Obesity during Pregnancy

Most of us are now familiar with the health risks that obesity can cause. Even being slightly overweight can put you
at risk for a number of serious illnesses, including arthritis, diabetes, and cardiovascular disease. But did you know
that being obese during pregnancy can also put you and your child at risk for severe pregnancy and health-related
complications? If you are suffering from obesity, find out about the possible pregnancy health risks you face and the
steps that you can take to reduce your risk.
What is Obesity?
The term "obese" actually refers to anyone who is more than 30% over their ideal body weight. Obesity can be the
result of many factors, including inactivity, poor diet, and certain health-related complications. How can you find
out if you are obese? Well, health care providers now use a scale known as the Body Mass Index (BMI) to calculate
weight-related risk. This index combines information about your height and body weight and compares them using
a number ranging from 18 to 40. Depending upon your BMI, you can find out if you are at risk for obesity. BMI is
usually indexed as follows:
• 18.5 to 25: This is the ideal weight range for most normal, healthy men and women.
• 25 to 29.9: If you fall into this BMI range, you may be overweight for your body height.
• 30 and over: If your BMI measures 30 or higher, you may be obese for your body height.
How common is Obesity during Pregnancy?
Obesity is becoming a growing concern among both genders and all age groups. In 1962, 13% of the American
population was classified as obese. By 1994, this number had increased to 23%. Yet, just six years later in 2000,
this number had skyrocketed to over 30%. Today, an estimated two-thirds of Americans are considered overweight
while one in three is obese. This means that almost 67 million Americans are obese. In fact, in America, being
obese has officially become a marker for classifying a pregnancy as high risk.
Of particular concern for women of childbearing age are the effects that obesity can have on your reproductive
health. Not only can obesity put you and your baby at risk for some serious health complications, but it can actually
interfere with fertility. This is because fat stores change the levels of sex hormones that your body produces, making
it increasingly difficult to become pregnant.
Complications for Mom
If you are obese during pregnancy, you are at risk of several serious health complications, including:
• Preeclampsia: Preeclampsia is a condition which causes high blood pressure, fluid retention, and swelling
during pregnancy. When serious, preeclampsia can restrict placental blood flow, endangering baby.
• Gestational Diabetes: Gestational diabetes is a form of diabetes that develops during pregnancy. It
prevents your body from breaking down sugar and can put your baby at risk for gaining too much weight in
utero.
• Cesarean Section: Women who are obese during pregnancy have an increased risk of experiencing
problems during delivery. Labor is more likely to be slow and prolonged, increasing the likelihood of
cesarean section.
• Postpartum Infection: Obesity during pregnancy also makes you more vulnerable to experiencing a
difficult postpartum recovery. In particular, if you have had a c-section, you are at risk for developing
dangerous postpartum infections.
Complications for Baby
If you are obese during your pregnancy, you baby is also at risk for developing some dangerous health issues.
• Macrosoma: Macrosoma is a condition in which your baby puts on too much weight during development.
This can complicate labor and delivery, making it difficult for your baby to enter and exit the birth canal.
Some large babies have their shoulders injured during birth. This is known as shoulder dystonia.
• Neural Tube Defects: Babies born to obese mothers are also at increased risk of suffering dangerous neural
tube defects during development. Neural tube defects, like spina bifida and anencephaly, are often
associated with low levels of folic acid during the first trimester. These defects can frequently be detected
early in pregnancy through the use of ultrasound imaging. However, women who are obese often produce
 poor ultrasounds. Because the ultrasound waves have trouble penetrating extra layers of fat, blurry images
are produced. As a result, neural tube defects aren’t always detected in these babies.
• Childhood Obesity: Studies show that babies who are born to obese mothers are more likely to suffer from
obesity by the time they reach the age of four. In one recent study, 29% of children born to obese mothers
were also obese by the age of four, compared with only 9% of babies born to mothers of normal weight.
What Can You Do?
If you are suffering from obesity, there are a few steps that you can take to help reduce the health risks posed to you
and your baby.
• Lose Weight Before Pregnancy: If you are planning on getting pregnant in the near future, get your
weight evaluated by your health care provider. If you are obese, consider losing weight through proper diet
and exercise. Even minimal weight loss can help to radically reduce your risk of pregnancy complications.
Those that are severely obese may want to consider obesity surgery.
• Watch your Weight Gain: Even if you are obese, you should never try to lose weight during pregnancy.
Weight loss or changes in diet can prevent your baby from getting the calories and nutrients she needs to
grow properly. Instead, focus on gaining weight in moderation. Most obese women need to gain between 15
and 25 pounds, putting on the majority of the weight during the third trimester.
• Exercise: Exercise should be continued throughout your pregnancy. Talk with your health care provider
about exercise levels that would be appropriate for you. Even if it’s just walking around the block a few
times, exercise can really help to reduce your risk of potential health complications
www.pregnancy-info.net/obesity_pregnancy.html

