Obese and Pregnant: Bad for Mother and Baby
For decades, doctors, nonprofits, websites, and advice gurus have had no qualms with telling pregnant women what they should and shouldn't do. Topping the list of no-no's are smoking and drinking (though the latter seems to be safe in moderation.) In a perfect world, expecting mothers would have the best scientific evidence at their fingertips and the wisdom to be able to make up their own minds about the risks associated with certain activities and lifestyles. But in the real world, pregnant women may have to juggle work, commuting, errands, and children, all while experiencing the nontrivial pains of pregnancy. They rely on health professionals to deliver helpful and sometimes frank advice based on good science. Today, there's one area where experts have been far too quiet: obesity.
Though often deemed too taboo to even discuss, it may be time to make obesity the new pregnancy taboo. Scientists and health experts have long warned about the personal health risks of obesity, but they've stayed relatively mum on the risks of maternal obesity. The consequences are considerable for both mother and baby.
That much was made plain in a systematic review of reviews published last week. A team of European researchers led by Trinity College Dublin's Jamille Marche explored all of the published research on obesity and its effects on mothers and babies, focusing on the highest quality studies and reviews.
They found that the risk of developing gestational diabetes was four times higher in obese women, and nine times higher in severely obese women. Gestational diabetes, which is similar to normal diabetes but usually ends after delivery, puts babies at an increased risk of heavier birth weight, preterm birth, as well as respiratory distress syndrome.
Marche and colleagues also discovered that obese women with a BMI above 35 (roughly 210 pounds for a woman who is 5'5" tall) nearly doubled their risk of delivering their babies preterm before 33 weeks. Preterm birth affects roughly one out of every nine infants born in the U.S. and is associated with a variety of complications. According to the CDC, preterm-related causes of death accounted for 35% of all infant deaths in 2010. Moreover, preterm birth is a leading cause of long-term neurological disabilities in children.
The review further revealed that fetal death was 34% more likely for obese women (180 pounds for a 5'5" tall woman) and twice as likely for severely obese women (above 210 pounds). The rate of fetal death in the U.S. was 6.26 per 1,000 births in 2011.
Obese expecting mothers also face an increased risk of preeclampsia, a potentially dangerous pregnancy complication characterized by high blood pressure and bodily organ damage. Moreover, their babies were more likely to suffer congenital anomalies and excessive weight at delivery.
The kicker of all these consequences is that obesity begets obesity.
"Maternal obesity is the most significant factor leading to obesity in offspring and, coupled with excess weight gain in pregnancy, also results in long-term obesity for women," the reviewers write.
Roughly one-third of women in the United States aged 20-39 -- the prime age range for pregnancy -- is obese. More than half of all pregnant women are overweight or obese.
Doctors working delivery rooms across America are noticing. Delivering a baby to an obese mother presents very real challenges to mother, baby, and doctor. In a March editorial published in the New York Times, Claire A. Putnam, an obstetrician and gynecologist at a Kaiser Permanente Hospital, wrote that we should consider creating "special labor and delivery centers for severely obese patients that are equipped with automatic lifts, specially designed monitors and appropriately trained teams."
Above all, she said, "We need to end the taboo against talking frankly about obesity. Doctors need to be sensitive and nonjudgmental, and patients should not take offense, especially when their health, and their children’s health, is at stake."
"It is crucial to reduce the burden of adverse maternal and foetal/child outcomes caused by maternal obesity," Marche and her colleagues write. "Women with obesity need support to lose weight before they conceive, and to minimize their weight gain in pregnancy."