Overweight and Obesity during Pregnancy: Complications & Guidelines

Being overweight and obese during pregnancy carries risks. Pregnancy and obesity should not coexist for the sake of the pregnant mother-to-be and the developing baby.

Pregnant women do tend to eat more and weight gain is normal during pregnancy. But being overweight or obese when pregnant is definitely unwarranted.

Obesity affects the pregnancy in an adverse manner. Maternal obesity, which refers to the obesity of a pregnant woman, carries risks and can have a serious impact both on the pregnant woman and the developing fetus and should be promptly and seriously addressed because the outcome of these complications doesn’t look good.

Pregnant women do tend to eat more and weight gain is normal during pregnancy. But being overweight or obese when pregnant is definitely unwarranted.

Obesity affects the pregnancy in an adverse manner. Maternal obesity, which refers to the obesity of a pregnant woman, carries risks and can have a serious impact both on the pregnant woman and the developing fetus and should be promptly and seriously addressed.

The outcome of such a situation can result in increased risk of complications in the baby and the mother.

These can include a miscarriage or child defects, hypertensive disorders and gestational diabetes in the mother, preeclampsia and the need for the cesarean section during delivery. Maternal mortality is another major risk that looms large.

A BMI of 25 to 29.9 indicates that you’re overweight, and a BMI of 30 or more means you’re obese.

According to The Centers for Disease Control and Prevention (CDC), about 1 out of 5 American pregnant women are obese with a BMI of 30 or more.

Pregnancy complications of maternal obesity

A proper nutrition ensures a proper pregnancy weight gain. Going overboard with weight and being overweight during pregnancy is linked to certain risks to your health and the health of the baby.

The risk of birth defects increases because of the presence of higher incidence of maternal diabetes in obese women and deficiency of nutrients like folic acid.

In pregnancy, obesity increases risks of pregnancy complications that include:

Risks to the baby

  • Miscarriage, stillbirth (death of fetus before delivery)
  • Preterm delivery
  • Babies born to obese women have a higher risk of developing heart and neural tube defects.
  • Physical and mental birth defects in the newborn are rare and you see them in about 2% to 4% of cases
  • Obesity of the child either in childhood or later in life
  • According to the Huffington post, women who are obese during pregnancy have an almost two-fold increased risk of having a child with autism. If the obese woman also has diabetes, the risk increases four-fold.
  • Epilepsy is another risk that can affect the child. According to a study conducted in Sweden and later published in published in the Journal of the American Medical Association (JAMA) Neurology, the child’s risk of epilepsy was linked to how obese the mother was early in her pregnancy. Risk increased by 11% in children whose mother’s BMI was between 25 to 30 and a BMI of 30 to less than 35, saw a 20 percent increased risk

Risks to the mother

Gestational diabetes

Maternal obesity substantially increases the risk of gestational diabetes (diabetes in the woman that is first diagnosed during pregnancy). If your BMI is 30 or above, you are three times more likely to develop gestational diabetes than women whose BMI is below 30.

This increases the risk of macrosomia, a condition in which the baby is larger in size than normal and the normal delivery becomes difficult because the shoulder can become stuck during delivery.

This increases the risk of requiring a cesarean delivery. It also increases the risk of the mother and child developing diabetes mellitus later in life.

Gestational diabetes mellitus (GDM), affects 7% of pregnancies, representing 200,000 cases annually in the U.S.  The risk of GDM is higher among obese women.

Obstructive sleep apnea (OSA)

Sleep apnea is a serious sleeping disorder where the person’s breathing is interrupted a number of times during sleep. This can result in less oxygen supply to the brain and the rest of the body.

OSA is associated with more incidences of preeclampsia, neonatal intensive care unit admissions, and cesarean delivery among the obese pregnant women.

Preeclampsia

Preeclampsia is a medical condition, which usually develops during the latter half of pregnancy and characterized by high blood pressure, the presence of high-level protein in urine and swelling of feet and hands.

This is a dangerous condition, which can lead to eclampsia that can cause the death of the baby and mother if left untreated.

Labor problems

Obesity can cause the pregnancy to continue beyond the due date. Obese women often require induction of labor to deliver the child.

Induction of labor is a procedure used to stimulate uterine wall contractions and deliver the child if the pregnancy has gone beyond the end of the 41st week. Postpartum bleeding is also more.

Cesarean section

Maternal obesity increases the risk of elective and emergency c-section. Surgery in such overweight women can increase the risk of anesthetic and perioperative complications such as wound infections.

Hospital stay is also prolonged. After a C-section, obese women are less likely to deliver further babies through a successful normal vaginal delivery.

Backache and leg pain

Though backaches are common in pregnant women, the incidence and severity are very high in obese pregnant women. The backbone supports the weight of the body and with more weight to support in obesity, the back muscles are unduly strained.

Add to it the weight of the growing pregnancy, the back muscles of the obese pregnant woman are severely strained and cause pain.

The back pain can radiate to the buttocks, down one leg or down both the legs.

Macrosomia 

Pregnant obese or overweight women are at a higher risk of giving birth to babies who are significantly of a larger size and weight. This is medically referred to as macrosomia.

For women with a BMI between 20 and 30, the risk of having a baby of 4 kgs (8lb 14oz) is 7%. With a BMI of over 30, the risk is doubled to 14%

Furthermore, research indicates that the higher the weight of the baby more is the risk of the baby developing childhood obesity.

Childhood obesity can make the child develop complications such as type 2 diabetes, hypertension, high cholesterol, sleeping disorders such as sleep apnea and more.

Blood clots

Pregnancy does increase the risk of developing blood clots but an additional burden of obesity significantly increases the risk. The risk is increased further after a cesarean section.

Other complications

  • Increased risk of postpartum depression
  • Increased frequency of infections. Obesity increases the risk of infections such as urinary tract infections.

What should be your weight gain during pregnancy if you were overweight before becoming pregnant

In a woman of normal weight before pregnancy, a weight gain of 25 to 35 pounds is recommended.

If you were overweight before pregnancy with a BMI of 25 to 29, then your weight gain should be 15 to 25 pounds (6.8 to 11.3 kilos) in the following way:

Breakdown

Approximately one to two pounds in the first trimester
Approximately one pound per week during the last six months or during the second and third trimesters

If a pregnant woman is already obese with a BMI of 30 or more, a modest weight gain of between 11 to 20 pounds can be allowed and is also recommended.

But in a pregnant woman with a BMI of 40 or more (extremely obese), a modest weight loss is recommended.

What should you do? Guidelines

If you are obese and pregnant, do religiously follow your doctor’s and dietician’s advice about your diet during pregnancy.

Preconception counseling becomes important wherein, the obese woman is advised before conception about the pregnancy risks that obesity carries.

Lifestyle changes and a well-planned recommended diet play an important role. Remember, a well-planned diet is not about dieting, it’s about a well-balanced diet that will give you the necessary nutrition and try and control your extra weight.

You also need prenatal vitamins and minerals and of course a well-planned exercise regimen of moderate intensity.

 

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