Understanding The Risks And Complications Of Obesity During Pregnancy

Complications of Obesity in Pregnancy

Question :

Describe obesity in Pregnant Women based on recommendation.

The greatest joy of life is perhaps becoming a mother. But with this joy also comes great responsibilities on the part of the parents, and particularly the mother, so that a healthy baby is born. A dream which most women share is getting pregnant. Best experience is to get pregnant but often there arises a few set of problems and complications, if not treated in a proper way. To have a healthy baby is the desire for all pregnant mothers during a women’s pregnancy. Complications will arise if a mother gives birth to unhealthy baby and it also decreases the mother’s chance of conceiving. A lot of changes occur in the body during pregnancy, both physically and internally (The health site, 2015). Therefore, the best time to get pregnant is in 20s (Dutta & Konar, 1998). In 30s, not only do the chances of conceiving decline but also there are more risks involved in getting pregnant. There are numerous ways to have a child, such as, through surrogacy or IVF (In Vitro Fertilization). Medical problems that interfere with the physiological adaptations of pregnancy increase the risk of poor pregnancy outcome. Few of the medical disorders during pregnancy are: Hypertension, Preeclampsia, Renal disease, Cardiac disease and Obesity in Pregnancy. All these diseases are associated with pregnancy. Hence, it is very essential to understand, if one is going to be a mother, about the risk factors during pregnancy.

Obese women, in America, are more than one third of the total number of women, one half or more of pregnant women are either overweight or are suffering from obesity, and 8 per cent of those women who are in their reproductive age, are extremely obese, which puts them at a higher risk related to complications regarding pregnancy (Acog.org, 2015). Assessment as well as counseling are very much encouraged for women who are obese which includes the different provision of some specific information related to the maternal as well as the fetal risks of obesity during pregnancy, and encouraged to take up a program on reducing weight. During the first stage of prenatal visit, a measure of height as well as weight must be taken for every women so that calculation of BMI (Body Mass Index) (Calculated in weight in Kg divided by height in m²) could be done, and also an information about a proper weight gain must be checked in the first visit as well as periodically throughout the pregnancy. A consultation regarding nutrition should be given to every overweight or to those women who are obese, and should also be encouraged towards following a healthy exercise routine (Barbeiri, 1977). A woman, who is pregnant, and has had a bariatric surgery must be checked for any deficiency in nutrition along with the requirement of vitamin supplementation, whenever indicated. Patients who are obese, who have undergone cesarean in their previous delivery, might also need thromboprophylaxis with pneumatic compression devices as well as unfractionated heparin and/or those weight heparin which are low molecular. For every obese women, anesthesiology consultation, should be considered in the initial stage of labor and should encourage consultation along with the specialists of weight-reduction before thinking about another pregnancy.

Increased Risk of Infertility

The first argument of obesity in pregnancy is complications of Obesity in Pregnancy. Women who are overweight and/or obese are at an increased risk of many complications related to pregnancy, which includes hypertension along with gestational diabetes mellitus preeclampsia, postpartum weight retention, and also cesarean delivery, as mentioned earlier. In the same way, a pregnant woman, who are over-weight or obese, have a higher risk of premature delivery, still birth, congenital anomalies (examples like neural tube defects), macrosomia when pregnancy is associated with diabetes mellitus and obesity with possible injury by birth and childhood and obesity (Repke, 1978). Numerous study regarding pregnancy says that in case of obese women there is more chance of premature delivery. A study conducted on almost 2,900 overweight women shows that obesity before pregnancy was related to a lower rate of a spontaneous pre-term birth.  Additionally, potential intrapartum along with operative and post-operative complications as well as difficulties associated with the anesthesia management, are also included. It is also more likely that an obese woman will initiate as well as continue breast feeding. A minimum of three cohort researches suggest, in women who have undergone a treatment related to infertility, obesity played an important risk factor related to spontaneous abortion. As per this recognition of the association, recommendations are to have a regular check up for all obese patients. Data established that risk related to defects in neural tube, which is very common in obese patients, is almost two times in pregnant women who have a normal weight once corrections are done for diabetes, which is a potential confounding factor (Sirimi & Goulis, 2010).

