“Doctor, I`am thinking about having a baby but I`am concerned that I`am too heavy. Is this something I should worry about?”
The answer to this question is an unfortunate, yet definite, yes. Losing weight is difficult, but returning your body to a healthy weight before pregnancy is one of the best things you can do for yourself and your baby.
The statistics on obesity are staggering. Only about one-third of American woman are of a natural weight. One-third are overweight, with a body mass index, or BMI, of 25 to 30, and one-third are obese, with a BMI greater 30. As a result, our prescriptions of normal weight have been dramatically skewed. Many health providers don`t even notice when a woman is overweight, but this carries many increased risks as well.
The consequences of obesity in nonpregnant woman are well known-diabetes, high blood pressure, stroke, certain cancers, joint problems, and liver and gallbladder disease. And now, the health risks of obesity on pregnancy are clear as well, as described in the following sections.
Infertility: Woman who are overweight have a higher chance of infertility. Specifically, many overweight woman do not have monthly menstrual cycles because they are not ovulating. Medication can be given to help with ovulation, but just a 5 to 10 percent reduction in body weight can cause ovulation, and regular menstrual cycles to resume.
Diabetes: An overweight mother is four times more likely to develop gestational diabetes. This form of diabetes can lead to extremely large infants, who are more likely to have birth injuries or who will require cesarean delivery.
Preeclampsia: Obese mothers are twice as likely to have high blood pressure related to pregnancy, which can increase their chance of blood clots, stroke, and premature birth.
Cesarean risk: When delivering a baby vaginally, we like to say that it`s “all about the push”.Woman carrying extra weight, especially in the midsection, have less muscle tone and thus less strength with which to push out their babies. In addition, the extra fat deposits within the birth canal make it much more difficult for the baby to slip through.
Many patients ask us what they can do to avoid a cesarean delivery. Maintaining a health weight is high on the list. Just look at these statistics. The chance of a cesarean delivery is
* 11 % for woman of normal weight;
* 18 percent for overweight woman; and
* a whopping 43 % for obese woman.
In addition, obese woman who have a cesarean have a higher risk of blood clots, bleeding, and infections after surgery.
Birth defects: in obese woman, the risk of spina bifida is twice that seen in normal-weight women. The risk for cleft lip is 20% higher, for heart defects, 30% higher, and for hydrocephalus, 60% higher.
Birth defect detection: Ultrasound is our best tool in obstetrics, yet this technology is limited by the distance the sound waves need to travel. For overweight women, three or more inches of fat on the abdominal wall can limit the detail of what we can see, so subtle birth defects may go undetected.
Pregnancy symptoms: Even the more mundane symptoms and discomforts of pregnancy, such as heartburn, carpal tunnel syndrome, back pain, pelvic pressure, and headaches, occur far more often in obese mothers. Public health officials are concerned because the maternal mortality rate in the United States has been on the rise in recent years. A major contributing factor is the increase in obesity. Of all maternal deaths, two-third are related to complications of obesity.
Clearly, one of the best things you can do before becoming pregnant is to get your to its healthiest weight.
