Thursday, April 8, 2010 at 10:02 AM
Women are supposed to gain weight when they get pregnant but almost half are overweight or even obese at the very start of the their pregnancy (Kaiser Center for Health Research). The extra weight poses health risks for mother and baby yet many women don't realize it because being overweight is so common these days. In this installment of our special series…Fighting Fat…ideastream assistant producer Kathryn Baker prepared this report on how doctors are getting much more blunt when talking to patients.
GYVES: We are seeing more and more obesity in our pregnant women. It is something that we just accept as common place now. We don't even bat an eye when we see somebody who weights over 250 pounds.
Dr. Michael Gyves is an obstetrician at University Hospitals. He says the risks for both mother and baby are plenty.
GYVES: They are at increased risk for high blood pressure, gestational diabetes, also an increased risk for shoulder distortia which is a condition in which the head delivers and then the shoulders get stuck. Significantly greater risk for having to be delivered by caesarian and when they have caesarians, there tends to be greater blood loss, the surgery takes longer, they are at greater risk for developing infection.
Gyves said you need not weight 300 pounds to be categorized as overweight or obese and some women don't recognize the risks associated with carrying extra weight. He spoke candidly with one new mother.
GYVES: OK so you have what we call gestational diabetes. Gestational diabetes is something that's brought on by pregnancy. Now there's another thing that contributes to developing diabetes and that is weight. Now how tall are you?
GYVES: Before you got pregnant you were close to 200 pounds, 190-something is that right?
GYVES: Now that is a significantly high weight for somebody who is 5'2 inches tall. Have you given any thought to losing some weight?
GYVES: If we look at the numbers you actually fit into the category that we call morbidly obese.
Gyves said these tough conversations are essential so the mother understands the risks and may get more engaged in her health.
GYVES: I would say generally the women I've talked to have been receptive to my discussion, particularly since we relate it to medical issues. Often times I bring this up because the woman has already developed a medical complication such as high blood pressure or diabetes.
Last May the Institute of Medicine which is the health arm of the National Academy of Sciences addressed the issue by outlining new guidelines for weight gain during pregnancy. The report advises obese women gain no more than 20 pounds - the first time the Institute has set a limit. Dr. Patrick Catalano, an obstetrician at MetroHealth Medical Center, co-wrote the new guidelines. He says it's not uncommon for obese women to gain more during pregnancy.
CATALANO: You know having to make sure you have the right kind of equipment available whether it's a wheelchair, whether it's an operating room table even because of the increased risk of caesarian delivery, having the right type of instruments.
Dr. Susan Dumas an anesthesiologist at University Hospitals said it's also more difficult to administer an epidural for pain relief in obese women.
DUMAS: One needle is 10 cm long and another needle which is 20cm long which we often will take out if a patient is larger.
An emergency C-section for an obese woman can be complicated. If they don't get an epidural in quickly they may have to put the woman to sleep and it's much more difficult to put a breathing tube in for someone overweight or obese. Obesity can also have a negative affect on breast feeding. Again, Dr. Patrick Catalano of MetroHealth.
CATALANO: If you are a heavy person, how do you get the baby on the breast and those kind of mechanical issues. Statistically obese women tend to breast feed less than women who are not obese but we try to encourage them to because they have the potential to gain the most out of it.
The best way to reduce the health risks associated with pregnant women and their babies would be to control obesity before getting pregnant. Of course, that's a lot easier said than done.
Kathryn Baker 90.3