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Unhealthy Weight and Pregnancy
Unhealthy Weight and Pregnancy (For patients)
 Reviewed By Medical Advisory Board     

Health-care providers and patients often feel uncomfortable discussing the topic of unhealthy weight gain. However, unhealthy weight increases the risk of many health conditions including hypertension and diabetes, and avoiding the subject of unhealthy weight gain misses an opportunity to possibly prevent or treat many weight related illnesses [1-4]. The continued rise in obesity and related diseases is of global concern [5], and has prompted the American College of Obstetricians and Gynecologists (ACOG) to recommend that the body mass index BMI be recorded for all women at the initial prenatal visit, and that Information concerning the maternal and fetal risks of a very elevated BMI in pregnancy should be provided [6].

The Body Mass Index

The body mass index (BMI) is a measure of someone's weight in relation to their height. The BMI is equal to a person's weight divided by their height . It is calculated either as:


BMI = (Weight in pounds /  Height in inches 2 ) x 703
 
     OR

BMI = (Weight in kilograms  / Height in meters 2)

The greater a person's weight is for a given height the higher their BMI will be. The National Institutes of Health (NIH) provides a BMI calculator at http://www.nhlbisupport.com/bmi/ and a table at http://www.nhlbi.nih.gov/guidelines/obesity/bmi_tbl.htm.

The BMI is used to screen persons for weight categories that may lead to health problems [7].

BMI Category
= <18.5 Underweight
= 18.5-24.9 Normal weight
= 25-29.9 Overweight
30 -34.9 Obese- Class I
35 - 39.9 Obese- Class II
40 and above Obese- Class III


U.S. Obesity Trends 1985–2007

As illustrated by the maps below the number of persons with an unhealthy BMI has increased greatly over the last 20 years. The maps below show  the percentage of persons with a BMI greater than or equal to 30  in the years 1987 and 2007.  In 2003, 1 in 5  U.S. women of reproductive age (aged 18-44 years) were obese (BMI greater than or equal to 30)  [8,9].

There are many factors that may be related to the increased prevalence of obesity over the last 20 years. Among these factors are changes in behavior known to increase the risk for weight gain such as increased  energy intake, reduced rates of smoking,  decreased numbers of hours  slept , and environments that encourage physical inactivity [10-13]. Some other factors that may be involved include increased pollutants in the environment that may affect hormones controlling body weight, increased use of medications that cause weight gain, and an aging population [14].


Obstetric Complications and BMI

There is good evidence that women with a high body mass index (BMI > 30 ) before or during pregnancy are at greater risk for complications in pregnancy including [6,15-19]:

  • Birth defects such as heart defects, neural tube defects, and other abnormalities.
  • Difficulty seeing all of the baby's organs and estimating the baby's weight with ultrasound.
  • Difficulty monitoring the  baby's heart rate tracing with  the fetal heart monitor
  • Gestational diabetes 
  • Pre-eclampsia
  • Problems having epidural and other anesthesia.
  • Delivery by emergency caesarian section.
  • Heavy bleeding after delivery.
  • Increased risk of forming abnormal blood clots.
  • Bladder and kidney infections.
  • Wound infection
  • Large babies with birthweight above the 90th percentile
  • Less likely to have successful vaginal birth after cesarean section
  • Increased risk of stillbirth.

The level of these risks increases as the mother's BMI increases [15-17, 31].

 Crude and adjusted risks of obstetric complications in the different BMI groups compared to normal (OR 1)

Click here to view table in a new window
Click here view table in same window

In view of the above risks the American College of Obstetricians and Gynecologists (ACOG) has  recommended [6]:

  • Preconception counseling for obese women who are planning a pregnancy.
  • BMI should be recorded for all women at the initial prenatal visit.
  • Information concerning the maternal and fetal risks of obesity in pregnancy should be provided
  • Overweight women (BMI 25-29.9) should be advised to gain no more than 15 to 25 pounds during pregnancy, and obese women (BMI = 30) no more than 15 pounds during pregnancy.
  • Obese women should be offered nutrition consultation, and they should be encouraged to follow an exercise program. This should be continued after delivery.
  • Screening for gestational diabetes at the initial prenatal visit with repeated screening later in pregnancy if the results are negative.
  • Women with a BMI of 35 or greater who have preexisting medical conditions, such as hypertension or diabetes, may benefit from a cardiac evaluation.
  • Consultation with Anesthesiology prior to delivery.
  • Use of compression stockings, hydration, and early mobilization during and after cesarean delivery should be encouraged.
  • Consultation with weight loss specialists before attempting another pregnancy

In addition studies show that wound complications in obese women undergoing cesarean delivery may be reduced by closure of the subcutaneous tissue in women with at least 2 centimeters of subcutaneous adipose tissue. Whereas, prophylactic use of subcutaneous drainage does not prevent significant wound complications after cesarean delivery. A vertical skin incision appears to be associated with a higher rate of wound complications than a transverse incision [21-23].

 Promoting A Healthy Lifestyle

As noted above the American College of Obstetricians and Gynecologists (ACOG) recommends women at an unhealthy weight should be offered both nutrition consultation and an exercise program. Although physical activity alone produces only a modest reduction in weight compared with dieting alone [24-26] regular physical activity helps maintain weight loss [28] and results in many health related benefits in patients even if they lose no weight [27] .

According to the American College of Sports Medicine (ACSM) patients who have known coronary, metabolic, pulmonary disease, or signs or symptoms suggestive of coronary heart disease (CHD) may benefit from diagnostic exercise testing before beginning an exercise program. Most other patients who are obese or overweight can begin with activities such as walking starting with a 5 minute work out and gradually working up to their goal over many weeks [29,30].

Lastly, breast feeding can help patients to lose the weight gained during pregnancy,  and may also have a small protective effect against childhood obesity [32-34].

See also: Unhealthy Weight and Pregnancy (Information sheet for patients)


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Created 1/24/2009

 

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