Washington, DC— Alarmingly, more than half of all women of reproductive age in the United States are overweight or obese. In fact, obesity is the most common health care problem in women of reproductive age and the risks associated with obesity and pregnancy are significant. Management of these issues are challenging, relative to optimal weight gain, caring for obesity-related complications and postpartum weight control concerns. Today, as part of an ongoing effort to address the obesity epidemic and care for patients, the American College of Obstetricians and Gynecologists (ACOG) issued new recommendations focusing on obesity in pregnancy and physical activity during pregnancy and the postpartum period. Fighting obesity is also part of the ACOG Presidential Task Force
set forth by Mark S. DeFrancesco MD, MBA, President of the College.
According to the new Practice Bulletin, "Obesity in Pregnancy
," the possible complications associated with obesity and pregnancy are extensive for both mother and fetus. Obesity is associated with an increased risk of miscarriage, premature birth, stillbirth and having a baby with a birth defect. Obese pregnant women are at an increased risk of cardiac problems, sleep apnea, gestational diabetes, preeclampsia and venous thromboembolism (VTE), or blood clotting in the veins. The cesarean delivery rate is also higher for obese women, and cesareans pose greater dangers for obese women than for normal-weight women because of increased risks associated with anesthesia, excessive blood loss, blood clots and infection at the incision site. Moreover, the negative impacts on the fetus are long-term: obesity in pregnancy may cause the newborn to have a medically complicated life, because the fetus is directly impacted by maternal obesity.
The optimal control of obesity begins before conception. For obese women, even small weight reductions prior to pregnancy may improve outcomes. "Maintaining a healthy weight is important to overall health at all times, but it becomes a vital sign when a woman is pregnant or planning a pregnancy," stated Patrick M. Catalano, MD, who helped develop the guidelines. "Ob-gyns are often the only physician women see on a regular basis, therefore we are in the optimal position to help educate women on the importance of fighting obesity."
The revised Committee Opinion, "Physical Activity and Exercise During Pregnancy and the Postpartum Period
," advises physicians to encourage their patients to maintain or adopt a healthy lifestyle before, during and beyond pregnancy. The most common risk of obesity in pregnancy is gestational diabetes. Exercise and judicious weight control in obese and overweight pregnant women help to prevent gestational diabetes and improve pregnancy outcomes. Exercise may also reduce the risk of preeclampsia and cesarean deliveries. The Committee Opinion offers more specific examples of safe physical activities during pregnancy, like modified yoga and Pilates, strength training, and running or jogging.
"Pregnancy should not be looked at as a state of confinement," stated Raul Artal, MD, the main author of the Committee Opinion. "In fact, it is an ideal time for lifestyle modification. That is because more than any other time in her life, a pregnant woman has the most available access to medical care and supervision." Dr. Artal is a member of a Medical Commission of the International Olympic Committee. The group is currently drafting guidelines for exercise in pregnancy and the postpartum period for elite Olympic athletes.
Practice Bulletin #156, "Obesity in Pregnancy," and Committee Opinion #650, "Physical Activity and Exercise During Pregnancy and the Postpartum Period," are published in the December issue of Obstetrics & Gynecology.