Author: Karen O’Brien, MD, Anna Jaques Hospital, an affiliate of Beth Israel Deaconess Medical Center
If you’re pregnant and carrying extra weight, you are not alone. More than 60 percent of women in the United States are overweight. More than half of women in the United States are overweight or obese when they become pregnant, and most go on to gain more than the recommended amount during pregnancy.
According to the Center for Disease Control and Prevention, obesity during pregnancy affects about one of five pregnant women in the United States. If you’re overweight or obese, you’re more likely than pregnant women at a healthy weight to have certain medical problems during pregnancy.
Obese women can have difficulty conceiving, as they may have some degree of ovulatory dysfunction due to polycystic ovary syndrome. Weight reduction in obese, infertile women appears to be associated with an increase in the frequency of ovulation and the likelihood of pregnancy. The risk of miscarriage is also greater in obese pregnant patients. Obese women have a higher prevalence of multiple gestations, possibly because of elevated levels of a hormone called follicle stimulating hormone (FSH).
The risks of obesity during pregnancy:
There are added risks that come with obesity during pregnancy. Some of those risks include (but aren’t limited to), miscarriage, stillbirth, high blood pressure, preeclampsia, gestational diabetes, and infections. Obesity also increases the risk of postpartum infection, whether the baby is delivered vaginally or by cesarean section. Plus, there is the risk of having a really big baby (called large-for-gestational-age or macrosomia). This in turn increases the potential for shoulder dystocia, a situation in which baby’s shoulders get stuck behind the mother’s pelvic bone at the time of delivery, making the delivery itself more complicated. Obese patients are more likely to go post-term and have longer labors, and there is a greater risk of post-partum hemorrhage and more extensive tears in the vaginal and even rectal area. Obese women also have a high rate of cesarean delivery and are more likely to have surgical, anesthetic, and postpartum complications. Lastly, maternal obesity has been associated with an increased risk of certain types of birth defects, especially spina bifida.
How to manage weight gain:
Exercising during pregnancy can help prevent and/or manage weight gain during each trimester. Additionally, exercise can have a positive impact on your pregnancy, by reducing your risk of pregnancy problems like gestational diabetes. Exercising also helps you feel good during your pregnancy and beyond.
If you're a relative newcomer to exercise, start with low-impact exercises such as walking, swimming, stationary biking, and prenatal yoga. Before you start an exercise regimen, speak with your obstetrician or midwife. He or she can work with you to set calorie goals, reduce fat intake and work with you to monitor your weight on a regular basis.
You can also manage your weight by maintaining a healthy diet during your pregnancy. If you’re obese and pregnant, you should seek the services of a clinical nutritionist during your pregnancy and maintain a daily food diary. Every state offers the WIC (Women, Infants & Children) program, which has a nutritionist or dietician on staff. I strongly encourage pregnant women to take advantage of their services.
One thing I always tell my patients is that they should never cut calories while pregnant. Your growing baby needs nutrients and calories to develop properly. Inadequate intake of nutrients can lead to an array of disastrous results, ranging from birth defects to neurological problems to miscarriage. Now is the time to focus on nutrition, not caloric intake.
You'll also want to watch your salt intake to prevent fluid retention, which can be common during pregnancy, especially for obese women. Fluid retention is hard on your body, and it is aggravated by a diet that is high in salt. To battle fluid retention, enjoy foods that are high in potassium, as potassium is known to lower blood pressure and aid in fluid absorption. Bananas are an excellent choice because they are very high in this vital nutrient.
Pregnancy can bring stress to not only you but your family. As a mom myself, I know from firsthand experience how crazed this time can be in your life. To reduce stress, set aside time for just you every day. Consider a nature walk or gentle yoga poses to ease stress, or close your eyes and listen to calming music. If you know you cope with stressful situations by indulging in comfort foods, surround yourself with healthful snacks—or at least choose foods that are lower in fat and sugar.
Postpartum, breastfeeding can help with weight loss. By breastfeeding, you can burn about 500 calories more than usual per day. Not only can breastfeeding help you lose some of the baby weight, it is also boosts baby’s immune system and is a lovely way to bond with your baby. Even though those initial weeks and months after delivery are exhausting, it’s important for you to pop baby in a carrier or stroller and get out of the house for walks to get into shape while enjoying some fresh air.
What to do before pregnancy to improve your chances of having a healthy pregnancy and a healthy baby:
Get a preconceptional checkup. This is a medical checkup you get before pregnancy. Your health care provider can help you with ways to eat more healthily and exercise. This can help you lose weight before you conceive.
Your prenatal care providers are there for you during every step of your pregnancy, which is why it’s imperative that you stay on top of all of your medical appointments. You may need to see your obstetrician or midwife more frequently to ensure that you and baby are maintaining healthy lives. Patients who are overweight usually will have screening for gestational diabetes in the first trimester, and this is repeated later in pregnancy if negative the first time round. An ultrasound of the baby is done at about 18 weeks along with bloodwork to screen for birth defects. Additional ultrasounds may be needed to follow baby’s growth closely throughout the pregnancy. Mom’s weight, blood pressure, and urinalysis are recorded at each prenatal visit.
Whether you’re obese and pregnant or only starting to think about conceiving, your obstetrician or midwife along with a maternal fetal medicine specialist will be able to guide you on the path that’s best for you and your baby’s health.
About Karen O’Brien, MD
Dr. O’Brien is board-certified in obstetrics and gynecology, as well as maternal fetal medicine, and practices at Beth Israel Deaconess Medical Center in Boston. She received her medical degree from Georgetown University, completed her residency at the University of Pennsylvania, and did her fellowship in maternal fetal medicine at Brown University / Women and Infants Hospital of Rhode Island. Dr. O’Brien is available for consult with Anna Jaques Hospital patients through the hospital’s clinical affiliation with BIDMC.