Women who have a BMI exceeding 30 are classed as extremely overweight or obese. Such women face a number of problems relating to pregnancy. It affects fertility and they find it hard to conceive. There is also a higher risk of preeclampsia, hypertension, gestational diabetes and sleep apnea among pregnant obese women. The child too may be affected with problems like birth defects, macrosomia etc. So, sufficient and timely care is needed during pregnancy and after delivery to ensure that both mother and child continue to enjoy good health.
According to statistics, the incidence of obesity is on the rise. Hence, there has been a proportional increase in the number of pregnant obese women. Obesity is measured by BMI or body mass index. It is defined as the weight per meter square of surface area and is obtained from the height and weight of an individual.
Obesity is becoming more and more common in pregnant women. According to several studies, the proportion of obese women among the pregnant women in USA range from 18.5% to 38.3%. Hence it is necessary to understand the risks posed by obesity during pregnancy and the level of care required to deal with these complications.
The risks for pregnant obese women
Obesity in pregnant women poses risk both towards the mother and the child. First of all, the incidence of infertility is higher among obese women. Even if they do manage to conceive, the risk of miscarriage and stillbirth are higher. For these reason, obese women who are planning to get pregnant, should first try to lose weight before planning a pregnancy.
The risks faced by the mother are as follows:
- Obese pregnant women often develop carbohydrate intolerance which leads to gestational diabetes with its own risks and complications.
- They are also far more likely to develop hypertension because of the hemodynamic changes brought about by hormonal changes. Studies show that obese women are 2.2 to 21.4 times more likely to get hypertension than the rest of the pregnant population.
- The above two conditions developing together give rise to preeclampsia – a condition that occurs 1.22 to 9.7 times more in obese mothers compared to the rest.
- Obese moms are also at greater risk of different types of infections like urinary tract infection and post partum infections some of which can be communicated to the baby.
- Obstructive sleep apnea is also more common among obese pregnant women.
- There is also a risk of developing a serious condition called thrombosis where a blood clot forms in the vein. In certain situation, this may prove to be fatal.
- Difficult surgical access, preterm delivery, hemorrhage, difficulty in administering anesthesia, Csection etc are other common complications faced by obese mothers. Obstructions of normal delivery, failed induction of labor, preterm births are also noted. Depression is common in obese pregnant mothers.
The babies of obese mothers are also at considerable health risks. These are as follows:
- They are more likely to develop macrosomia. This is a too large baby. They have a higher proportion of body fat and are more likely to develop childhood obesity.
- This leads to greater possibility of injury during birth including shoulder dystocia.
- The baby has a higher risk of developing chronic conditions like heart problems or diabetes later in life.
- Rate of congenital abnormalities are higher in babies born to obese mothers. Such abnormalities include communicative disorders, neural tube defects. There is also increased chance of dental asymmetry in the babies and cryptomorphism in case of male infants.
Care for pregnant obese women before delivery
The above risk factors clearly demonstrate that obese women require special care and counseling when they become pregnant. The steps for preterm care are as follows:
- Counseling should start before conception because many obese women suffer from infertility, miscarriage and stillbirth. So, they should be guided by proper dietitian to reduce weight. Weight loss surgery and gastric banding has also proven to be beneficial, but you may be asked not to try for a baby at least for a year after the surgery. Also, you should not diet while you are pregnant and any exercise during this time should be taken under medical supervision.
- Since there is a high risk of the babies of obese mothers for developing neural tube defects, pregnant obese women should receive high dose of folic acid supplements. However, there is no guarantee that this would be able to prevent neural tube disorder.
- The weight gain during pregnancy for obese women should be monitored more closely, though there is difference of opinion about this issue. Studies show that there is probably little relation between gestational weight gain in obese mothers and the gain in birth weight of the infant. But, high weight gain has been definitely related to macrosomia. So, maternal weight gain should be strictly monitored.
- Maternal blood pressure should be regularly monitored because pregnant obese women are at higher risk of developing hypertension.
- In addition to normal glucose test, periodic screening for gestational; diabetes should be done in pregnant obese women who are at higher risk of this condition.
- Above all, pregnant obese women require proper counseling in order to deliver a healthy infant.
Care for pregnant obese women during delivery
Several observations show that pregnant obese women may face difficulty during delivery. Macrosomia in infants are common, which leads to difficult labor. Sometimes, labor may be overdue and it may have to be induced. Delivery by C-section is more common in obese women. Even in that situation, there are several problems. For example, intubation and administration of anesthesia is more difficult in obese women. There is also difficulty in surgical access.
The best care for pregnant obese women during delivery is to ensure that it takes place in a hospital. Home births are not recommended for obese mothers. Several complications may develop both with the mother and the child. So, a
multidisciplinary medical team needs to be at hand. Continuous electronic fetal heart rate monitoring is also done.
There is also a higher risk of severe post partum hemorrhage and adequate preparation should be taken to intervene whenever necessary.
Care for pregnant obese women after delivery
Follow up care is essential after delivery in cases of obese mothers. Some of the steps are as follows:
- The maternal respiratory rate should be monitored closely for signs of sleep apnea or difficulty breathing, especially if anesthesia had been used.
- There is a high chance of thrombosis. So, adequate thromboprophylaxis measures are necessary. Anticoagulants should be given in strictly monitored doses while use of compression stockings may be considered.
- Obese women have a higher risk of post partum infection. So, the clinical signs should be monitored carefully and the doses of prophylactic antibiotics should be accordingly adjusted.
- It is necessary for the obstetrician to coordinate with the GP of the obese pregnant women to carry on the delivery of post partum care.
- Infertility is common in obese women. So, if you have undergone hormonal treatment, screening should be done immediately after birth for venous thromboembolism.
- If you have developed gestational diabetes, you should go for a glucose test six weeks after birth and then once every three years. You should be screened for Type II diabetes.
- Obese mothers should be encouraged to breastfeed. Such mothers often avoid breastfeeding due to social and psychological reasons, but their breast milk is necessary for the infant who has also suffered from maternal obesity.
Above all, lifestyle modification, proper diet and strict medical care can help most obese mothers. It must be remembered that obesity is probably a sensitive issue with the woman and there is a higher risk of depression in such women. So, doctors should take care that all counseling and discussions regarding obesity and childbearing should be done in a respectful way so that the woman is encouraged to live in the healthiest way possible.