Obesity and Pregnancy

“There is no better feeling than movement of life inside you”. Pregnancy is one of the most beautiful and yet the most difficult period of a woman’s life. Every woman wishes for a pregnancy that is smooth and uneventful. A beautiful healthy baby delivered normally, is what all of us hope for. As someone has rightly said, a baby fills a place in your heart that you never knew was empty.

As a bariatric surgeon and a weight loss expert, I see many obese women who are in the reproductive age group. As a practice, we always encourage these women to lose weight before planning a pregnancy. Pre-pregnancy obesity tends to bring about a host of complications during pregnancy. Some of these issues are discussed below in brief:

1. Pregnant women who are obese tend to have a higher rate of pregnancy induced high blood pressure (PIH) and pre-eclampsia. Pre-eclampsia is characterized by high blood pressure, protein the urine and swelling of hands and feet. In severe cases, pre-eclampsia may lead to growth restriction of the fetus, convulsions, pre-term labour, HELLP syndrome, heart problems and other organ damage.
2. Pregnant women who are obese are also prone to developing gestational diabetes. This may also pre-dispose them to developing type 2 diabetes in future.
3. There is also a higher rate of fetal defects in obese mothers. These birth defects in the baby may include, neural tube defects, spina bifida, heart problems, cleft lip and palate etc.
4. Obese women are also more prone to get a caesarean section as compared to normal weight women. This leads to a longer duration of stay in the hospital and a higher overall healthcare expenditure.
5. Obese women are also less prone to breastfeed their babies. Even if they do so, they do it for a much shorter duration as compared to normal weight women. Causes are multifactorial. Sometimes they may be due to issues with body image and at other times it could be due to decreased milk production.

So, yes, it is absolutely important to lose weight before you conceive. While diet and lifestyle modification are necessary, women who suffer from clinically severe obesity (BMI more than 37.5 kg/m²) must consider bariatric surgery as a weight loss option. Weight loss via bariatric surgery/ weight loss surgery, has been seen to decrease many pregnancy related complications in obese women. Surgery induced weight loss decreases the chances of developing, gestational diabetes, high blood pressure, pre-eclampsia and fetal macrosomia. Post weight loss, the chances of having a normal delivery increase. Women are also more inclined to breast feed their babies.

Weight loss also gives the gift of life to the baby. Babies of mothers who deliver after weight loss, have a much lower chance of developing obesity and type 2 diabetes in future.

However, it is important to note that women who undergo bariatric surgery/weight loss surgery must push the pregnancy behind by one year. First year after surgery is a period of active weight loss and the baby may not get enough nutrition during this phase. It is also important to have a complete health check up before planning a pregnancy to rule out any kind of nutritional deficiencies. I advise all my patients to connect me to their gynaecologist so that she/he is also in sync.

So as you look forward to adding an angel to your family, please ensure that you take care of your health first. A woman is the pillar of the family and a healthy mother will almost always deliver a healthy baby! So, wish you all the best on this beautiful journey.

With lots of love,

Dr. Aparna Govil Bhasker

References:

Kulie T, Slattengren A, Redmer J, Counts H, Eglash A, Schrager S. Obesity and women’s health: an evidence-based review. J Am Board Fam Med. 2011 Jan-Feb;24(1):75-85.