Weight Management in Pregnancy

Abstract

If addressing weight issues in the general population has proved vexing for medical care providers, addressing obesity in the obstetric population is even more so. The obstetrician is faced with a paradoxical situation: treat a person who needs to lose weight while in a condition in which she is expected to gain weight. How does an obstetrician bridge this conflict? This article reviews what is—and is not—known about weight management during pregnancy with particular emphasis on the overweight or obese patient in an attempt to address the gap between typical and ideal practices. In addition, we identify discrete actions the care provider can take to assist the pregnant patient identified with a preexisting weight problem. No one needs to be told that obesity is a problem worldwide; within the United States, the statistics are clear. Up to one-third of all females in the United States are obese,1 and obesity is so prevalent that currently only one state— Colorado—has an obesity prevalence rate of less than 20%.2 The obstetrical population reflects this sad state as well, with 40% of all women entering pregnancy obese or overweight.2 Most lay people are aware that obesity is a risk factor for diabetes, hypertension, and cardiovascular disorders, but what is less known to the general population is the potential impact of obesity on pregnancy. Obesity itself confers an increased risk for a host of adverse outcomes that not only extend to the antepartum or intrapartum time periods but can impact the lifelong health of the fetus grown in an obesogenic environment. Table 1 lists the risks that have been associated with obesity and pregnancy.1,3-5 Accompanying the increased risk of cesarean deliveries, obesity also confers an increased risk for blood loss, anesthesia complications (failed epidural, failed/difficult intubation), and wound breakdown/infection. Without interval weight loss between pregnancies, there is a lower chance for a successful vaginal birth after cesarean. Congenital anomalies that have been associated with obesity include open neural tube defects, cardiac, and musculoskeletal anomalies. Thus, obesity is not just a social issue but also a distinct medical problem that jeopardizes the health of both the patient and the fetus. Complicating the recommendations to patients are 2 distinct weight issues in pregnancy: the person’s prepregnancy weight, most commonly assessed in the context of body mass index (BMI), and the gestational weight gain (GWG) that occurs in pregnancy. Although it may be unclear which of the 2 has a more significant effect on adverse pregnancy outcomes, the one amenable to manipulation in pregnancy is GWG.