“Critical mass”: peculiarities of pregnancy for overweight women

Adiposity is not just an overweight in organism. This is a chronic recurring disease, which contributes to display and development of many other chronic diseases. This disease also influences pregnancy.
Basic sign of adiposity is overweight in organism. Adipose tissue is a depot (place of accumulation of coming energy). The more adipose tissue you have, the bigger is quantity of “excess” energy, received from food and not consumed.

Where does overweight come from?
Factors of development of adiposity are varied and may act both together and separately. Most popular of them are: peculiarities of behavior (hypodynamia – lowering of moving activity, overeating), genetic predisposition, defects of endocrine system. As a result of numerous researches it was determined that adiposity in childhood is a powerful predisposing factor of adiposity in mature age, especially when one or both parents suffer from it. Thus, if parents have normal weight, only 99% of children suffer from adiposity, if one parent suffers from it – 50%, and if two parents suffer from adiposity – in 70% of cases.
There’s a special center in our brain, hypothalamus, which controls sense of hunger and satiety. Constant overeating leads to defect of work of hypothalamus, and normal quantity of eaten food cannot already suppress sense of hunger, so a person has to eat more and more. Excess food is saved in store in a fat depot, what leads to overweight in organism, i.e. development of adiposity.

What’s overweight?
Doctors use Index of Body Mass (IBM), which is calculated like a ratio of body mass (in kg) to height (in m2). Indices of IBM from 25 to 30 kg/ m2 point out on overweight, and more than 30 kg/ m2 already allow diagnosing adiposity.
According to prognosis of World health authorities’ experts, if present rate of adiposity growth will remain the same, its level will increase in average on 8% by 2010 year, and by 2025 there will be more than 300 millions of people suffering from adiposity in the world. Results of series of epidemiological researches show that in Europe quantity of patients with adiposity in population is about 30%, and with overweight – about 25%.

Possible problems
Pregnancy. During pregnancy auspicious conditions for development of adipose tissue are created, which biological sense is in protection of a future baby. This is caused by hormonal change in female organism, to be exact, heightened synthesis of progesterone and chorionic gonadotrophin (hormones, which support pregnancy) and lack of estradiol, produced by ovaries mainly beyond pregnancy. Action of these hormones causes overweight mainly in breast, buttocks, hips, belly.
Those who suffer from adiposity seldom have pregnancy without complications. Most popular are: gestational diabetes, or diabetes for pregnant, arterial hypertension, hypercoagulability (increase of fibrillation), defects of heart activity, toxicosis, gestosis (it is characterized by increase of blood pressure, appearance of edemas, albumen in urine), infections of urinary tracts, incomplete pregnancy or prolonged pregnancy (state when pregnancy lasts for more than 41-42 weeks), premature discharge of amniotic fluid, birth of a baby with big body mass (more than 4000 g).
The most dangerous complication is preeclampsia – most serious form of gestosis, which main sings are increase of systolic pressure higher than 140 mm of mercury, diastolic pressure higher than 80 mm of mercury, and also proteinuria (loss of more than 3 g of albumen per day with urine). Signs of affection of other systems and organs can also be observed: headaches, pains in belly, defects of sight. While laboratory researches doctors find out increase of level of hepatic ferments, changes in fibrillation system.
Adiposity affects also development of a baby. As it is known, folacin plays main role in formation of nervous system, and while adiposity its interchange in organism of a pregnant woman changes, what may lead to development of defects of fetus’s nervous system.

