Overweight & Pregnant

Women of childbearing age in North Carolina are among those leading what the U.S. Surgeon General calls an “epidemic of obesity” that puts women and babies at risk for certain health complications. In our state, women ages 18-44 are more likely to be obese than their counterparts in California and New York, according to a March of Dimes 2003 geographical chart of obesity in women across the United States.

These women assume potential health risks for themselves and their babies if they are overweight at the outset of pregnancy. Studies show definitively that obese pregnant women have a higher incidence of Cesarean sections, hypertension and gestational diabetes, a type of diabetes that occurs only during pregnancy.

“The higher the degree of overweight, the more at risk you are,” says Cathy Greer, nutritionist supervisor at the Health Care Center at SAS Institute in Cary. “Someone that might be just 10 pounds overweight could have a very healthy pregnancy. Many women that are just marginally overweight have healthy pregnancies and do not have complications, but the more overweight you are and the closer you are to obesity, the more at risk you become.”

Add to the equation the increasing number of women who are postponing pregnancy until later in life, a factor which makes excess weight gain during pregnancy more likely, and the result is a greater number of women who are not optimally healthy during their pregnancies.

Defining Obesity and Overweight

According to a Centers for Disease Control (CDC) Body Mass Index (BMI) Chart, which is based on the relationship between weight and height, you are considered overweight if your pre-pregnancy BMI is between 25 and 29.9, and obese if it is greater than 30. For example, a woman who is five foot five inches tall and weighs 155 pounds prior to pregnancy has a BMI of 25.8, which is in the overweight category. If that same woman lost seven pounds, she would be at the high end of normal. To be classified as obese, she would have to weigh more than 180 pounds.

What Are the Risks?

Although the U.S. Surgeon General cautions that obesity during pregnancy is associated with increased risk of death to both baby and mother, physicians more frequently worry about their patients developing gestational diabetes and hypertension, or high blood pressure.

Greer says women with a family history of diabetes or high blood pressure are more at risk for these diseases during pregnancy even if they are not categorized as obese. “A woman who has certain medical conditions in her family health history could be more at risk when she is 15 to 20 pounds overweight than another woman with a different family history,” she says.

Gestational diabetes, which leads to abnormally high blood glucose levels, complicates 4 percent of all pregnancies in this country. Women with gestational diabetes can have large babies, which can lead to trauma during labor and delivery. Of women with gestational diabetes, 60 to 80 percent are obese. By decreasing carbohydrate intake under a doctor’s supervision, these women can reduce glucose levels that can adversely affect the baby.

Dr. Carter Gray, a clinical associate in the Duke University Women’s Health division of Obstetrics and Gynecology, has seen firsthand the difficulties associated with pregnancy and obesity.

“When it comes time to deliver, if they are having a difficult labor, C-sections can pose quite a problem,” she says. “Obese people are sometimes harder to intubate (open an airway for surgery), so we try to do local anesthesia. There also is a higher risk of infection and bleeding in obese women.”

Babies born to women with gestational diabetes can have a lot of weight across the shoulders, says Gray, which can make it difficult for the baby to pass through the birth canal. Sometimes these babies suffer damage during delivery of the nerve running from the neck down the arm.

Obesity during pregnancy also leads to a tenfold increase in the risk of maternal high blood pressure. This can sometimes lead to a serious condition called preeclampsia, in which women experience excessive swelling, poor kidney function and, possibly, a compromised placenta that cannot supply adequate nutrients to the baby.

Babies of obese women are also three times more likely to have neural tube defects like spina bifida, where the spinal column does not close properly and is exposed at birth. However, the risk remains relatively low, at less than 10 percent.

Maintaining a Healthy Weight During Pregnancy

So, what if you’re overweight and already pregnant? It’s not too late to make choices that protect the health of you and your baby. Eat right and exercise, but don’t attempt any diets that exclude food groups or heavily restrict calories. With proper nutrition and prenatal care, you can improve your chances of delivering a healthy baby.

