Obesity in pregnancy

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As far as neural tube defects, it has been shown that the number among obese mothers is double that of normal weight mothers (after correcting for diabetes as a potential confounding variable.) 19,20,21 Many studies have shown that maternal obesity and excessive weight gain in pregnancy are in fact associated with macrosomia, 9, 22,23,24 and that these babies are in turn at increased risk for childhood obesity. 10, 25 HEALTH CARE COST BURDEN Obesity in pregnancy has been shown by the CDC to be associated with an increase in the use of health care services. These can include: Greater use of inpatient and outpatient health care services Increased length of hospital stays for delivery Greater use of physician services Less use of services by nurse practitioners and physician assistants during prenatal visits Increased prenatal care costs The main study referenced was adjusted for age, race/ethnic group, level of education, and parity. In this study, it was found that: The mean length of hospital stay was significantly longer for women who were overweight, obese, very obese, and extremely obese in comparison with women with a normal BMI, particularly due to increased rates of cesarean delivery and obesity-related high-risk conditions. A higher than normal BMI was associated with significantly more prenatal fetal tests, obstetrical ultrasonographic examinations, medications from outpatient pharmacies, calls to the department of obstetrics and gynecology, and prenatal visits with physicians. Fewer of these visits were with nurse practitioners and physician assistants. 26 The costs are not only limited to the mother and her delivery. Babies born to obese mothers often need admission to neonatal intensive care units more often than those born to normal weight mothers. 27 Unfortunately, very few studies have been done looking at the economic impact of maternal obesity. There are no good studies to show robust estimates of actual cost. 38 Even without these specific numbers, it seems clear that the impact is significant, and hopefully in the near future, more work will be done to support this. RISK REDUCTION PRE-PREGNANCY (Primary Prevention) Before conceiving: Thursday, December 06, 2012 Get a preconception check-up Discuss healthy eating and exercise with your health care provider (to help lose weight before pregnancy) Create a healthy eating plan, with the help of the U.S.D.A. Choose My Plate online tool Consider weight reduction surgery WEIGHT LOSS SURGERY PRE-PREGNANCY Weight loss surgery before pregnancy can decrease the chances of experiencing weight-related pregnancy 4
complications, if it successfully leads to a sustained reduction in weight. Many providers therefore will recommend waiting at least 1 year after the surgery before trying to get pregnant. While uncommon, women who have undergone weight reduction surgery may have different complications during pregnancy, which should be discussed with the health care provider prior to trying to conceive. Early studies on pregnancy after bariatric (weight loss) surgery showed complications such as gastrointestinal bleeding28 , anemia29 , intrauterine growth restriction30 , and neural tube defects, 31, 32 however more recent studies suggest that previous bariatric surgery is not associated with adverse perinatal outcomes. 33, 34 Research has shown that pregnancies after bariatric surgery are in fact associated with fewer complications such as gestational diabetes, hypertension, macrosomia, and cesarean delivery than in obese women who had not had the surgery. 34, 35,36 Suggestions for women thinking of conceiving, who have undergone bariatric surgery: Those with gastric banding are at risk of becoming pregnant unexpectedly after weight loss following the surgery35 Patients should be advised to delay pregnancy 12-18 months after surgery Women with a gastric band should be monitored by their surgeon in case adjustment of the band may become necessary Patients should be monitored for nutritional deficiencies, and vitamin supplementation should be done as necessary RISK REDUCTION DURING PREGNANCY (Secondary Prevention) During pregnancy: Get early, regular prenatal care Determine the appropriate level of weight gain by BMI, and physicians should discuss this with the patient Exercise most days (as directed by the health care provider). Safe exercises include walking, swimming, riding a stationary bike, taking pregnancy aerobics, or yoga classes. Dietary modifications can help reduce maternal weight gain and improve obstetric outcome in overweight pregnant women37 Preconception counseling ans assessment are highly recommended due to the increased risk of several pregnancy complications in overweight or obese women 1 Screening for gestational diabetes should be considered during the first trimester, and later in pregnancy if the initial screen is negative22 ACOG RECOMMENDATIONS Recommendations for obese women who are pregnant or planning a pregnancy include: 5 Preconception counseling Thursday, December 06, 2012 Provision of specific information concerning the maternal and fetal risks of obesity in pregnancy Consideration of screening for gestational diabetes upon presentation of in the first trimester, and repeated screening later in pregnancy if results are initially negative.
Page 2 and 3: If you are obese, your BMI is 30.0
Page 6 and 7: Assessment and possible supplementa
Page 8: defects." Pediatrics 2003; 111: 115

Obesity in pregnancy

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