Obesity And Pregnancy
  Recognizing & Dealing With Excessive Weight Gain In Pregnancy

Are you overweight and pregnant? Or are you looking for information on the effects of obesity on fertility if you are trying for a baby?

Well, medical research has demonstrated that you are less likely to conceive if you are obese. But the problem goes beyond that. If you are pregnant and obese, you and your unborn baby are likely to experience more complications during pregnancy, in labor and there after. 

Does that mean that it is wrong to add on weight in pregnancy? No. Not if you add on a modest amount of weight. How much is modest weight in pregnancy?

Every pregnant woman is expected to put on an average of 6 to 15kg (up to 31 lb) of weight as the pregnancy progresses. This is as a result of increased blood volume needed for a healthy pregnancy, the additional weight of the baby, the placenta, increased breast size, and the increased size of the womb.

This additional weight gain tends to resolve in the following 6 to 12 weeks after delivery. So, when is one said to be obese in pregnancy?

What Is Obesity In Pregnancy

To be overweight is defined as having a BMI between 25 kg/m2 and 29.9 kg/m2, and to be obese is to have a BMI of 30 kg/m2 or more.

Obesity in pregnancy, or obesity and pregnancy (also called maternal obesity or gestational obesity) refers to the excessive weight gain occurring before or during pregnancy, in an expectant mother.

Anything in excess of the above weight gain of 10 to 15kg (some may stretch this up to 20kg) occurring during pregnancy is unhealthy and constitutes gestational obesity or obesity in pregnancy for an hitherto normal-weight woman, and no more than 15 to 25 lb (6 to 12Kg) additional weight for an already over weight or obese mother-to-be.

For clarity, a BMI of more than 35 puts a pregnant woman at moderate risk of complications associated with pregnancy and delivery, and certainly, a BMI of 40 or more confers a very high obstetric risk on the mother-to-be.

So too is a preexisting obesity before pregnancy. It dramatically increases the risk associated with pregnancy.

Risks Of Being Pregnant And Obese

A review published by the United Kingdom Centre for Maternal and Child Enquiries in the bi-yearly publication Saving Mother's Lives (previously known as Confidential Enquiry into Maternal and Child Health) reports that there is "substantial evidence that obesity in pregnancy contributes to increased morbidity and mortality for both mother and baby".

It continues "more than half of all women who died from direct or indirect causes were overweight or obese". What a grim report. No wonder obesity and pregnancy should be given more than the usual attention.

To be obese and pregnant or obesity and pregnancy puts the mother at increased risk of pregnancy related complications like being more likely to have:

• Miscarriages,
• High blood pressure in pregnancy (pre-eclampsia), which could lead to fits (eclampsia),
• Developing diabetes in pregnancy (gestational diabetes)
• Abnormally formed babies (congenital birth defects)
• Stillbirths - or babies dying inside the womb
• Difficulty with examination or difficult scanning during pregnancy
• Blood clots
• Non-alcoholic fatty liver disease
• More likely to need caesarean section than those with normal weight
  
• Increased difficulty with surgical operations like caesarean section as the increased fat makes the operation more hazardous
• Increased risk with anaesthetics like difficult intubation

• Delivery of too large for age babies with its attendant complications to mother and baby like:
  • Need for instrumental delivery (use of forceps, ventouse etc, etc)
  • More likely to have shoulder dystocia - the shoulder getting stuck inside during delivery, making it difficult to bring baby out
  • Babies born with severe fetal distress and unable to start breathing by themselves
  • Neonatal hypoglycaemia - babies born with very very low blood sugar and when not dealt with within minutes, could lead to permanent brain damage in the baby in severe cases
  • Neonatal sepsis - more likely to develop infection in early days after delivery because of a combination of one or all of the above

• Nasty wound infection after surgery
• Death of mother from blood clot or related complications during pregnancy or within the following 42 days after delivery.

In the United States alone, obesity accounts for over 300,000 deaths annually, and a large number of these include mothers-to-be.

Yes. It is no longer fashionable to pile on the pounds during pregnancy. No more "eating for two" in terms of the size of portions served when you are pregnant, but certainly true in terms of quality of food to eat when pregnant.

While dieting is not recommended during pregnancy, if you find out that you are obese, there is a lot you can do to remedy the situation before you become pregnant and even while you are pregnant.

