Weight loss protects mom and child
 

 
BY RONI RABIN
STAFF WRITER
Obese women who are contemplating having a child may want to get their weight under control before they become pregnant to reduce the risks both to themselves and their babies, doctors say.
Women who are obese are more likely to develop complications during pregnancy, including gestational hypertension and gestational diabetes, experts say, and they face an increased risk of miscarriage and stillbirth. They're more likely to require a cesarean section and are at risk for complications, both from cesarean surgery and from anesthesia.
Their babies also face increased risks: they are more likely to be born prematurely and to suffer from debilitating neural tube defects such as spina bifida. They are more likely to be born very large for their gestational age and to be obese as children.

"There's ongoing data which suggests that, long term, the kids are more likely to be obese," said Dr. Laura Riley, medical director of labor and delivery at Massachusetts General Hospital in Boston.

"If nothing else scares you, that ought to do it -- you don't want to be setting your kid up for a life of obesity."

Guidelines for approaching obesity during pregnancy were issued in September for the first time by a committee of the American College of Obstetricians and Gynecologists, in response to the growing ranks of obese women of child-bearing age, Riley said.

One of the chief recommendations is that doctors discuss the topic with their patients, no matter how uncomfortable that may be, Riley said.

"Patients would often be upset when I mentioned their weight, but in fact, I wasn't talking about their looks but the implications for their health," Riley said. "We're hoping to open a dialogue between patient and physician. ... Obesity is a medical illness, and you need to treat it as such."

A preconception visit is highly recommended, the expert panel concluded.

"If there's time, I think weight loss is the way to go," Riley said. Doctors should provide nutrition and exercise counseling and women should start changing their eating habits, Riley said.

Women who are overweight or obese should not gain as much weight during pregnancy as a woman of normal weight, although they should not diet during the pregnancy. The Institute of Medicine recommends that pregnant women who are overweight, with a body mass index of 25-29.9, gain no more than 15-25 pounds, while obese women with a BMI of 30 or more gain no more than 15 pounds. Women of normal weight are advised to gain 25 to 35 pounds. At the first prenatal visit, an obstetrician should record a woman's height and weight and calculate her body mass index. The doctor should offer nutrition counseling and discuss potential pregnancy complications, such as the difficulty estimating fetal weight and obtaining the fetal heart rate.