Pregnancy and Obesity
The usual definition of obesity is the body weight increase above the standard on height. In this context, the increase of adipose tissue occurs in the body. It is more common in women. The most important reason for the increase in this frequency is the weight gained before pregnancy, during the breastfeeding period. Frequency of obesity; environmental conditions may vary with genetic trend and socioeconomic differences. Obesity is generally related to cardiovascular diseases, hypertension, diabetes, respiratory problems, joint problems, and even some types of cancer. Obesity seen before and during pregnancy may progress with complications related to both mother and baby.
Adequate and balanced nutrition during pregnancy is very important for the physical and mental development of the fetus in the womb. Perception of the importance of this issue begins with the need to make weight regulation before pregnancy.
The relationship between height and weight mentioned in the definition of obesity is defined as body mass index (BMI; body mass index). The rate of obesity in women between the ages of 20 and 40 is between 20-35%. Severe forms of obesity are also increasing in women of childbearing age.
Mother’s risks in obesity
* Glucose metabolism disorders:
We know that the placenta increases the carbohydrate rate that goes to the baby during pregnancy and creates physiological support for the baby’s weight flow. It regulates this through the human placenta lactogen hormone. In women who started pregnancy with high weight and / or gained excess weight during pregnancy, glucose metabolism is more frequently impaired than candidates with normal weight.
Gestational diabetes, known as pregnancy diabetes, may be encountered more frequently in obese women, and this group should be evaluated with fasting blood glucose in the early period of pregnancy, and it should be evaluated with a 100 g glucose load test until 28 weeks at the latest in pregnancy. There are also publications suggesting that the loading test be done around 12 weeks and then between 24-28 weeks. Usually, a single loading test between 22-28 weeks is used and sufficient. However, in obese women who have a diabetic relative in the family history, who have had a pregnancy diabetes over 35 years old, or who gave birth to 4000 gr baby, it can be loaded in earlier weeks.
Increased tendency to hypertension in women with gestational diabetes. Since large baby inclination over 4000 gr also increases, vaginal delivery difficulties, non-progressive delivery action, and the frequency of wearing the shoulder of the baby at birth increase. On the contrary, the incidence of low-weight babies has also increased. Expressing excessive increase of amniotic fluid, polyhydramnios is more common in pregnancy diabetes. In diabetic pregnancies, ”fetal distress” develops more frequently in the womb and during birth and requires close monitoring.
The frequency of developing type 2 diabetes also increases in obese women who develop gestational diabetes.
In this group, nutritionist support, if necessary, endocrinologist consultation, regular blood sugar monitoring and regular walking are recommended.
Apart from these, ovulation problems are seen more frequently due to the negative effects of obesity on insulin sensitivity and there may be some difficulties in getting pregnant.
* Hypertensive diseases of pregnancy:
When obese pregnancies are compared to normal weight pregnancies, the risk of hypertension increases significantly. In this context, when pregnancy is added to the existing mild hypertension, the picture may get worse or pregnancy hypertension may occur if there is no hypertension before. Preeclampsia and eclampsia cases also increase in obese women.
In any form, hypertension complicates pregnancy. Since the blood flow from the placenta to the baby may decrease, growth restriction may develop in the fetus. There may be bleeding behind the placenta (placental detachment), which is a life-threatening emergency for both the fetus and the mother. In pre-eclampsia and eclampsia, the liver, kidney and brain may be affected and the baby may be under stress again.
The ideal is to try to lose as much weight as possible before pregnancy. In pregnancy, regular blood pressure monitoring, trying to stay away from stressful situations and environments, salt restriction and weight gain are the necessary measures to control. When hypertension is detected during pregnancy, the amount of amniotic fluid in the fetus should be closely monitored by doppler analysis and non-stress test.
* Weight gain during pregnancy:
When compared to normal weight pregnancies, mothers with obesity gain less weight during pregnancy. One study found that 32% of obese women gained an average of 5.5 kilos. This may reduce the risks for hypertension and diabetes, but may increase the likelihood of growth restriction of the fetus due to the possibility of malnutrition. However, if the woman is eating well and regularly and avoids fat and carbohydrates, fetal growth will not be affected much.
