Overweight Women Risk Problem Pregnancies

Some simple steps can reduce likelihood of high blood pressure, gestational diabetes

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By Kathleen Doheny
HealthDay Reporter

SATURDAY, Feb. 11, 2006 (HealthDay News) -- With one-third of American women heavy enough to be termed obese, and many others at a weight deemed unhealthy, it's no surprise doctors are becoming more concerned about women who are too heavy before they get pregnant.

The reason: They -- and their babies -- are at higher risk for health problems.

So last August, the American College of Obstetricians and Gynecologists issued an opinion on obesity during pregnancy, cautioning women and doctors about the risk that obesity poses to pregnant women and their babies.

For women who are obese before becoming pregnant, there is a heightened risk of miscarriage, blood-pressure problems, pregnancy-related diabetes and, perhaps, a greater need for Caesarean-section delivery, said Dr. Laura Riley, an obstetrician-gynecologist at Massachusetts General Hospital and former chairwoman of ACOG's obstetric practice committee.

"There's also a higher risk of the baby being overweight," she said, adding that a baby of about 10 pounds at birth is deemed overweight. Babies of heavy mothers are at greater risk of stillbirth, prematurity, neural tube defects and higher rates of childhood obesity, according to ACOG.

Women who aren't obese but are heavy -- with a body mass index (a ratio of weight to height) of between 25 and 30 -- are also at increased risk of diabetes, high blood pressure and a C-section if they gain too much weight during pregnancy, Riley said. A BMI of 18.5 to 24.9 is considered normal; a BMI of 25 to 29.9 is considered overweight; a BMI higher than 30 is deemed obese.

Ideally, "women should get down to their ideal body weight before they get pregnant," Riley said. "But it is not always easy." And not always feasible. "If you are 41, do you want to wait a year to lose the weight? Probably not," she added.

"But if you could get to your ideal body weight, that is what you should do," Riley said. "At the very least, you should see a nutritionist and figure out how you can minimize your weight gain" during pregnancy.

According to the ACOG recommendations, women of normal weight before pregnancy should gain 25 to 35 pounds while expecting; overweight women 15 to 25 pounds; and obese women, 15 pounds.

Netty Levine, a registered dietitian at the Nutrition Counseling Center at Cedars-Sinai Medical Center in Los Angeles, often works with pregnant women who are heavy. She cautions them not to diet, which is not recommended during pregnancy, but to focus on making "lifestyle changes for you and your future family."

For instance, Levine recommends that overweight women sit down and complete a food diary of what they eat for several days. Then she evaluates that record to see if the women are getting enough protein and calcium, and if they are eating too much fat or sugar. She also looks to see if portion sizes are too large -- one of the most common weight-control mistakes.

"This is no time to lose weight," Levine tells women who were too heavy when they got pregnant. "But you can keep it to a minimum." For obese women, that means 15 pounds or so.

For women who are heavy and hoping to get pregnant, Levine agreed with Riley -- the best idea is to slim down first. That might not require drastic changes, she tells women. Make small changes. "Get off those smoothies, drink more water. If you like waffles, top them with strawberries, just pass on the butter and syrup," she said.

Levine evaluates a woman's entire day -- and lifestyle -- and decides where the problem spots are when it comes to overeating. "Some people eat healthfully at home but have a business lunch every day. Or they eat healthfully at work and get home at night and overeat." Zeroing in on the trouble spots can help women fix the problem, she said.

More information

To learn more about a healthy pregnancy, visit the American College of Obstetricians and Gynecologists.

SOURCES: Laura Riley, M.D., obstetrician-gynecologist, Massachusetts General Hospital, Boston; Netty Levine, M.S., R.D. certified diabetes educator, clinical dietitian at the Nutrition Counseling Center, Cedars-Sinai Medical Center, Los Angeles

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