It is recommended by ACOG (the American College of OB/GYNs) that obstetricians provide education to pregnant women about the potential complications associated with pregnancy and an elevated Body Mass Index (BMI). BMI is a measure of body fat based on your weight in relation to your height and is a screening tool to assess whether a person is underweight, normal weight, overweight or obese.
The World Health Organization and the National Institutes of Health define normal weight as a body mass index (BMI) of 18.5-24.9, overweight as a BMI of 25-29.9, and obesity as a BMI of 30 or greater. The prevalence of obesity in the United States has increased dramatically over the past 20 years. One-third of adult women are obese.
A BMI of greater than 30 during pregnancy places the patient in a high-risk category. For instance, the risk of stillbirth is 6-fold higher at 39 weeks and 13 times higher at 41 weeks. The following are additional examples of increased risks/complications which occur in these patients:
- Increased c-sections
- Increased miscarriages
- Increased birth defects
- High blood pressure/ preeclampsia
- Preterm delivery
- Larger infants that can result in trauma to mother and infant during delivery
- Complications after delivery like infection, hemorrhage, clotting problems, wound problems
- Complications with the flu and other illnesses
- Problems with anesthesia
- Doctors and nurses can’t monitor the pregnancy and labor well
- Ultrasounds can’t see the baby well which results in poor predictions of baby’s weight
- The baby’s heart rate and uterine contractions are very difficult to monitor
- C-sections take much longer and are more complicated
Unfortunately, there is currently nothing that can be done during pregnancy, labor, and delivery that has been proven to decrease the above complications. Pregnancy is not the ideal time to try to lose weight. The recommended weight gain during pregnancy for patients with a BMI greater than 30 is 11 to 20 lbs. Patients who gain a lot of weight during pregnancy increase the risks listed above.
It is recommended that following pregnancy, everyone with a BMI greater than 30 begin a weight reduction program, including diet, exercise, and behavior modification. We encourage you to talk with your Primary Care Physician regarding lifestyle changes associated with these recommendations. Please ask us during pregnancy what your calculated BMI is you can know if you are at risk. Talk to Dr. Walker and Dr. Shakespeare if you have any questions regarding anything discussed in this section.