Dealing With Obesity Before Pregnancy

If you are obese and finding it difficult to get pregnant, losing 5 - 10 percent of your current body weight can significantly increase your chances of getting pregnant.

Have you been trying to lose weight and continue to find it difficult to do? Do not despair. It is not going to be easy, but it is do-able. If you think it is impossible, then think again. Mexican Manuel Uribe was the world's fattest man until February 2012. He lost 60 stone to hit 31 stone after dieting!

Yes. With dieting and exercise alone, with a big pouch of determination, you can do it. Don't put if off. To diet during pregnancy is dangerous. The best time is now. Do the following to put off the pounds:

• Sit back and mediate on why you want to lose weight. Write these down. Remind yourself of the potential complications to yourself and your unborn baby
• Undertake to write down everything that passes through into your mouth for a period of two weeks. This food diary should be total and comprehensive. Create a column in the diary on how you felt before seeking to eat - were you angry, stress or just hungry. This may help identify the reason for eating
• You could cut down on what you eat and avoid foods high in fat and sugar, and replace these with healthy options. If you find out that you are struggling with this, you may wish to enroll into one of the medically validated dieting programs in your area, like the Sainsburys Diet Program
• Start an Exercise program. Start by doing a little more than you would usually do, like stopping a bus stop earlier than you would normally stop and walk the extra distance. Use the stairs instead of lift at every opportunity. Go for a 20 or 30 minutes walk every evening if possible. What about running? Joining a dance club? Once your motivation level increases, and you sure you do not want to risk the problems associated with obesity and pregnancy, you can get your own in-house "gym" and stock it with any of these exercise equipment for the obese.
• Remember that you can see your doctor to prescribe you a supply of weight loss pills to help lose weight like Orlistat (also called Alli in some countries).

Doing all the above in conjunction with your health care provider could help in bringing down your weight and in improving your chances of getting pregnant. If your weight problem is caused by the condition known as polycystic ovarian syndrome (PCOS), your doctor may decide to put you on metformin and or clomiphen to help in improving your fertility and weight loss.

What if you are pregnant and want to lose weight?

Dealing With Obesity In Pregnancy

Aggressive weight loss during pregnancy is not advised. Neither is the use of weight loss medication.

If you are already pregnant and want to lose weight, a regime of sensible dieting and moderate exercise is best.

• Be sure to eat a selection of nutritious healthy meal to avoid starving yourself or your unborn baby of vital nutrients. See the guide on eating healthy in pregnancy and note the approximate portions of the various classes of food to include in your meal per day
• Cut down on fatty and sugary foods and fizzy drinks
• Exercise. Yes. Mild to moderate exercise is acceptable in pregnancy. This will not only help you with weight control, but make you fit and improve your experience during labour. Exercises you could do while pregnant include brisk walking up to 30 minutes at least 4 -5 days a week or jogging for 20 to 30 minutes. Another great way to deal with obesity and pregnancy by way of exercise is by taking up swimming for about an hour a few days a week, or in combination with other exercises like bike riding, pelvic exercises and use of exercise balls
• Be sure to verify from your health care provider that your health will allow you to do any exercise before embarking on such.
  

You can read more on workouts in pregnancy here.

Because of the increased risk of folate and vitamin D deficiency, higher probability of developing gestational diabetes and problems with fetal growth in the pregnant and obese, management of women with obesity in pregnancy requires the routine administration of:

• 5mg of folic acid from before pregnancy up to 12 weeks into the pregnancy
• 10 micrograms of vitamin D daily throughout pregnancy and breastfeeding
• Regular weighing especially at 28th and 34th week of pregnancy
• Blood glucose tolerance test at 24th to 28th week of pregnancy
• Routine ultrasound scan to ascertain the growth pattern of the foetus at 28th and 34th week
• Behavioural counselling with recommendations for diet and exercise

If you or your loved one require further help with dealing with obesity in pregnancy, see your GP or Family doctor who can give you detailed practical help.

You May Also Like To See:

• Safe Exercises And Working Out During Pregnancy
  
• Tips To Eating Healthy During Pregnancy
• Best exercise equipment for the obese
• Pregnancy Without Pounds: The Look Good Feel Great Pregnancy Kit. A weight control in pregnancy e-book, often referred to as the Ultimate Pregnancy Package.

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