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Maternal obesity is obesity (often including overweight) of a woman during pregnancy. Maternal obesity has a significant impact on maternal metabolism and offspring development. Insulin resistance, glucose homeostasis, fat oxidation and amino acid synthesis are all disrupted by maternal obesity and contribute to adverse outcomes. Modification of lifestyle is an effective intervention strategy for improvement of maternal metabolism and the prevention of adverse outcomes.

What is considered obese?

Nearly two-thirds of Americans are considered overweight and one in three are obese, meaning they have a body mass index of 30 or greater. A woman who is 5 feet, 5 inches tall would be considered obese if she weighs 180 pounds or more and a 5-foot-8-inch woman would be considered obese if she weighs 200 pounds or more.

Does obesity affect the fetus?

Defects/ impairments

Over 18% of American women are classified as obese, and between 18 and 38% of pregnant women meet this criteria, it is an important issue in maternal and child health in this country. However, very little is known about the mechanism of the link between maternal obesity and diabetic effects in offspring. Maternal obesity is associated with increased odds of pregnancies affected by congenital anomalies, including neural tube defects,which even taking enough folic acid does not fully protect against the risk, spina bifida, which is a leading cause of childhood paralysis, and cardiovascular anomalies. The chances of having neural tube defects in the newborn of an obese woman has been shown to be twice that of a normal pregnant female. Some other anomalies that were increased among mothers with obesity included septal anomalies, cleft palate, cleft lip and palate, anorectal atresia, hydrocephaly, and limb reduction anomalies. Babies are also more likely to be admitted to neonatal intensive care units because of all the affects from the obese mother. Each year, nearly 2,500 babies are born with these defects, and many other affected pregnancies end in miscarriage and stillbirth.

Mental or physical affects on the fetus

Maternal obesity is linked with elective preterm delivery, neonatal death, and delivery of an extremely low birth weight of infant. In follow-up studies of babies whose birth weights were below 1000g, it was shown that 40% to 45% of the survivors had severe neurodevelopmental impairments.

It has been demonstrated through a study on rats that when in a pregnant state if the mother ate a diet rich in fat, sugar, and salt,that mother's offspring was more likely to overeat and have a preference to junk food. Even when the offspring were not given the option of junk food, their bodies metabolized food differently than offspring whose mother ate healthier. Offspring of mothers who ate badly had higher levels of cholesterol and triglycerides in their bloodstream and higher risk of heart disease. In addition, these offspring had higher levels of glucose and insulin, which indicate development of type 2 diabetes. The rats were studied through adulthood and were found to be fatter than the offspring whose mothers ate healthier. This study showed that the diet of mothers not only effects the offspring's' chemical physiology but also their likelihood of becoming even more unhealthy through their natural preference to bad habits.

Paternal Obesity Effects on Fetus

Researchers from the NIHs National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) conducted a study and found that early-onset paternal obesity is connected with an increased risk of liver disease in their kin. Researchers found that obese fathers had an elevated level of serum alanine aminotransferase (ALT), a liver enzyme, compared to fathers who were not obese. They did a secondary analysis that excluded obese offspring. Children who were a normal weight but had obese fathers still had elevated ALT levels, which indicated that a child's ALT levels are not dependent upon the child's own BMI.

Obesity Effects on the Mother

Disease

Obese women have an increased risk of infertility and pregnancy-related complications, some of these are: hypertension, gestational diabetes, and blood clots. Maternal obesity is also known to be associated with increased rates of complications in late pregnancy such as cesarean delivery, and shoulder dystocia. In addition, morbidly obese women who have never had children before are at increased risk of all–cause preterm deliveries. It is well recognized that obese women are at increased risk of preeclampsia and that women who have never been pregnant are at higher risk of preeclampsia than women who have had children in the past.

Effects of negative diets

Poor glycemic control can lead to neural tube defects. The usual increase in insulin resistance seen in late pregnancy is enhanced in obese mothers, causing an postprandial increase in glucose, lipids, and amino acids, as well as excessive fetal exposure to fuel sources. This, in turn, increases fetal size, fat storage, and potential risk for disease. For mothers, impaired glucose tolerance and hyperlipidemia is more common among obese mothers.

Modifying The Risks

There are many options available in treating obesity, such as: altering your diet and exercising regularly. Moderate forms of exercise, such as walking, can lead to healthy weight loss. Many people who are obese turn to gastric bypass surgery in order to reduce their appetites. It is always advised to consult a physician on any obesity treatments.

It is recommended that obese women should try to lose weight before becoming pregnant, yet women should not diet during pregnancy because a sufficient nutrition is important for pregnant women and women planning pregnancy. Women with gastric banding can have normal pregnancies and better outcomes than women who do not have the surgery, but in most cases, doctors have agreed that pregnancy should wait until surgery-related weight loss has stabilized. Clinicians have been encouraged to talk to women who are pregnant or may become pregnant about getting enough folic acid, smoking cessation, and to avoid alcohol. Women are also recommended to have appropriate calorie intake and exercise adequately.