Childbirth.  Not only pregnancy, but also childbirth itself for women suffering from adiposity pass with a series of peculiarities, what is caused by hormonal changes. Internal system, setting childbirth going, remains to be incomplete by the end of pregnancy for such women, and absence of formation of birth dominant (a center of excitement in brain) leads to prolonged pregnancy, and further – to asthenia of birth activity, which weight is increased proportionate to degree of adiposity.
While asthenia of birth activity, which cannot be cured with medicaments, doctors have to use surgical operation (Cesarean section), to prevent a new-born baby’s anoxaemia. But probably, a necessity of Cesarean section will be caused by inconsistency between sizes of mother’s pelvis and fetus, as pregnant women with adiposity, as it was mentioned before, more often give birth to babies with big body mass.
In its turn, surgical operation is also accompanied by big quantity of complications, as thick hypodermic layer worsens healing of postoperative scars.
You can buy skilful scales, analyzing mass of fat, muscles and bones. During pregnancy you can use this scales only for weighing, as they still cannot consider mass of fetus, placenta, amniotic fluid.
6-30% of women in childbirth with adiposity suffer from bleeding during delivery and also post-natal period, which is caused by as defect of uterus retractive capacity, as changes in fibrillation system.
You should also remember that women, suffering from adiposity, are in the risk group of development of defects of carbohydrate exchange, i.e. appearing of diabetes, so 2 months after delivery or cessation of lactation they should pass a test to determine level of glucose in blood.

How to reduce risk?
Regardless of many complications, adiposity is not a contra-indication for pregnancy. While preparation to conception a woman should consult not only accoucheur-gynaecologist, but also endocrinologist, during whole pregnancy she must observe all doctors’ advices.
First of all, a woman should control her weight. Overweight of pregnant women with normal body weight should not exceed 10-12 kg, about 4 kg of which go for increase of fat tissue, and overweight of pregnant women with adiposity should not exceed 5-6 kg.
Majority of pregnant women with adiposity should pass tolerance test to glucose while their first visit to obstetrician-gynaecologist. If there are some defects discovered, you should stick to a special diet, and in some cases a doctor may even prescribe injections of insulin for you.
To lower excitability of food center, you should eat frequently (8-6 times per day), and food should be low-calorie, but take big volume in stomach, what contributes to removal of hunger. Exclude taste substances that increase excitability of food center and appetite (salty, spicy dishes, broths) from your ration, and also substances, which are quickly absorbed and digested (sweets, sweet fruits).
Protein content in a pregnant woman’s ration should be enough, 20% of daily ration. You should receive about 30% of fats, and 50% of carbohydrates daily. Nutrition should be rational, don’t eat only meat or dairy food, just as only fruits and vegetables, and, of course, don’t misuse sweets. Menu for pregnant woman should be varied: 6-11 parts of it should be cereals, 3-5 parts – vegetables, 2-4 parts – fruits, 3-5 parts – dairy produce, 2-3 parts – meat food, legumes or nuts, 1 part - sweets. Caloric content of ration depends on IBM, but in average is it equal to 2500 kilocalories per day.
Women with adiposity should reduce caloric content of food, but no more than on 10%, otherwise coming food will not provide a normal growth and development of fetus. Remember that pregnant women with adiposity should not go without food, as then ketonemia can appear, i.e. products of metabolism will be found in a woman’s blood – ketones, influencing fetus development negatively.
Pregnant women with adiposity should arrange fasting days 1-2 times per week. Here’re some of them (volume of eaten food should be divided into 5-6 meals).

Cotton-cheese: eat 400 g of non-fat cotton cheese per day, 2-3 cups of tea without sugar (you may put lemon in it) or dog-rose extract.

Apple: 1,5 kg of raw or baked apples. 2 cups of tee without sugar.

Cucumber: 1,5 kg of fresh cucumbers, 2 cups of tea without sugar. Calorie content of cucumbers is very low (2 times lower, than of cabbage and 3 times lower, than of apples).

Salad: salad of 1,2 – 1,5 kg of various raw vegetables (cabbage, carrot, lettuce, cucumbers) with vegetable oil and 1-2 spoons of sour cream.

It’s better to start with cotton-cheese day, as cotton cheese creates more pronounced feeling of satiety, than vegetables and fruits. It’s useful to make a graph of results of systematic weighing to control change of body weight.

In addition to nutrition, restricted in calorie content, but complete, medicinal gymnastics is also recommended to prevent overweight. This gymnastics helps to increase energy demands, which contribute to mobilization of fat from depot. A complex of exercises for pregnant women is composed individually, depending on term of pregnancy and degree of adiposity. During pregnancy you should remember, that basic task is not to reduce quantity of fat tissue, but to avoid gaining additional one, at the same time providing normal growth and development of fetus.


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