“Women do gain weight during pregnancy and that is healthy for both mom and baby,” says Dr. Mary Schultz, M.D., an OB/GYN with Agnesian HealthCare. As a nation, however, our waist lines are expanding and starting a pregnancy overweight or obese can be a concern. The American Congress of Obstetricians and Gynecologists’ report, “Obesity in Pregnancy,” explains the known risks that obesity poses to pregnant women and their babies.
“Obesity has become an epidemic,” says Gary D.V. Hankins, MD, chair of ACOG‘s Committee on Obstetric Practice, which developed the document. “At this point, 49% of non-Hispanic black women are obese, 38% of Mexican-American women are obese, and 31% of non-Hispanic white women are. And, everything we do in obstetrics is made more difficult and more complex by obesity—from using external monitors to performing surgery.”
According to ACOG, some studies show that obesity is an independent risk factor for miscarriage among women who undergo fertility treatment. Data also links obesity to miscarriage in women who conceived naturally. Obesity has been linked to an increased risk of gestational hypertension, preeclampsia, and gestational diabetes. And the higher the body mass index (BMI) a woman has, the higher the chance she will need a cesarean.
Other studies show that obese women have more complications during and after cesarean surgery, including excessive blood loss, operating time greater than two hours, and wound infection. Surgery in obese women also poses anesthetic challenges, among them difficult epidural placement and respiratory problems from difficult intubation.
Elevated risks to the babies of obese women include stillbirth, prematurity, macrosomia (large for gestational age), neural tube defects, and higher rates of childhood obesity.
“A lot of ob-gyns don’t bring up weight with patients,” says Laura E. Riley, MD, immediate past chair of ACOG’s Committee on Obstetric Practice. “We’re hoping to open the dialogue between patient and physician, so that patients come to understand that maintaining a healthy weight isn’t just about how you look, but that it also has real medical implications.”
Vivian M. Dickerson, MD, immediate past president of ACOG, emphasizes that the time to begin frank discussions about weight is before a pregnancy is achieved. “In preconception visits, we talk to patients about genetic risks and immunity to rubella, but rarely do we discuss their weight or diet and exercise,” Dr. Dickerson says. “But optimizing your weight before conception is one of the most important things you can do to have a healthy baby.”
To battle obesity, more people are turning to bariatric surgery. But as a result of the surgery, many patients who later become pregnant may see a host of complications such as gastrointestinal bleeding, anemia, intrauterine growth restriction, prematurity, and neural tube defects. The surgery can also lead to deficiencies in iron, vitamin B12, folate, and calcium. On the other hand, pregnancies following bariatric surgery are often less likely to be complicated by gestational diabetes, hypertension, macrosomia (large babies), and cesarean delivery.
“Because we’re just beginning to learn what the risks and upsides might be, it’s a balancing act for doctors and patients,” said Dr. Dickerson. “Patients need to proceed with caution because we really haven’t had enough experience yet with this to make solid conclusions.”
ACOG’s recommendations for obese patients who are pregnant or planning to conceive include having a preconception consultation and weight-loss counseling, seeking information on the risks of obesity and pregnancy, and continuing nutritional counseling and exercise programs after delivery.”