Weight Gain and Obesity in Pregnancy
For this blog post, we turn to the pages of Contemporary OB/GYN magazine. Raul Artal, MD and Amy Flick, MD recently authored an article titled “Obesity and Weight Gain in Pregnancy” and it appeared on July 1, 2013. The authors note that pregnancy is a time for lifestyle modifications in obese patients. They also address several myths surrounding weight management and physical activity in pregnancy.
Myth: We need additional studies to demonstrate benefits and no adverse consequences of weight loss to the mother and/or fetus.
Fact: Studies are already available showing that additional weight gain is detrimental.
Myth: “Obligatory physiological changes” during pregnancy should result in a “net maternal gain” to reflect the products of conception and increases in the breasts, uterus, etc.
Fact: Overweight and obese women are able to generate the additional calories needed to sustain these changes from their own reserves.
The authors note that excessive or any weight gain in overweight and obese patients is detrimental to pregnancy outcome. The 2009 Institute of Medicine (IOM) guidelines modified the recommended weight gain in pregnant women with BMI of 30 and greater to between 11 and 20 lb. Research prior to these recommendations and since has shown that no weight gain, and in fact weight loss, is associated with decreased rates of preeclampsia, cesarean deliveries, large for gestational age (LGA), operative vaginal deliveries, low Apgar scores, and admissions to a neonatal intensive care unit.
Because of this, many authorities have advocated for lesser weight gain and even weight loss for patients in the upper tiers of obesity. In recognizing that modest weight gain and even weight loss in the presence of an adequately growing fetus is beneficial in obese patients, a recent committee opinion from the American College of Obstetricians and Gynecologists states: “For an obese pregnant woman who is gaining less weight than recommended but has an appropriately growing fetus, no evidence exists that encouraging increased weight gain to conform with the updated IOM guidelines will improve maternal or fetal outcomes.” Physical activity, weight maintenance, and even weight reduction have not proven harmful in obese pregnant patients according to studies in the recent literature.
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