Obesity in pregnancy

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If you are obese, your BMI is 30.0 + before pregnancy. About 1 in 4 women of reproductive age in the United States is obese. 1 DETERMINATION of OBESITY The World Health Organization (WHO) and the National Institutes of Health (NIH) define weight by body mass index (BMI) as follows 2,3 : BMI Weight Classification 18.5-24.9 Normal 25.0-29.9 Overweight Obese 30.0-34.9 Class I 35.0-39.9 Class II >=40.0 Class III Online BMI Calculator 3 The 1999-2002 National Health and Nutrition Survey (NHANES) found that approximately one third of adult women are obese, with this being greatest among non-Hispanic black women (49%) compared with Mexican- American women (38%) and non-Hispanic white women (31%.) 4 RECOMMENDATIONS FOR WEIGHT GAIN IN PREGNANCY 5 Height and weight should be recorded at the initial prenatal visit to determine BMI. Prenatal weight gain recommendations are based off of the Institute of Medicine (IOM) guidelines as follows: Normal weight women: 25-35 lbs Overweight women: 15-25 lbs Obese women: 15 lb See the newest chart from the National Institute of Medicine for more detail: Table 1, pg 2. TRACKING YOUR WEIGHT GAIN Pregnant women can chart their weight gain alongside the average pattern curve, as in the example provided by March of Dimes. BE CONSISTENT: Weight should be taken at the same time of day, in the same way (clothed or not). Weight Gain Chart Example 6 COMPLICATIONS DURING PREGNANCY- The Mother Women who are overweight when they get pregnant and during their pregnancy are at higher risk for many complications. They include the following: 2 Infertility: Some overweight women are unable to get pregnant. Thursday, December 06, 2012
Miscarriage: The baby may die in the womb prior to 20 weeks of pregnancy. Stillbirth: The baby may die in the womb after 20 weeks of pregnancy but before birth. Preeclampsia and High Blood Pressure: Only pregnant women are able to get preeclampsia, and the risk is increased with being overweight. It can increase the chances of a preterm birth (birth prior to 37 weeks of completed pregnancy.) Gestational Diabetes: Diabetes during pregnancy Labor and Birth Complications: Large for gestational age baby Increased risk for cesarean section Complications with anesthesia Increased risk for post-surgical wound infection Higher rates of surgical blood loss Intrapartum complications, such as difficulty estimating fetal weight, inability to obtain external fetal heart rate and uterine contraction patterns, and trouble performing emergent cesarean delivery. Studies have shown that Class I and II obesity are associated with a higher risk of gestational diabetes, gestational hypertension, preeclampsia, and fetal macrosomia in comparison with a BMI of less than 30 7,8,9,10,11 . Additionally, the cesarean delivery rate was seem to increase with BMI. 7 Operative and postoperative complications have been shown to include higher rates of excessive blood loss, increased operative time, wound infection, and endometriosis. 12, 13, 14 Additionally, surgery in obese women can lead to anesthetic challenges, with difficulty in placing epidural, need for multiple attempts, and respiratory events from intubation problems. 15 POST PREGNANCY COMPLICATIONS Incremental increases in gestational weight gain beyond that recommended for obese women substantially increase the risk of weight retention at 1 year postpartum. 16 COMPLICATIONS FOR THE BABY A majority of babies born to overweight or obese mothers are born healthy, however, there is an increased risk for many complications if a woman is overweight or obese during pregnancy. These include: Birth defects, particularly neural tube defects Preterm birth Injury, such as shoulder dystocia during birth, due to large size of the baby. Death after birth Large size (macrosomia) Obesity during childhood Thursday, December 06, 2012 Some studies have reported a greater rate of premature delivery for obese women than those who are of a normal weight, 8,17 but some have reported that pre-pregnancy obesity is associated with a lower rate of spontaneous preterm birth, 18 thus this issue is still unclear. 3
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Page 8: defects." Pediatrics 2003; 111: 115

Obesity in pregnancy

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