Obesity in pregnancy
Obesity in pregnancy
Obesity in pregnancy
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complications, if it successfully leads to a susta<strong>in</strong>ed reduction <strong>in</strong> weight. Many providers therefore will<br />
recommend wait<strong>in</strong>g at least 1 year after the surgery before try<strong>in</strong>g to get pregnant. While uncommon, women<br />
who have undergone weight reduction surgery may have different complications dur<strong>in</strong>g <strong>pregnancy</strong>, which<br />
should be discussed with the health care provider prior to try<strong>in</strong>g to conceive.<br />
Early studies on <strong>pregnancy</strong> after bariatric (weight loss) surgery showed complications such as gastro<strong>in</strong>test<strong>in</strong>al<br />
bleed<strong>in</strong>g28 , anemia29 , <strong>in</strong>trauter<strong>in</strong>e growth restriction30 , and neural tube defects, 31, 32 however more recent<br />
studies suggest that previous bariatric surgery is not associated with adverse per<strong>in</strong>atal outcomes. 33, 34<br />
Research has shown that pregnancies after bariatric surgery are <strong>in</strong> fact associated with fewer complications<br />
such as gestational diabetes, hypertension, macrosomia, and cesarean delivery than <strong>in</strong> obese women who had<br />
not had the surgery. 34, 35,36<br />
Suggestions for women th<strong>in</strong>k<strong>in</strong>g of conceiv<strong>in</strong>g, who have undergone bariatric surgery:<br />
Those with gastric band<strong>in</strong>g are at risk of becom<strong>in</strong>g pregnant unexpectedly after weight loss follow<strong>in</strong>g the<br />
surgery35 Patients should be advised to delay <strong>pregnancy</strong> 12-18 months after surgery<br />
Women with a gastric band should be monitored by their surgeon <strong>in</strong> case adjustment of the band may<br />
become necessary<br />
Patients should be monitored for nutritional deficiencies, and vitam<strong>in</strong> supplementation should be done as<br />
necessary<br />
RISK REDUCTION DURING PREGNANCY (Secondary Prevention)<br />
Dur<strong>in</strong>g <strong>pregnancy</strong>:<br />
Get early, regular prenatal care<br />
Determ<strong>in</strong>e the appropriate level of weight ga<strong>in</strong> by BMI, and physicians should discuss this with the<br />
patient<br />
Exercise most days (as directed by the health care provider). Safe exercises <strong>in</strong>clude walk<strong>in</strong>g, swimm<strong>in</strong>g,<br />
rid<strong>in</strong>g a stationary bike, tak<strong>in</strong>g <strong>pregnancy</strong> aerobics, or yoga classes.<br />
Dietary modifications can help reduce maternal weight ga<strong>in</strong> and improve obstetric outcome <strong>in</strong><br />
overweight pregnant women37 Preconception counsel<strong>in</strong>g ans assessment are highly recommended due to the <strong>in</strong>creased risk of several<br />
<strong>pregnancy</strong> complications <strong>in</strong> overweight or obese women 1<br />
Screen<strong>in</strong>g for gestational diabetes should be considered dur<strong>in</strong>g the first trimester, and later <strong>in</strong> <strong>pregnancy</strong><br />
if the <strong>in</strong>itial screen is negative22 ACOG RECOMMENDATIONS<br />
Recommendations for obese women who are pregnant or plann<strong>in</strong>g a <strong>pregnancy</strong> <strong>in</strong>clude:<br />
5<br />
Preconception counsel<strong>in</strong>g<br />
Thursday, December 06, 2012<br />
Provision of specific <strong>in</strong>formation concern<strong>in</strong>g the maternal and fetal risks of obesity <strong>in</strong> <strong>pregnancy</strong><br />
Consideration of screen<strong>in</strong>g for gestational diabetes upon presentation of <strong>in</strong> the first trimester, and<br />
repeated screen<strong>in</strong>g later <strong>in</strong> <strong>pregnancy</strong> if results are <strong>in</strong>itially negative.