Obesity & pregnancy

One-third of Americans today are classified as obese, and another one-third considered overweight.

And according to the U.S. Centers for Disease Control and Prevention (CDC), nearly one-quarter of women giving birth are obese (for example, 175 pounds or more for a 5'4" woman) before becoming pregnant.

Gaining weight during pregnancy is anticipated and necessary for a healthy mother and baby. However, for obese women ? defined as a body mass index (BMI) of 30 or higher ? starting a pregnancy can present a wide range of complications and possible health challenges for them and their babies.

Beginning a pregnancy already obese makes it harder to lose weight after the baby is born, and commences the nine-month term with well-defined health disadvantages to both the mother and baby.

The list is long of potential health complications for an obese pregnant woman and her baby. Following are six common concerns for obese pregnant women and their physicians:

Preeclampsia: This occurs when a pregnant woman develops high blood pressure, often in the second or third trimester of their pregnancy. Preeclampsia takes place at a higher rate in obese women and frequently requires premature delivery, placing the baby at risk.

Gestational diabetes: This occurs when a woman without diabetes develops high blood sugar levels during her pregnancy and it happens more frequently in obese pregnant women. This can lead to the baby growing larger than normal and increasing the risks of a stillbirth.

C-sections: Otherwise known as surgical births, both emergency and elective, are more common in obese women. Complications from a C-section can include wound related infections, excess blood loss and blood clots.

UTI Infection: Obese pregnant women suffer more urinary tract infections (UTIs) than women of normal weight. Moreover, the babies of obese moms also have higher risks of infection after birth.

Labor challenges: Obesity can interfere with the use of certain pain medications commonly offered during labor, such as an epidural. Labor is also more likely to be induced ? brought on with the use of drugs ? in obese expectant women.

Overdue deliveries: Typical full-term pregnancies range from 37 to 40 weeks, but obese mothers often deliver later. This can make the delivery more difficult and put more stress on both the mother and the baby.

The realities of dangers associated with obesity in pregnancy make it obvious why starting pregnancy at a normal weight is advisable. But the research points to even more fertility related challenges for obese women, suggesting that it is more difficult to become pregnant in the first place if you're overweight or obese.

Extra weight can inhibit normal ovulation. Obesity is also thought to influence the outcome of infertility treatments such as IVF (in vitro fertilization), reducing the chances that an implanted embryo will "take." Lastly, obesity also increases the risk of miscarriage once a pregnancy is established.

In a perfect world it would be advisable for obese women to lose weight prior to pregnancy. Regrettably this doesn't usually happen.

As a general rule of thumb, overweight women should aim to gain about 15 to 25 pounds, while obese women should target an 11- to 20-pound gain. It is also recommended that all patients, obese and normal weight, remain physically active every day while pregnant.

And lastly, maintain a healthy diet of lots of vegetables and fruits, lean proteins, six to eight glasses of water a day and avoidance of processed or fried foods.

Dr. Kecia Gaither is a double board-certified physician in OB/GYN and Maternal Fetal Medicine.