OBESITY IN PREGNANCY.
Everyone knows that being overweight carries health risks. This is never more true than during pregnancy.
Although the majority of obese women will go on to have a normal pregnancy and birth, it is important to be aware of the risks and complications to you and your baby should you have a raised BMI at booking, and why you will receive extra care from health professionals
When you book with your midwife, you will be weighed and have your BMI (body mass index) calculated.
A healthy BMI is above 18.5 and less than 25.
If your BMI is below 18.5 you are considered to be underweight and will be offered growth scans to check the growth and well being of your baby during your pregnancy.
If your BMI is above 25 but below 30 you are considered overweight. If your BMI is above 30, you are considered obese. YOU ARE NOT ALONE. 20% of pregnant women have a BMI of 30 or above at the beginning of their pregnancy.
The higher the BMI - the greater the risks of complications for you and/or your baby!
Some of the risks for the obese pregnant woman includes:
- Gestational diabetes
- Thrombosis - a blood clot in your legs or lungs
Complications to your baby include,
- Increased risk of neural tube defects. (problems with the development of the baby's brain or spine)
- A large baby and the risks involved in that
- Your baby will have an increased risk of developing diabetes or becoming obese in later life.
The risks during labour and birth are also increased and may include:
- Premature labour
- A long labour
- Postpartum haemorrhage
- Increased chance of needing a caesarian section
- A difficult delivery including shoulder dystocia. (Where the baby's shoulder gets stuck under the symphysis pubis)
- A difficult caesarian section and a higher risk of a wound infection post partum
- Anaesthetic complications
If you are overweight, you will receive support and advice from the health professionals in charge of your care.
They will advise you on a healthy diet. You should not "eat for two", as this is incorrect and will lead you to put on excess weight during your pregnancy. In fact you do not require any additional calories during the first two trimesters and only 200 calories daily increase is needed during your final trimester - so a couple of pieces of fruit or vegetables should cover this.
It is not recommended that you embark on a new diet during pregnancy but you should make healthy changes.
This should ensure that your weight does not increase during your pregnancy or you may actually lose a small amount of weight which will not be harmful.
You should stay active although you should not start a new exercise regime especially one that is high impact. But low impact exercises are very beneficial. It can help you to sleep better, improves muscle strength, reduces stress levels, improves your circulation and oxygen flow to the placenta which will benefit your baby. It can also reduce your blood pressure and constipation and can also reduce the likelihood of suffering postnatal depression.
Good exercises during pregnancy include walking, swimming, yoga and low impact aerobics.
Obviously you should avoid contact sports such as hockey, martial arts and football due to abdominal trauma that you could sustain.
You should drink plenty of water during exercise to reduce dehydration and avoid becoming overheated as this can overheat your developing baby. For this reason you should also avoid the sauna and steamroom.
If your BMI is above 30 and therefore increasing the risk of the baby having neural tube defects, you should take a daily dose of 5mg of folic acid which is above the recommended dose given to women with a healthy BMI. This will have to be prescribed by your doctor.
You are also at increased risk of becoming vitamin D deficient, therefore you should also take 10 micrograms of vitamin D supplement.
Because of your increased risk of developing a deep vein thrombosis, you will be assessed to decide if you need to take a daily injection of Low Molecular Weight Heparin throughout your pregnancy which will thin your blood.
You will also be tested for gestational diabetes, usually around 24-28 weeks gestation.
Your blood pressure will also be monitored throughout due to the increased risk of pre-eclampsia and gestational hypertension.
You may also be offered additional ultrasound scans to check the development and growth of your baby.
When planning your labour and birth you will be advised to give birth in a consultant led obstetric unit that has a Special Care Baby Unit attached.
You will probably also be given an appointment to see an anaesthetist who will give you information on any anticipated difficulties that you may encounter if anaesthesia for a caesarian section is required. He will probably advise you to have an epidural sited early in labour although this may be difficult if your BMI is above 30.
If you do have a BMI of over 30 remember to start taking 5mg of folic acid at least one month before you try to conceive, and continue until you are 13 week gestation.
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