It is essential that a woman develops a close relationship with her health care provider to plan for a healthy pregnancy. Together they can focus on a nutrition and exercise plan for the expectant mother. By setting realistic goals, the outcomes for a pregnant woman and her baby are greatly improved. I discussed the health issues due to obesity during pregnancy with Cynthie K. Anderson, M.D. (Medical Director, UW Arboretum Obstetrics & Gynecology).
“Women need to monitor their weight and exercise before they conceive,” suggested Dr. Anderson.
“Labor and delivery are super hard. The more fit you are the better delivery you will have.”
Dr. Anderson has seen the statistics for obese pregnant women rise in Wisconsin with the rates pushing 50%. How is it determined that a pregnant woman is obese? A doctor will measure the woman’s weight and height and using calculations determine her Body Mass Index (BMI). Women with a BMI of 25 are overweight while women with a BMI of 30 or higher are considered obese.
Complications to the Mother
“Women face difficult problems when they are obese during their pregnancy. Vaginal birth may not be successful. Cesarean section rates increase as the woman’s BMI increases. If a woman has to have a cesarean, there is a greater chance of blood clots, wound infection and the wound may not heal properly,” says Anderson.
Additionally, these women face the possibility of blood pressure issues. If she becomes hypertensive, there is a greater chance of preeclampsia (maternal organ damage and seizures). Gestational diabetes is common. It’s really important that women discuss these complications with their doctor early on in pregnancy, or even before conception.
Complications to the Baby
Obese pregnant women have an increased chance of having a stillborn child. There are 2x the odds of a pregnant obese woman having a miscarriage. A baby born to an obese woman has a greater risk of birth defects. Here are some alarming rates of birth defects:
– Odds are increased 3 times for a neurotube defect (example: spinal bifida)
– Odds are increased 1.5 times for a cardiac anomaly
– Odds are increased 1.5 times for a gastrointestinal anomaly
– Odds are increased 1.4 times for a limb reduction (arms and legs are not formed properly)
Prenatal Visits for an Obese Woman
“Expecting obese women should attend more prenatal visits so the doctor can monitor both the mother and baby for complications. At one of the first prenatal visits, the doctor will complete baseline testing to screen for kidney problems, hypertension and type 2 diabetes. A sleep study may be necessary to rule out sleep apnea. If the woman is not receiving sufficient oxygen while sleeping, a CPAP machine may be required. The CPAP machine helps to reduce the risk of pulmonary hypertension. Due to excessive fat tissue, it is often difficult for the doctor to determine how big the baby is growing. The doctor will schedule ultrasounds each month to keep a watchful eye on the baby,” noted Dr. Anderson
Prenatal visits can occur as frequently as two times a week so that the mother’s blood pressure is checked and a test is done for gestational diabetes. A crucial appointment is scheduled with an anesthesiologist in case a cesarean section needs to be performed. “It can be hard for an anesthesiologist to find the correct landmarks for an epidural block on an obese woman. During a cesarean, an obese woman can have pulmonary problems due to the pressure from excess weight on her chest, so it’s important for obese women to attend all prenatal appointments,” explained Dr. Anderson.
Weight will be carefully watched by the doctor. A pregnant woman with a normal BMI could possibly gain from 20 to 35 pounds while pregnant. An obese pregnant woman can healthily gain very little with a maximum weight gain of 11 to 20 pounds. The less weight the obese woman gains, the lower the rates of gestational diabetes, preeclampsia and incidence of cesarean section decreases.
The Solution is Exercise and Nutrition
The nutritional needs of women change during pregnancy. Your doctor can suggest wholesome fruits, vegetables, meats and dairy products for a healthy pregnancy.
Exercise is vital! “Women can start slowly with 5 to 10 minutes of exercise a day and build up to 30 minutes a day,” emphasized Dr. Anderson. “It is fine to exercise when you are pregnant with a focus on exercises that do not stress the joints such as yoga, walking, swimming, Zumba and aerobics. No contact sports though.”
“Obese women who are struggling to conceive should discuss with their doctor a healthy plan for weight loss. A 5 to 10% in weight loss will increase ovulation, thereby increasing the chance of conceiving,” suggested Dr. Anderson.
“We have had success with obese women having gastric bypass surgery before they conceive. Women in this situation should plan to conceive after the surgery and would work closely with their surgeon and doctor to assure that there are no vitamin deficiencies for the baby. The pregnancy outcomes have been much better and we have seen lower complication in both the baby and mother,” said Dr. Anderson.
Be Healthy and Plan with Your Doctor!
A healthy weight can lead to an easier and healthier pregnancy for mom and baby! I urge you to build your nutrition and fitness plan with your doctor. It is never too late, but it’s even better if you start before conception!
Because it all beigns with a healthy woman…
Sue Ann Thompson is founder and president of the Wisconsin Women’s Health Foundation (WWHF), a statewide non-profit organization whose mission is to help Wisconsin women and
their families reach their healthiest potential. WWHF provides programs and conducts forums that focus on education, prevention, and early detection; connects individuals to health resources; produces and distributes the most up-to-date health education and resource materials; and, awards grants and scholarships to women health researchers and related community non-profits.
To learn more, visit wwhf.org or call 1-800-448-5148.
