Obese and Pregnant: Risks to You and Your Fetus

Any pregnant woman who is overweight or even obese can expect to have a healthy pregnancy and a healthy baby. If you are obese before pregnancy, you’re more likely to have problems getting pregnant (becoming infertile) than women who have a healthy weight. The more your BMI increases, the less chance you have got to even get pregnant with IVF (In-vitro Fertilization).

Being overweight or obese during pregnancy may not have any effect at all on you or your fetus, but letting your body mass index (BMI) to increase above 30, can bring the risk of having major pregnancy complications.

If you're a lucky woman, you may not experience any of these complications, but then it's always good to be on guard as it's helpful to be aware of these complications while planning to conceive, just in case. Naturally, you have got a lot of things to do before and during pregnancy to help you have a healthy pregnancy and a healthy baby.

Weight does make a difference to how well your pregnancy goes. It generally gets complicated due to so many factors that can influence your health, such as your family history, your lifestyle, your ethnic background, your BMI and also your age. And trust me; all of them can play their significant part (NCCWCH 2008).

6 Defining Obesity

Obesity is a complex disorder of you having an excessive amount of body fat. It is defined by body mass index (BMI) to determine if you are obese. A BMI of 25-30 is considered to be of an overweight; 30 and above defines obesity and 40 and higher extreme obesity.

The amount of body fat that a person puts on can negatively effect their health if the weight gain is more than 20% of what it should be. Not everyone gains weight the same, and some pre-existing conditions can contribute to weight gain. If you've noticed that you've been gaining weight rapidly, it's in your best interest to see your health care professional and find out why you're gaining the amount of weight you are.

Obesity can effect your health in a number of ways:

- Diabetes

- Asthma

- Insomnia

- High Blood Pressure

Diet and exercise are the keys to losing weight, but it's a hard fought battle, and without the proper support and information it's easy to be sucked into a spiral of dieting, weight loss and a return of weight gain. If you're overweight and are afraid of becoming obese, talk to your health care professional and get their medical advice before starting any type of diet and exercise routine.

It's easier to eat healthy and exercise when you have support, if you have a friend who is looking to lose weight too, try starting out together, and don't be discouraged if they lose more weight faster than you. Different bodies respond differently to exercise and weight gain, you can't expect to shed the same amount of weight as someone else because of your own personal factors.

Things like:

- Genetics

- Medication

- Self Destructive Behaviour

- Endocrine Disruptors

All play a part in your ability to lose weight. So never give up hope, but try to be realistic for yourself and take the baby steps if that's what you need to do.

5 Ability to Conceive

If you are obese, your fertility can be affected because your normal ovulation cycle might be restrained and result in an interrupted ovulation or an irregular period making it harder to pinpoint when you're most fertile. Fertility depends on a regular cycle and release of eggs from the ovaries. For obese women, getting pregnant the old fashioned way, it might be harder, and you might find yourself looking into alternative ways to get pregnant.

But even the alternative fertility methods can be an uphill battle for an obese person. Obesity tends to affect the outcome of In-Vitro Fertilization (IVF); so if your BMI increases above 30, you stand a higher chance of of risking an unsuccessful IVF.

Studies suggest that for women who have to undergo infertility treatment, obesity is an independent risk factor leading to spontaneous abortion. Studies also provide data linking spontaneous abortion among obese women who do conceive naturally as well.

Your weight upon entering pregnancy has a large factor in your risk for spontaneous abortion, premature birth and complications. Another risk factor that effects the ability of an obese woman to maintain a pregnancy is if she suffers from Polycystic Ovary Syndrome.

Women with Polycystic Ovary Syndrome is a disease that effects more obese and overweight women than women who have stable and normal BMI. Polycystic Ovary Syndrome is a hormone imbalance that effects the regular release of eggs from the ovary resulting in irregular periods and infertility. If this health issue isn't addressed it can further lead to heart disease and diabetes.

4 Risks of Illnesses

By being obese during pregnancy, you become more susceptible to pregnancy complications like:

Gestational diabetes:Women who are overweight or obese are more likely to have diabetes (gestational) that develop during pregnancy and cause elevated blood sugar. Uncontrolled levels of high blood sugar can cause a variety of problems.

