Your Appointment

How to Prepare

May We Help You?

Request an Appointment Renew a Prescription Request Medical Records Register as New Patient Contact the Doctor

Helpful Resources

Patient Forms Articles East Valley Resources For Expectant Mothers Office Policies Something Special

Obesity and your Pregnancy Risk

Pregnancy can be a pleasant experience for most, but untoward outcomes may cause undue stress on both the mother and her family and your new baby. The greatest risk of a pregnancy is actually a health baby and mother. However, certain pre-pregnancy (pre-conceptional) risk factors may reduce this risk. This article will summarize the definition of obesity, the risk factors associated with becoming pregnant, conditions acquired during pregnancy related to obesity and life-long risks of obesity during a pregnancy.

Obesity is defined as a body mass index for women above 30 according to the World Health Organization (WHO). A more concerning problem, in the United States is the growing trend of overweight patients. For this article, we will focus on patients who fall into the Obese category, either Class I, II, or III. Currently in the United States, it is estimated that as much as 40% of women of child bearing age may be obese. Current recommendations by the Center for Disease Control (CDC) recommend a weight based 1200 to 1600 kcl/day diet. In the February 6 issues of Morbidity and Mortality Weekly Report, it was proposed that U.S. women increased their daily calorie consumption 22 percent between 1971 and 2000, from 1542 calories per day to 1877 calories. This increase is likely accounting for many of the conditions associated with metabolic syndrome being on the rise such as diabetes and heart disease among women.

The risk factors associated with obesity and pregnancy never come into play until one is to conceive. The menstrual cycle of the overweight patient is often erratic. This process is usually due to an ovulation and is postulates to be attributed to insulin resistance. Many authors believe that it is the resistance to insulin that poses the greatest risk for these patients being co-diagnosed with Polycystic Ovarian Syndrome (PCOS). Women who do not ovulate monthly will have extreme difficulty in achieving a pregnancy. It is also known that women with a BMI greater than 30 are three times more likely to experience miscarriage. Because of irregular cycling, a pregnancy due date may be very difficult to establish. Some of the same symptoms like breast tenderness, hormonal changes and nausea may be present to help diagnose an early pregnancy, but many times these symptoms never occur. When a positive pregnancy test is discovered, the obese patient should seek obstetric care immediately to help in establishing a due date via ultrasound.

Now you are pregnant, what should I expect? Again, the greatest risk is still a healthy pregnancy, but close monitoring is needed. The first question often asked is “How much weight should I gain?” Recent data suggests that minimal weight gain for the obese patient may aid in the prevention of certain conditions associated with poor outcomes. Conditions such as Toxemia/Pre-eclampsia, gestational diabetes and hypertension are dramatically increased in the obese patient. Diabetic screening will routinely be performed to establish your risk for diabetes of pregnancy. Hypertension associated with pregnancy can have rapid and detrimental outcomes for both mother and child. Toxemia is a similar condition to hypertension but often more serious because it can involve other organ systems such as the brain, liver or kidney. Third trimester monitoring of urine for protein and blood pressure will help detect hypertension.

Now that mother and baby are healthy, what are your life-long risks? Metabolic syndrome is the greatest risk. This syndrome increases the risk of cardiovascular disease and diabetes and is characterized by the constellation of abdominal obesity, dyslipidemia, glucose intolerance, and hypertension. The real question is how to prevent these lifetime risks due to either obesity prior to pregnancy or immediately afterwards. Diet and exercise may prove fruitful for some patients, but as many as half fail this therapy. Bariatric surgery is sometimes an option. The usual next step is often medical therapy in addition to diet and exercise. The US Food and Drug Administration has two drugs approved for weight loss therapy:

• sibutramine inhibits serotonin and norepinephrine uptake, thereby reducing appetite and increasing satiety (loss of hunger)
• orlistat decreases fat aborption by inhibiting pancreatic and gastrointestinal lipases(both not recommended during pregnancy)

 

 

 

Home | Location | Our Physicians | Health Info | For Patients | Services | Contact | About | Research | Employment