Both Gray and Greer advise overweight women to start slowly, under a doctor’s supervision, with a regular exercise routine. Gray keeps close tabs on her obese patients. “Every time a patient comes in, we check weight and blood pressure, and we talk about how things are going. Obviously we’re not going to put anyone on a diet, but we do encourage women to be active and eat healthy foods,” she says.

She also encourages her patients to take advantage of exercise and nutrition classes through the Duke Center for Living. The Duke program, ActivMoms, helps women who want to get and stay fit before, during and after pregnancy. The ActivMoms philosophy, as stated in the program’s brochure, is that women who exercise during and after pregnancy:

• Are better prepared for the “marathon of labor”.

• Experience fewer complications during and after delivery.

• Return to their pre-pregnancy body faster.

• Tend to have “self-soothing” babies or babies that can calm themselves.

Jennifer Jones, a mother of two who participated in the ActivMoms class at Duke during her second pregnancy, was so pleased with the results that she now recommends the class to all of her pregnant friends. “I became pregnant 10 months post partum, and I had gained probably 40 pounds with my first pregnancy,” says Jones. “I already tend to be on the overweight side, so when I got pregnant again, I thought, ‘I cannot gain another 40 pounds.’ I actually ended up losing weight during my second pregnancy because I did do the ActivMoms class and gained only 16 pounds.”

Jones, who recently moved to Alabama, says she did ActivMoms aerobics classes twice a week and walked on non-class days. She now has two healthy children, a 1-year-old girl and a 2-year-old boy.

Duke University physician Geeta Swamy, a specialist in Maternal-Fetal Medicine, is currently collaborating on a postpartum study of 400 women through the ActivMoms program that will track weight loss in participants for one year after their pregnancy. Swamy says the current trend of having children later in life has made it more challenging for women to manage their weight during and after pregnancies.

“Women who are older and women who are in minority races tend to gain more weight during pregnancy,” she says.

Studies have shown that women of advanced maternal age (35 or older at the time of delivery) gain more weight and have more trouble losing it. That sector of the childbearing population is increasing. From 1981 to 2003, the birth rate for women age 40-44 doubled, according to a CDC report.

“We know that women who are obese during pregnancy are more likely continue to be obese after pregnancy,” Swamy says. “And we know that women who have had multiple pregnancies are more likely to be obese, so with each subsequent pregnancy they are more likely to become obese.”

Some Weight Gain Is Healthy

According to the March of Dimes, if you are overweight prior to pregnancy you should gain 15-25 pounds. If you are normal weight prior to pregnancy, you should gain 25-35 pounds, and if you are underweight prior to pregnancy you should gain 25-40 pounds. If you have a multiple pregnancy (twins, triplets, etc.), you should speak to your health care provider about proper weight gain guidelines.

“Thirty years ago, health-care providers were recommending that women eat for two,” says Greer, the nutritionist. “We’ve really done away with that mentality because with pregnancy you only need about 300 more calories a day” A suggested menu for these 300 extra pregnancy calories daily could be: two ounces of lean protein, an extra fat-free dairy serving, two more servings (perhaps one each) of fruits and vegetables, and one whole grain.

Of course, the best way to avoid all of the risks associated with obesity and pregnancy is prevention. If possible, achieve a healthy weight prior to conception. Greer cautions women about getting caught in a cycle of weight gain during their childbearing years. “A large percentage of women do not lose the last nine pounds following a pregnancy and then with subsequent pregnancies they are starting with a higher pre-pregnancy weight,” she says. “It can become more difficult to get that weight off with each baby.”

Interestingly, women aren’t the only ones who need to watch their waistlines during and after pregnancies. Swamy says the more children men have, the more likely they are to put on the pounds, too. That makes working toward a health lifestyle a common goal — one that moms and dads can achieve together.