With millions of women heavy enough to be
termed obese, and many others at a weight deemed unhealthy,
it's no surprise doctors are becoming more concerned about
women who are too heavy before they get pregnant.
The reason: They -- and their babies -- are at higher
risk for health problems.
So last August, the American College of Obstetricians
and Gynecologists issued an opinion on obesity during
pregnancy, cautioning women and doctors about the risk
that obesity poses to pregnant women and their babies.
For women who are obese before becoming pregnant, there
is a heightened risk of miscarriage, blood-pressure problems,
pregnancy-related diabetes and, perhaps, a greater need
for Caesarean-section delivery, said Dr. Laura Riley,
an obstetrician-gynecologist at Massachusetts General
Hospital and former chairwoman of ACOG's obstetric practice
committee.
"There's also a higher risk of the baby being overweight,"
she said, adding that a baby of about 10 pounds at birth
is deemed overweight. Babies of heavy mothers are at greater
risk of stillbirth, prematurity, neural tube defects and
higher rates of childhood obesity, according to ACOG.
Women who aren't obese but are heavy -- with a body mass
index (a ratio of weight to height) of between 25 and
30 -- are also at increased risk of diabetes, high blood
pressure and a C-section if they gain too much weight
during pregnancy, Riley said. A BMI of 18.5 to 24.9 is
considered normal; a BMI of 25 to 29.9 is considered overweight;
a BMI higher than 30 is deemed obese.
Ideally, "women should get down to their ideal body
weight before they get pregnant," Riley said. "But
it is not always easy." And not always feasible.
"If you are 41, do you want to wait a year to lose
the weight? Probably not," she added.
"But if you could get to your ideal body weight,
that is what you should do," Riley said. "At
the very least, you should see a nutritionist and figure
out how you can minimize your weight gain" during
pregnancy.
According to the ACOG recommendations, women of normal
weight before pregnancy should gain 25 to 35 pounds while
expecting; overweight women 15 to 25 pounds; and obese
women, 15 pounds.
Netty Levine, a registered dietitian at the Nutrition
Counseling Center at Cedars-Sinai Medical Center in Los
Angeles, often works with pregnant women who are heavy.
She cautions them not to diet, which is not recommended
during pregnancy, but to focus on making "lifestyle
changes for you and your future family."
For instance, Levine recommends that overweight women
sit down and complete a food diary of what they eat for
several days. Then she evaluates that record to see if
the women are getting enough protein and calcium, and
if they are eating too much fat or sugar. She also looks
to see if portion sizes are too large -- one of the most
common weight-control mistakes.
"This is no time to lose weight," Levine tells
women who were too heavy when they got pregnant. "But
you can keep it to a minimum." For obese women, that
means 15 pounds or so.
For women who are heavy and hoping to get pregnant, Levine
agreed with Riley -- the best idea is to slim down first.
That might not require drastic changes, she tells women.
Make small changes. "Get off those smoothies, drink
more water. If you like waffles, top them with strawberries,
just pass on the butter and syrup," she said.
Levine evaluates a woman's entire day -- and lifestyle
-- and decides where the problem spots are when it comes
to overeating. "Some people eat healthfully at home
but have a business lunch every day. Or they eat healthfully
at work and get home at night and overeat." Zeroing
in on the trouble spots can help women fix the problem,
she said.