Abstract
This article describes the special care needed by the pregnant woman who is extremely obese. Many pregnant
women who are extremely obese have underlying medical conditions, and a multidisciplinary, coordinated approach
to their care involving anesthesia providers, physicians, and the nursing staff is needed to develop a detailed plan for
vaginal and cesarean births. Such an approach, begun preconceptionally or during pregnancy, can enable care to be
delivered smoothly and safely and should include an evaluation of the unit's equipment and furniture to determine if
they are appropriate for obese persons. Equipment that should be evaluated for size and weight limits include beds,
operating room tables, commodes, wheelchairs, scales, walkers, blood pressure cuffs, transfer devices, and
intermittent pneumatic compression devices.
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The growing trends in maternal obesity

This month’s edition of the BJOG journal (an international journal of obstetrics and gynaecology),
produced by Royal College of Obstetricians and Gynaecologists, documents a number of these articles and
is devoted entirely to obesity and its effects on women, in particular to problems associated with maternal
obesity.
There are 16 scientific studies, review articles, and commentaries in the October issue, conducted by
leading experts in the specialty. Topics covered include: prioritising for IVF and fertility treatment
(Farquhar and Gillett), prevention and management strategies (Krishnamoorthy, Schram and Hill),
difficulties in operating on obese women (Alexander and Liston), increased need for, and risks associated
with, caesarean-sections (Barau et al), and the impaired effectiveness of epidurals during labour (Dresner
et al).
Philip Steer, the editor-in-chief of BJOG said “Maternal obesity needs to be recognised as a serious and
growing health problem. The RCOG is so concerned it has convened a special study group to debate the
topic, discuss ideas on how to manage the situation and find possible solutions. Experts will meet early
next year and will publish their deliberations in due course.”
Professor Adam Balen, editor of the BJOG October edition and co-convenor of the RCOG Scientific
Advisory Group on Obesity says “We need to be tackling the problems of obesity in childhood in order to
reverse the trend that is leading to increasing rates of infertility and health risks in pregnancy to both
mother and baby”.
Some of the issues raised in the BJOG October edition are summarised in brief below.
Maternal obesity
Obesity during pregnancy is a risk factor for adverse pregnancy outcomes. This is a major concern in the
West, where 28% of pregnant women are overweight and 11% are obese. In the UK population, 33% of
women are currently overweight (BMI>25) and 23% are obese (BMI>30), a total of 56% over the
recommended BMI.
The complications of obesity during pregnancy have far-reaching implications for both mother and child.
Some of these possible complications include: increased risk of miscarriage, increased need for caesarean
sections and greater risk during procedure, increased risk of pre-eclampsia and thromboembolism.
According to Confidential Enquiries into Maternal and Child Health (CEMACH), obesity is a feature of
35% of maternal deaths.
Risks to the developing fetus include increased risk of congenital anomalies, macrosomia (large size at
birth), stillbirth and perinatal mortality. Potentially there are also long-term obesity problems for the child.
Caesareans and maternal obesity
In an observational study conducted over four and a half years by French hospitals and the Medical
University of South Carolina, a linear association was noted between maternal pre-pregnancy BMI and the
rate of caesarean sections. The incidence of caesarean sections in obese women is approximately doubled
compared to the whole population. The risk also changes according to the degree of obesity, there is an
increasing need for caesareans with increasing severity of obesity. Possible reasons for the need for a
caesarean include heavier babies and narrower pelvis due to a build up of fatty tissue in the pelvis.
Prioritising for IVF, should a high BMI exclude treatment?
It is not simply a case of weighing up economic effectiveness in terms of provision of IVF for obese
patients, patient safety and clinical effectiveness are also primary factors that need to be taken into
account.
The Clinical Priority Access Criteria is a scheme that has been implemented in New Zealand for patients
seeking assisted reproduction. It has confronted the debate over IVF provision for obese patients; women
with a BMI of >32kg/m2 have been required to lose weight prior to undergoing treatment; without
achieving this weight loss IVF is not undertaken. Five years of implementation have produced some
interesting results and it is believed that restriction of access has actually improved standards of care by
encouraging women to become more healthy before trying for a pregnancy.
‘By reducing weight prior to pregnancy, obstetric complications and health problems for the offspring
should also be improved as well as reducing the costs of the assisted reproduction technique treatment.
Lifestyle changes such as weight reduction and exercise are firmly in the control of the patient.’ (Farquhar
and Gillett)
Management and intervention
Women affected by maternal obesity need to be treated with dignity and respect, there needs to be open
discussions regarding their care and about the risks involved during pregnancy. While it is useful to have
protocol and guidelines in place for the management of obese women, obstetric teams need to be able to
adapt to individual circumstances.
A BMI of >30 kg/m2 should be identified as high risk and require increased obstetric surveillance. In the
future increasing numbers of overweight and obese women will require obstetric intervention, increasing
the pressure already placed on financial and manpower resources. Ideally we would like to see prevention
of maternal obesity rather than treatment, achieving a normal BMI prior to conception would be the ideal
goal.
Problems encountered when operating on maternally obese women include an increased time required to
anaesthetise the patient and increased fetal compromise. There is also a need for additional equipment
such as specially adapted operating tables and surgical equipment. The problem of maternal obesity needs
to be recognised so that a plan for core delivery of these women will be formulated.
Royal College of Obstetricians and Gynecologists
http://www.rcog.org.uk/news/growing-trends-maternal-obesity