It's estimated that nearly 5% of pregnant women develop diabetes, and the risk increases along with an increased BMI. Overweight women are twice as likely to have gestational diabetes, and obese women are 4-8 times more likely to have it than women who have a normal weight.

What you should do: Learn about ‘gestational diabetes’ online, from your medical practitioner or your nurse/midwife. You can also get more information from the Canadian or American Diabetes Association. Learn how to manage this condition by Eating Right. Check your blood sugar if you need to and follow your practitioners’ advice and never miss your prenatal appointments.

Preeclampsia: Preeclampsia (also known as ‘Toxemia’) is a serious health condition common in obese and overweight pregnant women. This condition is generally diagnosed after 20 weeks of pregnancy, if you have high blood pressure and a high level of protein in the urine. Moms-to-be with preeclampsia will often have headaches and swelling in the feet, legs, and hands as it causes blood vessels to constrict, raises your blood pressure and decreases blood flow throughout your body.

Preeclampsia can progress slowly or rapidly and can range from being mild to severe. In severe cases, it can cause organ damage to you and cause problems for your baby who may have poor growth, less amniotic fluid, and placental abruption. It's scary for all moms-to-be to know that there is no cure for preeclampsia.

If this condition goes undiagnosed, it can lead to a serious condition, called eclampsia, which can put you and your baby at a much higher risk, and in rare cases, cause death. If a mom-to-be with preeclampsia gets seizures it means she has eclampsia.

Research shows that about 6 -12% of overweight and obese women are diagnosed with preeclampsia, while about 4% of women with a BMI in the normal range can be diagnosed.

What you should do: But you can help protect yourself by learning the symptoms of preeclampsia, how it can be managed and by seeing your doctor for your regular prenatal care. When preeclampsia is diagnosed early, it becomes easier to manage. See your doctor immediately if you experience persistent and/or severe headaches, puffiness or swelling in your face, hands or eyes, intense pain or tenderness in your upper abdomen (right side), sudden weight gain, a decrease in urine, or blurry/double vision, temporary loss of vision or sensitivity to light. If you have severe preeclampsia, you can be prescribed anti-seizure medications. But at times you can have preeclampsia and not have any symptoms. Therefore, it is necessary to see your doctor to regularly get your blood pressure checked and your urine for protein.

Gestational Hypertension: When blood pressure readings are higher than 140/90 mm Hg in you who had normal blood pressure prior to 20 weeks in pregnancy and has had no proteinuria (excess protein in the urine), you are then diagnosed with Gestational Hypertension, also called as pregnancy-induced hypertension.

If you had high blood pressure before being pregnant, or are diagnosed with it before completing 20 weeks of pregnancy, then you have chronic hypertension which puts your heart at risk. Being mild, gestational hypertension doesn’t actually cause any noticeable problems for you or your baby. However, gestational hypertension can develop into preeclampsia, and/or put you at risk for intrauterine growth restriction, preterm birth of your child, abruption of the placental and chances of still birth.

Several studies have shown that roughly 10% of obese women have gestational hypertension compared to around 4% of women with normal BMI.

What you should do:Find and learnabout gestational hypertension and how to manage it. Don’t miss to go to all your prenatal appointments. Get your blood pressure checked at each visit to your doctor. Your doctor will monitor your readings and health regularly and would possibly put you on blood-pressure-lowering medication.

Urinary Tract Infection: Women who are obese during pregnancy are at increased risk of urinary tract infections. In pregnant women, hormones bring about changes in the urinary tract, activating infections. To add to it, the growing uterus puts pressure on the bladder, blocking the urge to completely empty the urine from the bladder. This urine that stays in the system becomes the source of infection. If left untreated, these infections may go on to infect your kidneys and you may suffer preterm labour and/or low birth weight. Urinary tract and kidney infections in pregnant women should be treated to prevent complications.

  • What should you do: If you suspect you have urinary tract infection, then talk to your doctor who will then test your urine for bacteria and red and white blood cells. Your urine may also be sent for urine culture, a test to see what kind of bacteria are in the urine. You may also be treated immediately for your discomfort with antibiotics.

4. Pregnancy Complications

Pregnancy Overdue: Another risk factor obesity brings about in pregnancy is that it will continue beyond the expected due date and may need to have labour induced artificially. It may further go on to require caesarean section (C-section) births. Management of prolonged pregnancies in obese is often complicated as inducing labour is associated with a high risk of caesarean section and the possible complications that follow includes infection, bleeding and clots.

