Overweight & pregnant: what extra pounds mean to you and your baby - health

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an increasing number of American women who want to get pregnant soon might want to reconsider their timing: They’re overweight.


an increasing number of American women who want to get pregnant soon might want
to reconsider their timing: They’re overweight. A study that looked at 53,000
pregnant women’s weight at their first prenatal visit found that the average had
increased by 20 percent from 1980 to 1999. That’s bad news for them and their
babies.

“Doctors have long known that very obese women risk pregnancy complications,
but new research indicates that even women who are not hugely overweight have
elevated risks,” says Hugh M. Ehrenberg, M.D., of Case Western Reserve School
of Medicine in Cleveland, the lead author of a recent study on obesity and pregnancy
published in the American Journal of Obstetrics and Gynecology. The list of potential
complications is formidable: hypertension, preeclampsia and eclampsia, gestational
diabetes (which can lead to overly large babies), Cesarean delivery and postoperative
complications.

There’s more: A new Centers for Disease Control and Prevention study confirmed
that a woman who is overweight before becoming pregnant is two to three times
more likely to have a baby with heart abnormalities, spina bifida or other birth
defects. Another new study links excess weight and obesity to lower levels of
the “lactation hormone” prolactin after childbirth, which may explain why overweight
women tend to stop nursing earlier than average-weight women. Finally, weight
gained during pregnancy can be cumulative and difficult to lose (see “The Road
to Obesity” on pg. 64).

To prevent such problems, a woman should, if possible, be at or close to her
ideal weight when she becomes pregnant. Sometimes losing just 5 to 10 percent
before getting pregnant is enough to decrease her risk factors. But since not
every pregnancy is planned, many overweight women want to know whether–and how–they
can safely deal with their weight while pregnant. The thinking on this issue is
changing.

Revising the weight-gain rules * “We used to tell all women to gain 25 to 35
pounds during pregnancy, but now we suggest that an overweight or obese woman
gain only 15 to 25 pounds,” says Paula Bernstein, M.D., an OB-GYN in Los Angeles
and a co-author of Carrying a Little Extra: A Guide to Healthy Pregnancy for the
Plus-Size Woman (Penguin Putnam, 2003). That’s because an overweight woman already
has a greater store of the nutrients her developing baby needs.

A body mass index (or BMI, a formula that relates weight to height) of 25 to
29.9 is considered overweight, while a BMI greater than 30 is the current standard
for obesity. “Even a woman with a BMI of 25 begins to be at risk for pregnancy
complications,” Bernstein says.

Though doctors currently advise against losing weight during pregnancy, Ehrenberg
is investigating whether doing so might benefit a very heavy woman’s health without
risking her baby’s. One concern is that ketosis–the incomplete metabolism of
fatty acids that occurs when carbohydrates are severely limited and weight loss
occurs rapidly, as is the case with high-protein diets–may harm a fetus. But
a balanced, calorie-restricted diet can result in weight loss without causing
ketosis.

“Until now, the research regarding weight loss during pregnancy has been done
on women who are already at an ideal weight,” Ehrenberg says. “But as a significant
number of women now are overweight when they become pregnant, we need to establish
whether they can lose weight through diet and exercise without harming their baby.”

Safe ways to gain less * If you’re overweight and pregnant, you can safely limit
your weight gain by working with a registered dietitian and a certified trainer
who have expertise in pregnancy nutrition and exercise. Bernstein advises significantly
obese women to have a thorough cardiovascular checkup before starting an exercise
program that can be followed during pregnancy and beyond.

“Whatever you do, do it in moderation,” Bernstein says. “This isn’t the time
to train for a marathon or join a high-impact aerobics class. Start any new exercise
slowly and build up gradually. Avoid exercise that can damage your joints, which
are more vulnerable during pregnancy. Walking and swimming are excellent choices.”

Pregnancy can be an ideal time to tackle weight issues–for your sake and your
child’s as well. Your habits will influence his, so think of pregnancy as an opportunity
to become a model of healthy eating and exercise.

(*) THE ROAD TO OBESITY

Women who are overweight before they become pregnant tend to retain weight afterward,
and those who do not lose their pregnancy weight within six months of giving birth
are at particular risk for obesity, a study published last year in the Journal
of Obstetrics and Gynecology found.

“We call it the ’stair-step effect,’” says Jana Klauer, M.D., a New York weight
and nutrition specialist. “It occurs when a woman retains the weight from her
first pregnancy and becomes pregnant a second and maybe a third time without ever
returning to her prepregnancy weight. A thin woman may find herself overweight
after two or more pregnancies, and a woman who is slightly overweight when she
first becomes pregnant and never loses her pregnancy weight may ’stair step’ herself
into obesity the next time.” Breastfeeding can help: It burns more than 500 calories
a day.

Jill Alison Ganon is a co-author of Caring for Your Premature Baby (HarperCollins,
1998) and Raising Twins (HarperCollins, 2000).
 
 

COPYRIGHT 2003 Weider Publications

COPYRIGHT 2003 Gale Group



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