Nutrition Recommendations

Avoid foods that are high in saturated or trans fats or that are high in sugar, such as potato chips, peanut butter, margarine, and other processed foods. Enhance your diet with whole grains, vegetables, fruits and lean protein. Foods that contain factors such as choline, folic acid, omega-3 fatty acid, and vitamin D are important for proper development of the fetus. Foods such as soybeans, grape juice, and cabbage are a high source of choline; eggs, yeast, mushrooms, citrus fruits, green vegetables, milk, chicken, tuna, and salmon contain folic acid. Omega-3 can be found in flaxseed oil, cottage cheese, or yogurt. Vitamin D can be obtained by adequate exposure to natural sunlight.

Pregnant women that ate more sweets, such as candy and processed juices, in early pregnancy were at higher risk of gaining excessive weight. A healthy, well-balanced diet during pregnancy can also help to minimize some pregnancy symptoms such as nausea and constipation.

Exercise Recommendations

During pregnancy doctors recommend light exercise. Doctors claim exercise can help the comfort of the mother and the well-being of the unborn child. Some benefits include, but are not limited to: reduced back pain, less likely to feel constipation, less likely to gain excess weight, decreased chance of gestational diabetes, easier labor, quicker recovery, and the baby will be in better physical and emotional health.

If negative signs and symptoms occur after exercising, pregnant females should stop immediately. Some signs are: dizziness, faintness, headaches, shortness of breath, uterine contractions, vaginal bleeding or fluid leaking, or heart palpitations.

Here are some workout tips for pregnant women:

1. Drink plenty of water before, during and after your workout. Your baby needs the fluids.

2. Remember to breathe. If you hold your breath for more than a few seconds, you are doing too much and your baby loses precious oxygen.

3. After the first trimester, do NOT do any exercises that require you to be on your back. It puts too much pressure on your organs and the growing fetus.

4. Do NOT perform squats. It can cause the separation of the placenta from the uterus.

5. Perform each exercise slow and fluidly. Do not make any jerky movements.

The following are good exercises for pregnant women:

1. Any sitting exercise machine. Such as; lat pulldown (back), cable curls (biceps), lateral raise (shoulders), triceps extensions, leg extensions (quadriceps), seated leg curl (hamstrings), seated calf raise, cable crossovers (chest)

2. Use low weight with high reps. Try to perform between 12-15 repetitions in 2-3 sets each. If the last few reps are difficult, you will need to lower the weight.

3. It is not a good idea to do abdominal work after the first trimester. Especially on your back.

References

1. ^ Nelson SM, Matthews P, Poston L (2010). "Maternal metabolism and obesity: modifiable determinants of pregnancy outcome". Hum. Reprod. Update. 16 (3): 255–75. doi:10.1093/humupd/dmp050. PMID 19966268.{{cite journal}}: CS1 maint: multiple names: authors list (link)
2. ^ Obesity Increases Risks in Pregnancy - Moms and Babies Have More Problems By Salynn Boyles. WebMD Health News. Feb. 3, 2006
3. ^ medscape.com > Maternal Obesity Increases Risk for Congenital Anomalies By Alice Goodman. February 10, 2009
4. http://www.webmd.com/diet/news/20060203/obesity-increases-risks-in-pregnancy
5. http://www.ajph.org/cgi/reprint/AJPH.2005.074294v1.pd
6. http://www.sciencedaily.com/releases/2008/06/080630200951.htm
7. Early-onset paternal obesity linked to increased risk for liver disease in child. Copyright 2009. Thiandian.com Company Limited. http://www.thaindian.com/newsportal/health/early-onset-paternal-obesity-linked-to-increased-risk-for-liver-disease-in-child_10033634.html
8. ^ Maternal Obesity in Early Pregnancy and Risk of Spontaneous and Elective Preterm Delivery: A Retrospective Cohort Study Gordon C.S. Smith, MD, PhD; Imran Shah, MSc; Jill P. Pell, MD; Jennifer A. Crossley, PhD; Richard Dobbie, BSc. Posted: 01/19/2007; American Journal of Public Health. 2007;97(1):157-162.
9. http://medicalcenter.osu.edu/patientcare/healthcare_services/pregnancy_childbirth/care/the_pregnant_mother/Pages/index.aspx
10. http://pregnancy.about.com/od/stayinghealthy/a/morepgexercise.htm
11. ^ http://www.essortment.com/all/pregnantexercis_rtbs.htm

• Obstetrics
• Health issues in pregnancy
• Obesity