From: Subject: Planned Parenthood Plus-Size Pregnancy - Date: Sun, 21 Jan 2007 15:51:28 -0500 MIME-Version: 1.0 Content-Type: multipart/related; type="text/html"; boundary="----=_NextPart_000_0000_01C73D74.0315F5E0" X-MimeOLE: Produced By Microsoft MimeOLE V6.00.2900.3028 This is a multi-part message in MIME format. ------=_NextPart_000_0000_01C73D74.0315F5E0 Content-Type: text/html; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable Content-Location: http://www.plannedparenthood.org/news-articles-press/politics-policy-issues/medical-sexual-health/obese-pregnancy-10350.htm Planned Parenthood Plus-Size Pregnancy - = = = =
 
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Plus-Size Pregnancy=20

by=20 Heather Boerner

Half of = all women=20 of childbearing age in the United States = are=20 considered overweight, and one in three = is=20 obese.  Research shows that being=20 overweight or obese =97 defined, = according to the=20 standard body mass index (BMI), as more = than 25=20 BMI for overweight individuals, and more = than 30=20 BMI for those who are obese =97 raises a = woman's=20 risk for certain pregnancy-related=20 complications.  How common are = those risks,=20 and what can overweight women do to have = a=20 healthy pregnancy?=20

The Risks

Overweight and obese pregnant women = have=20 increased risks for stillbirth, = premature birth,=20 birth defects (particularly neural tube = defects=20 such as spina bifida), and large birth = weight,=20 also known as macrosomia.  = Macrosomia can=20 cause injuries to the woman and = newborn=20 during vaginal delivery and may require = cesarean=20 section (c-section).  And = overweight or=20 obese women who have c-sections are more = likely=20 to experience excess blood loss, long = surgery=20 time, and post-operative infection.

The risks for preeclampsia, a = potentially=20 life-threatening condition that involves = increased blood pressure and kidney = problems,=20 and gestational diabetes, in which the = body's=20 ability to process sugar is decreased or = impaired, are also higher for pregnant = women who=20 are overweight or obese.  For = instance, 2.3=20 percent of women with a BMI between 19 = and 25 =97=20 considered normal weight by medical = standards =97=20 develop gestational diabetes.  For = women=20 with a BMI of 30 or more, the risk = nearly=20 triples.  For morbidly obese women = =97 those=20 with a BMI of 40 or more =97 the risk = goes up to=20 9.5 percent.  The risk for = preeclampsia in=20 normal weight women is up to 10 = percent. =20 For obese women, the risk is as high as = 25=20 percent.

Weighing the = Factors

In a recent study in the American = Journal=20 of Obstetrics and Gynecology, Dr. = Gladys=20 Ramos found that race is also a factor = in the=20 complications of obese women.  For=20 instance, Latinas were more likely than = women of=20 other races to develop preeclampsia, = gestational=20 diabetes, and to have a c-section.  = Asian-American and white women were = equally as=20 likely to have larger birth-weight = babies. =20 And African-American women were more = likely to=20 have low birth-weight babies, but less = likely to=20 develop preeclampsia.  Being = younger than=20 18 or over 35 can also increase risks. =

Given the possible outcomes, = overweight women=20 should talk to their health care = providers about=20 their risks, says Sujatha Reddy, an=20 Atlanta-based ob/gyn. =93The right way = to approach=20 this issue is, if you=92re thinking = about getting=20 pregnant, don=92t assume the = worst.  Don=92t=20 think it=92s not possible to have a = healthy=20 pregnancy [if you are overweight] =97 = because it=20 is,=94 says Reddy.

Guidelines for = Care

Recent guidelines from the American = College=20 of Obstetricians and Gynecologists = (ACOG) seek=20 to ensure that health care providers = improve the=20 care they give pregnant women who are = overweight=20 or obese.  Health care providers = should

  • Educate women about the recommended = amount=20 of weight gain during pregnancy =97 = which,=20 according to the Institute of = Medicine,=20 ranges from 25=9635 pounds for = normal-weight women=20 to 15 pounds for obese women.=20
  • Record women's height and weight = during the=20 initial prenatal visit to calculate BMI. =
  • Offer nutrition consultation to all = obese=20 women and urge them to follow an = exercise=20 program.=20
  • Consider screening obese pregnant = women for=20 gestational diabetes during the first = trimester=20 and repeating the testing later in = pregnancy.=20
  • Inform patients of potential = pregnancy=20 complications related to obesity.=20
  • Suggest patients consult an = anesthesiologist=20 prior to delivery, in case of emergency=20 c-section.

In addition to these guidelines, ACOG = recommends cardiac screenings for obese = women=20 with preexisting high blood pressure or=20 diabetes.  For women with a BMI of = 40 or=20 more, ACOG suggests that doctors ensure = they=20 will have a larger operating table for = c-section=20 delivery, extra staff on hand, and = additional=20 blood supplies.

A Healthy Goal

Does this mean that women must lose = weight=20 before considering pregnancy?  Not=20 necessarily, says Dr. Laura Riley, = OB/GYN at=20 Massachusetts General Hospital =97 but = it can=20 help.  According to Riley, when a = woman who=20 is overweight or obese does become = pregnant, she=20 should be prepared to talk about weight = =97 a=20 potentially sensitive subject for any = women,=20 regardless of size.

Riley ensures that the ACOG = guidelines were=20 not meant to stigmatize overweight or = obese=20 patients.  =93As a practicing = obstetrician,=20 there=92s a fine line between telling a = patient=20 about obesity as a pregnancy = complication and=20 the patient understanding that I=92m not = criticizing her weight," she says.  = "This=20 is not about whether you can look like = one of=20 those skinny waifs on the cover of=20 Vogue.  This is a medical=20 issue.  Obesity and excessive = weight gain=20 during pregnancy can have a significant = impact=20 on maternal and fetal health.  We = are=20 trying to make physicians aware of the = risks so=20 they can talk about weight without = making=20 judgments.=94

Dr. Anjel Vahratian, an = epidemiologist who=20 studies the effect of overweight and = obesity on=20 pregnancy, says the goal is to encourage = all=20 women to maintain a healthy diet and = exercise=20 program, regardless of weight.

=93Half of all pregnancies are = unplanned,=94 says=20 Vahratian.  =93If you happen to = fall under=20 the category of being obese, it is = important to=20 adopt a healthy lifestyle.  That = way, if=20 you become pregnant, you'll be better = able to=20 manage your health and that of your = fetus.=94

To Brette McWhorter Sember, a = plus-size=20 mother of two and author of Your = Plus-Size=20 Pregnancy, the key is to eat = healthfully=20 and exercise at a level that feels = reasonable,=20 not for women to put undue pressure on=20 themselves.

=93Just remember that it=92s = important to feel=20 good about your body during your = pregnancy,=94=20 says Sember.  =93This is not a time = to beat=20 yourself up.=94


Heather = Boerner is a=20 freelance health writer based in San=20 Francisco.

Published:=20 11.13.06 |=20 Updated: 11.13.06

=A92006 = Planned=20 Parenthood =AE Federation of = America,=20 Inc.
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