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28 December 2011
When obesity and pregnancy collide

While women can have a successful pregnancy at any size, they need to understand the challenges that their weight will create, warns an article in the journal Seminars in Perinatology. In the article, University of Rochester maternal fetal medicine expert Loralei L. Thornburg highlights some expected - and some surprising - issues to take into account before, during and after pregnancy.

Thornburg says that vitamin deficiency is one of the biggest issues that larger women face in pregnancy, noting that 40 percent are deficient in iron, 24 percent in folic acid and 4 percent in B12. This is a concern because certain vitamins, like folic acid, are very important before conception, lowering the risk of cardiac problems and spinal defects in newborns. Other vitamins, such as calcium and iron, are needed throughout pregnancy to help babies grow.

Thornburg stresses that vitamin deficiency is to do with the quality of the diet, not the quantity. "Obese women tend to stray away from fortified cereals, fruits and vegetables, and eat more processed foods that are high in calories but low in nutritional value. Women also need to be sure they are taking vitamins containing folic acid before and during pregnancy."

The article also notes that obese women with excessive weight gain during pregnancy have a very high risk of complications, including indicated preterm birth, cesarean delivery, failed labor induction, large-for-gestational-age infants and infants with low blood sugar. "If a woman starts her pregnancy overweight or obese, not gaining a lot of weight can actually improve the likelihood of a healthy pregnancy," Thornburg points out.

Paradoxically, the risk of spontaneous preterm birth - when a woman goes into labor for an unknown reason - is actually 20 percent lower in obese than non-obese women. There is no established explanation for why this is the case, but Thornburg says current thinking suggests that this is probably related to hormone changes in obese women that may decrease the risk of spontaneous preterm birth. She adds that obese women have a greater likelihood of indicated preterm birth - early delivery for a medical reason, such as maternal diabetes or high blood pressure.

Obese women also have increased rates of respiratory complications, and up to 30 percent experience an exacerbation of their asthma during pregnancy, a risk almost one-and-a-half times more than non-obese women. According to Thornburg, respiratory complications represent just one piece of the puzzle that adds to poor health in obesity, which increases the likelihood of problems in pregnancy.

Finally, the article notes that breast breastfeeding rates are low among obese women, with only 80 percent initiating and less than 50 percent continuing beyond six months, even though it is associated with less postpartum weight retention and should be encouraged as it benefits the health of both mother and baby. Thornburg acknowledges that it can be challenging for obese women to breast feed. It often takes longer for their milk to come in and they can have lower production (breast size has nothing to do with the amount of milk produced). "Mothers need to be educated, motivated and work with their doctors, nurses and lactation professionals to give breast feeding their best shot. Even if you can only do partial breastfeeding, that is still better than no breastfeeding," she concluded.

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Source: University of Rochester Medical Center

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