* Difficult and traumatic labour:
In obese women who develop glucose metabolism disorders, if a large baby has developed, it may be faced with non-progressive labour, difficult birth, and wearing the shoulder of the baby. Cesarean requirement is increased 1-3 times in women with obesity. In the case of Caesarean, there are wound healing difficulties, wound infection, fat necrosis and increased risk of embolism.
Anti-embolism socks should definitely be worn when caesarean is required and heparin should be used until it becomes mobile.
Urinary tract infection may be more common in obese women during pregnancy. It can be easily diagnosed by performing a complete urine analysis and, if necessary, a urine culture. Urinary tract infections should be attempted to be recognized without turning into kidney infections or creating a threat of preterm labour. However, since urinary tract infections without symptoms that we call “asymptomatic bacteriuria” during pregnancy are common, the diagnosis may not always be made early. As a result, when the diagnosis of infection is established, the problem can be solved by selecting antibiotics suitable for use in pregnancy by studying the antibiogram.
The possibility of wound infection with increased wounds in the caesarean necessity is also among the problems of this group.
* Thromboembolic diseases:
Thromboembolic diseases are more common in pregnancy, both with the effect of obesity and with the increase in physiological thrombotic tendency caused by the nature of pregnancy. The use of heparin can be discussed if the family has a history of intense embolism, if the woman has had a thromboembolic event, or if tests are found necessary. However, obesity alone is not enough reason for heparin use. Leading an active life and taking additional measures such as varicose anti-embolism stockings and heparin use, if cesarean is required, can reduce risks.
Risks of fetus in obesity
In obese mothers, especially if there is glucose metabolism disorder, the large baby develops more frequently, which brings with it the risk of difficult labour, non-progressive labour and shoulder snagging. The possibility of large baby appears to have increased 1.4-18 times in obesity. Increased subcutaneous thickness of babies suggests that the underlying cause of fat size is excessive fatty tissue.
There are also publications stating that apgar scores may be lower in fetus at the birth of obese mothers. This rate may be related to difficult births in obesity. Again, with regard to birth traumas, infant mortality rates appear to have increased partially during and immediately after birth.
If obesity is related to pre-existing and undiagnosed diabetes in the expectant mother, the rate of some anomalies increases in case of pregnancy in the mother whose blood glucose levels are high. An example of this is the increase in the frequency of neural tube defects and heart anomalies.
How much weight should we gain during pregnancy?
Weight gain during pregnancy is an absolute must for the healthy development of the baby. However, the average gain should be considered in ideal and a diet and exercise should be adjusted accordingly.
In pregnant women who gain weight under 6 kilograms during pregnancy, growth restriction is more common in the fetus.
It is an ideal way not to exceed 1-2 kilograms in total during the first 3 months of pregnancy as much as possible and then limit the weekly weight gain to 300-500 grams. In obese women, gaining a total of 6-7 kilos during pregnancy and trying not to exceed this limit will help reduce the likelihood of problems.
Weight gain does not only indicate fat intake. Increased blood volume, amniotic fluid, placenta growing breasts and baby’s weight will also take place naturally in the increase.
For women who start pregnancy at normal weight, the average weight gain should be between 10-14 kilograms.
Of course, the ideal is to solve this problem before pregnancy in the presence of obesity. However, when obesity is present, complications can be tried to be reduced under the control of a nutritionist. Even 5% of the weight, accompanied by a balanced nutrition program before pregnancy and exercise, will contribute to reducing the risks of mother and baby. However, for this purpose, excessively limited nutrition, heavy exercise and short-term programs will bring more harm than good.
Even if she is obese, the loss of weight of the pregnant woman after the 4th month with strict diet programs is never suitable for the nature of pregnancy. The woman can stop weight gain by eating very balanced and adequate nutrition, however, reducing the diet for weight loss can negatively affect the feeding of the fetus.