Obesity Increasing Among Pregnant Women In U.S., New York Times Reports

Main Category: Pregnancy / Obstetrics
Also Included In: Obesity / Weight Loss / Fitness
Article Date: 16 Jul 2008 - 7:00 PDT

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One in five women who gives birth in the U.S. is obese, and physicians are seeing a greater number of pregnant women who are morbidly obese -- weighing 400, 500 or 600 pounds -- the New York Times reports. According to the Times, excess weight can cause obese women to have riskier pregnancies, because they are more likely to develop hypertension and diabetes, as well as to deliver prematurely.

The need to manage this group's conditions and meet its logistical needs is giving rise to a new medical subspecialty, which some have named "bariatric obstetrics," according to the Times. Mark Chames -- an obstetrician at the University of Michigan Health System who treats at least one dozen morbidly obese pregnant women monthly -- will head the hospital's new Center for Bariatric Obese Care when it opens later this summer. According to Chames, the challenges of caring for these patients begin early. "We perform an anatomical survey of the fetus, but in an extremely obese woman, the ultrasound signal often can't penetrate through all the tissue," Chames said, adding that in these cases, a vaginal probe is used instead. Chames said that because obese women are at a greater risk of having infants with neural-tube defects and other malformations, thorough examinations are critical.

Furthermore, obese women encounter more difficulties during labor. Their fetuses often are too large to fit through the birth canal, which often results in caesarean sections. Longer surgical instruments also are required, as are extra-wide operating room tables, which are reinforced to support hundreds of additional pounds.

According to the Times, patients at the bariatric obstetric clinic at St. Louis University are counseled not to gain any weight during pregnancy and are even encouraged to lose weight. Raul Artal, chair of the ob-gyn department and the clinic's director, said that asking women to lose weight during pregnancy "goes against everything we were taught in medical school, everything we've always told our patients." Some scientists warn that little is known about the potential dangers to this approach, but emerging evidence suggests that obese women who maintain or lose weight during pregnancy experience fewer complications and deliver healthier infants. Artal and other obstetricians also say that official recommendations on weight gain during pregnancy -- which currently advise obese women to put on at least 15 pounds -- need to change, because the guidelines were issued by the Institute of Medicine in 1990, when low-birthweight infants, rather than obesity, were considered to be of greater concern. According to the Times, a panel of experts has begun meeting to review the recommendations, which would pertain to all pregnant women. Studies have shown that many women in the U.S. put on more weight than what guidelines suggest, which they do not lose after delivery, and that the intrauterine environment provided by an obese woman makes it more likely that the fetus will grow up to be overweight later in life. "Pregnancy is itself a major contributor to the obesity epidemic," Artal said (Paul, New York Times, 7/13).

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