The second argument of obesity in pregnancy and few other risk factors in pregnancy which include the increase in risk of infertility which is one of the prime causes that affect ovulation and fertility in obese women is by altering the normal hormonal patterns in a woman. This affects the normal functioning of the ovaries. Infrequent or irregular menstrual cycles arise because of it, which disturbs the normal phase of ovulation (Nhs.uk, 2015). One major case is the fat deposition in the abdomen of a woman is known to produce male hormones which prevent follicular matures and results in an ovulation (decreased ovulation). An IVF (In Vitro Fertilization) treatment in obese women have less success rate than that performed on non-obese women. A person needs to lose a great amount of weight to make an IVF treatment a successful one. It increases chances of miscarriages. If nature makes it possible to conceive despite great issues, caring and nurturing the baby can still be a risk. The chance of still birth is tripled in case of obesity and miscarriage in women. Obese women who undergo a miscarriage make it difficult for her to conceive a second time (Dutta & Konar, 1998). It can lead to PCOS (Poly Cystic Ovarian Syndrome). Overproduction of insulin is caused due to obesity which may further cause irregular ovulation too. A link between obesity, excess insulin production and the infertility condition is always present which is termed as polycystic ovarian syndrome (PCOS). PCOS is a specific medical condition which is associated with irregular menstrual cycles, either decreased or even stopped ovulation, elevated levels of male hormones and obesity. It can also lead to other lifestyle-related issues. It is noticed in general that obese people also end up having numerous lifestyle related issues like high BP, diabetes, and higher cholesterol levels. Many health issues together makes conceiving a challenge for women with higher waistlines.

PCOS

The third argument of obesity in pregnancy is the recommendations in order to prevent obesity in Pregnancy. Lose weight before planning pregnancy. If a patient knows that she is obese or overweight then she should try and control her weight. A 15 percent weight loss can also help and aid in conceiving without any treatment or medication. Women having PCOD, if they manage their weight well, may not need any medications to conceive and can sail smoothly during pregnancy. Exercises especially aerobics, brisk walking as well as aqua workouts, are among many options from which the beginners can chose, especially which has a lower impact and yield better results soon. Give up all the vices. Smoking and drinking along with weight issues can come in the way of a healthy pregnancy and conception. Pregnant mother who has any of these vices are advised to give it up soon for the sake of a healthy pregnancy (Sirimi & Goulis, 2010).

Eat a balanced diet. Pregnant women should not miss out her breakfast, lunch and dinner and include two snacks in between meals. Reduce having food or even drinks which contains high levels of sugar as well as fat. Fruits along with green vegetables as well as salads should be eaten.

If an obese pregnant woman has tried everything and followed her weight loss regimen and diet alterations with discipline, visit an IVF specialist to check on her health status and chances of getting pregnant. Though obesity can come in the way of personal conception, a pregnant lady should not forget that partner’s health status is equally important while planning for pregnancy. If the other partner also suffers from same predicament as the obese pregnant woman— being overweight, ask to exercise and lose weight, consult a specialist as well as follow a regular lifestyle changes to improve the chances of getting pregnant (Nhs.uk, 2015).  

Pregnancy is a physiological burden in the child bearing age of a woman and obesity in pregnancy becomes a challenging task on the part of the patient herself as well as the members of the family to the nutrition expert, anesthesiologist and the obstetrician. The health related complications can be disastrous and lead to escalating medical expenses. It is advisable to eat a balanced diet which may help a woman to prevent excess gain in weight. Eating healthy food and doing regular exercise before conceiving should be continued during pregnancy. Great efforts should be made to attain normal weight within a year of delivery which helps prevent long term weight gain as a result of the pregnancy. 

References

Dutta, D. & Konar, H., 1998. Text book of obstetrics. Calcutta, India: New Central Book Agency Ltd.

Acog.org, (2015). The American Congress of Obstetricians and Gynecologists – ACOG. [online] Available at: https://www.acog.org [Accessed 10 Jan. 2015].

Nhs.uk, (2015). NHS Choices – Your health, your choices. [online] Available at: https://www.nhs.uk [Accessed 10 Jan. 2015]

Barbeiri, Robert L., 1977. Harrison’s Principle of Internal Medicine. Harvard Medical School.

Repke, John T., 1978. Harrison’s Principle of Internal medicine. New York Medical College.

Padubidri, Padubidri Vg, 2008. Hawkins & Bourne Shaw’s Text Book of Gynaecology. Elsevier India. ISBN 8131211312, 9788131211311, pp – 1-483.

The health site, (2015). High-fat diet not good in pregnancy. [online] Available at: https://www.thehealthsite.com/news/high-fat-diet-not-good-in-pregnancy/ [Accessed 11 Jan. 2015].

Sirimi, N. & Goulis, D. (2010). Obesity in pregnancy. HJ, 9(4), pp.299-306.