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Carene's Wellness Corner
Obesity and Pregnancy: Increased health risks for mom and baby

One-third of reproductive age women are obese in the United States, which can make it difficult to get pregnant and cause medical issues for a mother-to-be and her fetus, lead to a difficult labor and delivery, and put the baby at higher risk for health problems.

"It is an epidemic that has reached a crisis stage," says Katharine Wenstrom, MD, director of the Division of Maternal-Fetal Medicine at Women & Infants Hospital.

Pregnancy and ObesityDifficulty getting pregnant
Fat produces the female hormone estriol (a form of estrogen). When a woman has higher than normal levels, she may ovulate irregularly. Obesity can also be associated with polycystic ovarian syndrome, which causes infertility.

Obese women also have an increased risk of health problems such as diabetes. Being insulin resistant can cause a woman to have irregular ovulation or to not ovulate at all, explains Kenneth K. Chen, MD, division director of Obstetric and Consultative Medicine at Women & Infants.

Pregnancy complications
Elevated blood sugar levels from diabetes can cause a fetus to have birth defects, which might not be initially visible because when a womanis obese, it is harder to see fetal structures with ultrasound. "Birth defects may not be recognized before delivery," Dr. Wenstrom adds.

The babies of diabetic mothers are also at risk of being unusually large, making delivery difficult. Infants of diabetic mothers are also more prone to metabolic problems as newborns, and often have difficulty keeping their blood sugar levels normal after birth. These infants are also at increased risk of childhood obesity.

Another complication from obesity is high blood pressure. Chronic high blood pressure can cause less than optimal blood flow to the fetus, resulting in it being abnormally small, and increases the risk of developing pre-eclampsia (high blood pressure, fluid retention, and abnormal kidney function). In addition, obese women are more likely to develop sleep apnea (which can increase blood pressure), infections after Cesarean delivery, and blood clots, Dr. Chen says. The risk of stillbirth also increases.

Delivery challenges
If a woman is having a big baby, labor and delivery can be problematic and she may require a Cesarean section (C-section). When a fetus is large because the mother is diabetic, it is more likely to have large shoulders, making delivery difficult and possibly resulting in damage to the nerves in the baby's shoulders, arms, and hands. In general, obese pregnant women are more likely to need a C-section due to pregnancy complications or obstructed labor.

A C-section, however, also brings increased risks for obese women, such as serious bleeding complications or poor wound healing. It can be more difficult to give epidural anesthesia to an obese woman for pain relief, therefore, she may need to be put to sleep for the C-section. But, administering general anesthesia can be tricky and it is more likely to result in complications or even death, Dr. Chen explains.

Ultimately, "It's better to try to control fetal size with diet and exercise during pregnancy, and then let the patient go into labor naturally," Dr. Wenstrom notes. "Inducing labor increases the need for a C-section."

Suggested treatments
When looking to get pregnant, losing just 20 or 30 pounds can make an important difference, says Dr. Wenstrom. If a woman is infertile because of obesity, it is better to try and lose weight before attempting in vitro fertilization.

"Once an obese woman is pregnant, she doesn't need to gain a lot of weight as long as the fetus is growing," Dr. Wenstrom says. Eating a healthier, balanced diet during pregnancy can help to avoid excessive weight gain. Pregnant women should also do a regular low-impact exercise such as walking or swimming.

Prenatal care is especially important, so any medical conditions that develop can be treated early on.


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