans can make an important difference in avoiding the complications of obesity.
Finally, obese women have a very high rate of pre-term birth. This means that the baby is delivered early for a medical reason. Pre-term babies are not as fully developed as those born after 39 weeks of pregnancy. As a result, they have an increased risk of both short-term and long-term health problems.
Losing weight before becoming pregnant is the best way to decrease the risk of problems caused by obesity. Losing even a small amount of weight (5-7% of the current weight, or about 10-20 pounds) can improve overall health and pave the way for a healthier pregnancy. To lose weight, we need to use up more calories than we consume. You can do this by getting regular exercise and eating a healthy diet. Your obstetrician may refer you to a nutritionist to help you plan a healthy diet. Increasing your physical activity is important if you want to lose weight. Aim to be moderately active (for example, biking, brisk walking and general gardening) for 60 minutes or vigorously active (jogging, swimming laps or doing heavy yard work) for 30 minutes on most days of the week. You do not have to do this amount all at once. For instance, you can exercise for 20 minutes three times a day. Losing weight can also help to become pregnant as morbid obesity is a frequent cause of infertility.
For some women, bariatric surgery may be an option if they are very obese or have major health problems caused by obesity. If you have weight-loss surgery, you should delay getting pregnant for 12-24 months after surgery, when you will have the most rapid weight loss. If you have had fertility problems, they may resolve on their own as you rapidly lose the excess weight. It is important to be aware of this, because the increase in fertility can lead to an unplanned pregnancy. Some types of bariatric surgery may affect how the body absorbs medications taken by mouth, including birth control pills. You may need to switch to another form of contraception.
Despite the risks, you can have a healthy pregnancy if you are obese. It takes careful weight management, attention to diet and exercise, regular prenatal care to monitor for complications, and special considerations for your labor and delivery. Finding a balance between eating healthy foods and staying at a healthy weight is important for your health, as well as your baby’s health. In the second and third trimesters of pregnancy, a woman needs an average of 300 extra calories a day – about the number of calories in a glass of skim milk and half a sandwich. Working with your obstetrician to determine a weight goal for becoming pregnant and while expecting can be very important.
Once you are home with your new baby, stick to your healthy eating and exercise habits to reach a normal weight. Breastfeeding is recommended for the first year of a baby’s life. Not only is it the best way to feed your baby, it also may help with postpartum weight loss. Overall, women who nurse for at least a few months tend to lose pregnancy weight faster than those who do not.
Obesity is a serious condition. An expectant mother’s efforts to control her weight can lead to a better quality of life for her and her baby. If you plan to be or are already expecting, working with your physician to develop nutritional and exercise plans can make an important difference in avoiding the complications of obesity.