Weight guides for pregnant women
The 2009 guidelines from the Institute of Medicine update those made in 1990 and reflect changing U.S. demographics, particularly the surge in the number of Americans who are overweight or obese.
Healthy women at a normal weight for their height (BMI of 18.5 to 24.9) should gain 25 to 35 pounds during pregnancy.
Underweight women (BMI less than 18.5) should gain more, 28 to 40 pounds.
Overweight women (BMI of 25 to 29.9) should gain less, 15 to 25 pounds.
Obese women (BMI greater than 30) should limit their gain to 11 to 20 pounds.
ABOUT THE BMI
Body Mass Index is based on a person's weight and height; for example, a 5-foot-6-inch woman weighing between 115 and 154 pounds has a normal BMI. Individuals can determine their BMI using the online calculator at www.nhlbisupport.com/bmi/ .
Source: Institute of Medicine
DAYTON — As Americans have grown in girth in recent decades, so has their awareness of the health risks for carrying those extra pounds. But now doctors are calling attention to the dangers obesity poses for those with no choice — the unborn.
Babies born to overweight mothers are at greater risk for birth defects, premature birth, stillbirth, infant death and diabetes and weight problems in childhood, according to The Institute of Medicine. The institute’s May 2009 report issued new pregnancy weight guidelines and urged doctors to advise women of childbearing age about the numerous risks of obesity to themselves and their babies.
“We try to counsel women in our clinic on nutrition and exercise before they are pregnant, because that’s the best time to lose weight,” said Dr. Shannon McAfee of Southview Hospital Women’s Center.
One-third of U.S. women are now obese, says the American Congress of Obstetrics and Gynecology. For non-Hispanic black women, the percentage is nearly half.
“Stillbirth is a big issue these patients don’t realize they’re at risk for,” McAfee said. “They also have a much higher rate of Caesarean sections.”
As the head of the prenatal diagnostic unit at Miami Valley Hospital, Dr. Jiri Sonek has seen dramatic strides in recent decades in the imaging technology for detecting fetal problems during pregnancy.
But at the same time, Sonek has seen those strides erased in many cases by the increasing number of obese pregnant women coming to the unit. “You have the need now to get equipment on the cutting edge because there are times when you have these 300-pound women where you can’t see anything (inside the womb) without it.”
With nearly two-thirds of American women of childbearing age either overweight or obese, doctors and hospitals say they have had to super-size their equipment, including examining tables and wheelchairs, and increase their vigilance in order to stem the many complications the extra weight can pose for both mother and baby.
“It would almost be a shorter interview to tell you what obesity doesn’t increase the risk for,” Sonek said. “It’s one of those problem issues from the beginning of the pregnancy to the end and even beyond delivery. You have to be much more on the alert.”
Obese mothers run a greater risk of developing dangerously high blood pressure and diabetes. They’re also more likely to undergo a C-section and to suffer complications afterward, Sonek said. Their babies face a higher chance of birth defects, premature birth, stillbirth and infant death as well as diabetes and weight problems in childhood.
The growth in the proportion of fatter Americans led the Institute of Medicine last May to update its guidelines on how much weight women should gain during pregnancy. The report also called on health care providers to help women achieve a healthy weight before and during their pregnancy.
“Expectant mothers and their care providers need to balance the benefits of pregnancy weight gain for the fetus with the risks of too much or too little increase, which can result in consequences for both mother and child,” the report said.
Sonek said the rise in obesity is raising the cost of maternal and fetal care because of the need for more C-sections, longer hospital stays and more diagnostic imaging.
“In the past, it would be very easy to measure the uterus and sort of judge from that how the baby is growing,” he said. “These days — again using the example of a 300-pound woman — you can’t even feel the uterus. You tend to do more ultrasounds to check on the growth of the fetus.”
Following delivery, doctors must be more careful in preventing leg clots in obese women and, in the case of C-sections, more vigilant in preventing infection of the incision under folds of extra flesh, he said.
All told, the combination of increased risks, reduced diagnostic capability and more intensive post-natal care for obese women “means we’re seeing more complications despite our best efforts to prevent them,” Sonek said.
Contact this reporter at (937) 225-2437 or jdebrosse@DaytonDailyNews.com.
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