What should you do: Try to exercise, eat a sensible diet, and since you can’t lose weight, try gaining only the appropriate amount of weight to avoid longer labour. Start preparing yourself for the day by having a positive mind set, attending classes on childbirth and easing of labour.

Difficulties in Labour: Various studies have shown that overweight and obese women more likely need to go for induced labour or for C-section induction. Being obese can also interfere with the use of certain types of pain medication, such as an epidural or spinal block.

Recent studies have also found out that roughly 50% of overweight women are more likely to have a C-section than women who are at a normal weight, whereas obese women are twice as likely to have a C-section.

Difficulties arise during labour due to many other factors associated with being obese and pregnant: longer labour time, eclampsia or preeclampsia, gestational hypertension, or gestational diabetes. In such situations your doctor will more likely recommend a scheduled C-section or as an intervention, when you have difficulty during labour.

What should you do: Talk to your doctor and find out if s/he considers you at high risk for a C-section. You can also lower your odds of having to go for a C-section by following your doctor's recommendations on exercising during pregnancy, gaining of weight, and attending classes for preparation of child birth.

C-section: It is commonly believed and assumed that obese women have to undergo C-section because their fat interferes with their ability to give birth vaginally. Obesity during pregnancy can increase the chance of elective and emergency C-sections and also increase the risk of C-section complications, such as in administering anesthesia, painful scarring, wound infections, severe bleeding, blood clots, bowel obstructions, long lasting pain and getting readmitted to the hospital.

What should you do: You need to be proactive about your health before being pregnant. Check for your blood sugar, blood pressure, thyroid function and stabilize their levels if need be and also address other health concerns by seeing your doctor regularly for check-ups and follow-ups. You also need to get regular exercise and practice excellent nutrition. And if you are obese and pregnant then you also need to pay careful attention to your baby’s position since poor positioning of the baby could cause long and hard births.

Miscarriages or Stillbirth: Since overweight and obese women have higher rates of menstrual irregularities and infertility they are more likely to delay their prenatal care because they may not realize that they are pregnant. This increases their risk for miscarriages. Stillbirth is when a baby dies in the womb before birth but after 20 weeks of pregnancy.

Studies showed beingunderweight can increase miscarriage risk by 70% and obesity increases the risk of miscarriage by 67%.

What should you do: Early ultrasounds and/or trans-vaginal ultrasound should be performed to verify dating, to exclude multiple gestations, and for early diagnosis of congenital anomalies, such as anencephaly.The most important single method to improve reproductive performance in obese women is weight loss that can be achieved with lifestyle changes and diet.

3 Risks to the Fetus

Obesity during pregnancy can cause various health problems for a baby, including:

Macrosomia: Overweight women can have average-size babies (around 7 pounds), while obesity carries a risk for macrosomia, or having a large baby (at least 9 pounds, 15 ounces). Your baby is more likely to be large if you have undiagnosed or poorly managed gestational diabetes; a family history of large babies; or if you go past your delivery due date.

Research suggests that as birth weight increases, so does the risk of childhood obesity.

What should you do: If you have gestational diabetes, keep a check on your blood sugar levels, work with a nutritionist and talk to your doctor. If your doctor suspects your baby is large, ask him/her about your options. Depending on your situation, your doctor may suggest a trial of labour to see if vaginal delivery is possible before opting for C-section.

Chronic Conditions: If you are obese during pregnancy then you might increase the risk of your baby developing heart disease or diabetes as an adult.

Birth Defects: Research suggests that obesity during pregnancy may slightly increase the risk of having a baby who may be born with a birth defect. These defects, though very rare, could affect a baby's brain and spinal cord (neural tube defects, spina bifida), heart or abdominal wall (Stothard et al 2009). Birth defects change the shape or function of one or more parts of the body causing problems to overall health, in how the body develops, or in how the body works.

What should you do: You can protect your baby against neural tube defects by taking 5 milligrams (mg) of folic acid daily during your first trimester. Ask your midwife or doctor for a prescription.

Preterm Birth:Preterm birth, also known as premature birth, is the birth of a baby at less than 37 weeks gestational age. This is too soon and can cause serious health problems for your baby.

