Pregnancy, or the desire to become pregnant, often inspires women to take better care of themselves – quitting smoking, for example, or eating more nutritiously.
But now many women face an increasingly common problem: obesity, which affects 36 percent of women of childbearing age. In addition to hindering conception, obesity – defined as a body mass index above 30 – is linked to a host of difficulties during pregnancy, labor and delivery.
These range from gestational diabetes, hypertension and pre-eclampsia to miscarriage, premature birth, emergency cesarean delivery and stillbirth.
The infants of obese women are more likely to have congenital defects, and they are at greater risk of dying at or soon after birth. Babies who survive are more likely to develop hypertension and obesity as adults.
To be sure, most babies born to overweight and obese women are healthy. Yet a recently published analysis of 38 studies found that even modest increases in a woman’s pre-pregnancy weight raised the risks of fetal death, stillbirth and infant death.
Personal biases and concerns about professional liability lead some obstetricians to avoid obese patients. But Dr. Sigal Klipstein, chairwoman of the committee on ethics of the American College of Obstetricians and Gynecologists, says it is time for doctors to push aside prejudice and fear. They must take more positive steps to treat obese women who are pregnant or want to become pregnant.
Klipstein and her colleagues recently issued a report on ethical issues in caring for obese women. Obesity is commonly viewed as a personal failing that can be prevented or reversed through motivation and willpower. But the facts suggest otherwise.
Although some people manage to shed as much as 100 pounds and keep them off without surgery, many obese patients say they’ve tried everything, and nothing has worked. “Most obese women are not intentionally overeating or eating the wrong foods,” Klipstein said. “Obstetricians should address the problem, not abandon patients because they think they’re doing something wrong.”
Obese patients should be cared for “in a nonjudgmental manner,” it says, adding that it is unethical for doctors to refuse care within the scope of their expertise “solely because the patient is obese.”
Limiting weight gain
Weight loss is best attempted before a pregnancy. An obese woman who becomes pregnant should aim to gain less weight than would a normal-weight woman. Although women should not to try to lose weight during pregnancy, “a woman who weighs 300 pounds shouldn’t gain at all,” Klipstein said.
Klipstein also noted that obesity can cause physiological changes that can negatively affect pregnancy, starting with irregular ovulation that can result in infertility.
Obese women are more likely to have problems processing blood sugar, which raises the risk of birth defects and miscarriage. There is also a greater likelihood that their babies will be too large for vaginal delivery, necessitating a cesarean delivery that has its own risks involving anesthesia and surgery.
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