Myth and Truth About Obesity and Pregnancy
excessive caloric intake, many
obese women are deficient in
vitamins vital to a healthy pregnancy. This and other startling statistics
abound when obesity and
In the December(2011) issue of the journal Seminars in
Perinatology, maternal fetal medicine expert Loralei L. Thornburg, M.D.,
reviews many of the pregnancy-related changes and obstacles obese women may face
before giving birth. The following myths and truths highlight some expected and
some surprising issues to take into account before, during and after pregnancy.
Many obese women are vitamin deficient.
Forty percent are deficient in iron, 24 percent in
folic acid and 4 percent in
B12. This is a concern because certain vitamins, like folic acid, are very
important before conception, lowering the risk of cardiac problems and spinal
defects in newborns. Other vitamins, such as calcium and
iron, are needed
throughout pregnancy to help babies grow.
Thornburg says vitamin deficiency has to do with the quality of the
diet, not the quantity.
Obese women tend to stray away from fortified cereals, fruits and vegetables,
and eat more processed foods that are high in calories but low in nutritional
"Just like everybody else, women considering pregnancy or currently pregnant
should get a healthy mix of fruits and vegetables, lean proteins and good
quality carbohydrates. Unfortunately, these are not the foods people lean
towards when they overeat," noted Thornburg. "Women also need to be sure they
are taking vitamins containing folic acid before and during pregnancy."
patients need to gain at least 15 pounds during pregnancy.
In 2009, the Institute of Medicine revised its recommendations for
gestational weight gain for obese women from "at least 15 pounds" to "11-20
pounds." According to past research, obese women with excessive
weight gain during pregnancy have a very high risk of complications,
including indicated preterm birth,
failed labor induction, large-for-gestational-age infants and infants with low
The risk of spontaneous preterm birth is higher in obese than non-obese women.
Obese women have a greater likelihood of indicated preterm birth -- early
delivery for a medical reason, such as maternal
high blood pressure. But, paradoxically, the risk of spontaneous preterm birth
-- when a woman goes into labor for an unknown reason -- is actually 20 percent
lower in obese than non-obese women. There is no established explanation for why
this is the case, but Thornburg says current thinking suggests that this is
probably related to hormone changes in obese women that may decrease the risk of
spontaneous preterm birth.
Respiratory disease in obesity -- including asthma and obstructive sleep
apnea -- increases the risk for non-pulmonary pregnancy complications, such as
cesarean delivery and preeclampsia (high blood pressure).
Obese women have increased rates of respiratory complications, and
up to 30 percent experience an exacerbation of their
pregnancy, a risk almost one-and-a-half times more than non-obese women.
According to Thornburg, respiratory complications represent just one piece of
the puzzle that adds to poor health in obesity, which increases the likelihood
of problems in pregnancy. She stresses the importance of getting asthma and any
other respiratory conditions under control before getting pregnant.
There are two basic approaches that are both important in optimizing the
mother's health. First identify and avoid
that can worsen asthma; particularly dust mites, animal dander or mold. And
then, since, most patients with persistent asthma can't avoid enough of the
triggering factors to have that suffice, to be on appropriate
therapy. This is
important because of their health and because there are risks from uncontrolled
asthma to the baby's health. Our study adds strength to the safety profile of
the inhaled steroids, which are clearly the most effective preventative medicine
relative to asthma.
The ultimate goal of controlling asthma during pregnancy is to ensure
that the fetus continues to get adequate oxygen by preventing asthma
Breastfeeding rates are high among obese women.
Breastfeeding rates are poor among obese women, with only 80 percent
initiating and less than 50 percent continuing beyond six months, even though it
is associated with less postpartum weight retention and should be encouraged as
it benefits the health of mom and baby.
It can be challenging for obese women to breast feed. It often takes longer
for their milk to come in and they can have lower production (breast size has
nothing to do with the amount of milk produced). Indicated preterm birth can
result in prolonged separations of mom and baby as infants are admitted to the
neonatal intensive care unit or NICU. This, coupled with the higher rate of
maternal complications and cesarean delivery -- up to 50 percent in some studies
-- in obese women, can make it harder to successfully breast feed.
"Because of these challenges, mothers need to be educated, motivated and
work with their doctors, nurses and lactation professionals to give breast
feeding their best shot. Even if you can only do partial breastfeeding, that is
still better than no breastfeeding at all," said Thornburg.
Dated 23 December 2011