The Elephant in the Middle of the Delivery Room – Obesity in Pregnancy

During a recent work meeting we discussed our ultrasound schedule and the need to increase the number of appointment slots due to a backlog of patients requiring weekly ultrasound assessment. These are mostly high risk pregnancies due to chronic hypertension and gestational diabetes. Over 90% of these patients are overweight when they become pregnant, increasing their risk for both of these medical problems.

Talking to patients about weight is a very loaded proposition (pun intended) when a patient is not pregnant and even more so when the mood swings that can be associated with pregnancy are in effect. The natural reaction for a patient is to be defensive, which can be difficult to overcome in a 10-15 minute normal ob appointment time slot. We try to tackle more obvious sources of empty calories – soda, fast food and juice – as well as activity levels. There is still the idea that when pregnant you need to “eat for two” and exercise increases your risk for miscarriage or pre-term delivery. Neither of these is true.  Recommendations are  that caloric increase needs to be 200-300 calories a day and 30 minutes of exercise 4-5 days a week is recommended.

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Obesity is now the #1 health problem in the US.   Outside of pregnancy, it increases the risk of many cancers  (uterine in women), diabetes, hypertension, joint pain and heart disease. During pregnancy obesity increases the risk of stillbirth (25% of stillbirths are thought to be related to maternal obesity), hypertension, gestational diabetes, preterm birth, cesarean section and post-partum hemorrhage. Children born to these same overweight parents have a 50% risk of being overweight themselves as adults, continuing the cycle for another generation.

Setting a good example for our children at home is one place that we can start to change the cycle.  A recent post on another blog, Wellfesto, was a good example of how we as mothers influence our children’s eating habits. http://wellfesto.com/2014/05/27/want-to-raise-healthy-kids-start-by-raising-a-healthy-you/.

We try to protect our children from as much harm as we can once they are born – they ride home from the hospital and spend the first 5-6 years of their life buckled in a car seat, we buy helmets for them when they are riding a trike, we slather them with sunscreen when at the beach.  We need to start seeing obesity, both in pregnancy and after, as a greater risk factor to our children than all of the previously mentioned risks. Once acknowledged, more changes individually and in our society will help to get us back on the right track. It worked with smoking in pregnancy!

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