2 Target Weight Gain During Pregnancy

To determine how much weight you need to gain during your pregnancy, your BMI and weight are considered before hand as well as your health. All these are important to determine your health and the baby's health as the pregnancy progresses. Talk to your doctor; take help to determine what could be best in your case and how well you need to manage your weight throughout your pregnancy.

Generally, guidelines taken into consideration for pregnancy weight gain are: the recommended weight gain of 11 to 20 pounds (about 5 to 9 kilograms), in obese women carrying a single fetus weight gain of 2-3 pounds per month is expected, and a weight gain of 25 to 42 pounds (about 11 to 19 kilograms) is expected in obese women with multiple births/twins.

Don't let the numbers get you down, be focused and avoid any extra weight gain during pregnancy. Some over weight and obese women lose weight during pregnancy due to the morning sickness. If you have managed to lose some weight for this reason, the trick is maintaining a healthy pregnancy and trying not to gain more weight than the recommended amount. You can do this by getting active during your second trimester when you energy increases and you feel normal again.

Talk with your health care provider ahead of time and learn about the exercises and dietary restrictions that are healthy for you and your unborn baby. It's not okay to intentionally lose weight when you're pregnant by cutting calories out of your diet. Your baby needs those calories to survive. Eating right and exercising can help you avoid preeclampsia and gestational diabetes, not to mention feel better about yourself and stop you from gaining excess, unnecessary weight.

If your doctor puts you on a diet and exercise plan, stick to it the best you can for the good of your health and that of your unborn child.

1 Make a Difference

Being obese and pregnant, your risk factors clearly show you require special care and counselling during your pregnancy. Your doctor will need to closely monitor your pregnancy and depending on the situation and condition you are in, your doctor may recommend preterm care as follows:

- Counselling

- Dietitian

Counselling should start before you conceive because being obese you tend to suffer from infertility, miscarriage and stillbirth. You will have to give your doctor a full account of your medical conditions so they can help you to have the healthiest pregnancy possible. Counselling will mentally prepare you for your journey ahead and give you a professional ear and advice to see you through.

Another possible avenue is seeing a nurse or registered dietitian to help you make healthier eating choices and snacking habits. You need to be guided by a registered dietitian to reduce weight and maintain a healthy diet. Discuss with your doctor about any medical conditions you might be having like diabetes, thyroid, hypertension or sleep apnea and ask about ways to manage it.

If you are obese, your babies are at a high risk for developing neural tube defects/spina bifida. So you should receive high dose of folic acid supplements. You should also take calcium, Vitamin D, iron and other essential nutrients. However, there is no guarantee that this would be able to prevent neural tube disorder.

Anything you can start doing today to help yourself and your baby out will go a long way to a healthier lifestyle.

7. Testing early for Gestational Complications 

Generally, women are at average risk of gestational diabetes, gestational hypertension. So a regular follow-up and check-up with your doctor for early diagnose and treatment is necessary. Your blood pressure is checked up regularly by doctor and you may be asked to monitor it at home on daily basis.

A screening test called the glucose challenge test is often done between weeks 24 and 28 of pregnancy if you have gestational diabetes. Your doctor may recommend this screening test earlier during your first prenatal visit if he/she finds you to be overweight or obese.

If your test results turn out to be normal, then you may have to repeat this screening test later test between weeks 24 and 28 of pregnancy. But if your tests are abnormal in your first visit itself then you will have to go for further tests and your doctor will advise you to monitor your blood sugar levels on a daily basis at home and try controlling the blood sugar levels.

Fetal Echocardiography: Between weeks 22 and 24 of pregnancy, your doctor may ask you to go for a fetal ultrasound to get a detailed picture of your baby's heart (fetal echocardiography), to rule out or confirm a congenital heart defect.

Regular Prenatal Visits: As your pregnancy progresses, you need to make more frequent prenatal visits to monitor your health and your baby's health. Regular fetal ultrasounds might be recommended to help your doctor evaluate your baby's growth and plan for your delivery.

If you want to be pregnant and are obese, avoid smoking, alcohol and illicit drugs. Ask your doctor to help you quit these.

Above all, you do require proper counselling in order to deliver a healthy baby.

Many women have their child's best interests at heart. Knowing what to watch out for if you are obese and pregnant is the first step to having a healthy pregnancy and a healthy baby!

"Pregnancy is the perfect time to make such an effort"!

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