Obesity May Complicate Pregnancy, Experts Say

WASHINGTON -- With obesity on the rise in the United States, women of child-bearing age are being warned about excess weight.

Doctors say obesity increases women's risk of miscarriage and other serious, even life-threatening complications, such as gestational hypertension, preeclampsia and gestational diabetes. And the higher the body mass index a woman has, the higher the chance she will need a Caesarean section.

Elevated risks to the babies of obese women include stillbirth, prematurity, macrosomia (large for gestational age), neural tube defects and higher rates of childhood obesity.

"Everything we do in obstetrics is made more difficult and more complex by obesity -- from using external monitors to performing surgery," said Dr. Gary Hankin, of the American College of Obstetricians and Gynecologists.

New guidelines published this month by the organization urge doctors to discuss weight before a woman conceives.

"In preconception visits, we talk to patients about genetic risks and immunity to rubella, but rarely do we discuss their weight or diet and exercise," Dr. Vivian Dickerson said in a news release. "But optimizing your weight before conception is one of the most important things you can do to have a healthy baby."

Once a woman is pregnant, recommendations include mild exercise and forgetting about "eating for two," which experts call a myth.

The guidelines say women who are slender before pregnancy should gain 25 to 35 pounds. But the overweight should gain only 15 to 25 pounds, and the obese just 15 pounds.

Dieting during pregnancy is a big no-no; it can harm the baby.

"A lot of OB-GYNs don't bring up weight with patients," said Dr. Laura Riley, of ACOG's Committee on Obstetric Practice. "We're hoping to open the dialogue between patient and physician so that patients come to understand that maintaining a healthy weight isn't just about how you look, but that it also has real medical implications."

Obese women of child-bearing age might also think twice about bariatric surgery, the guidelines say. Surgery patients who later become pregnant may see a host of complications and vitamin deficiencies. But the surgery may also reduce the risk of some complications, such as Caesarean delivery, gestational diabetes and hypertension.

"Because we're just beginning to learn what the risks and upsides might be, it's a balancing act for doctors and patients," Dickerson said. "Patients need to proceed with caution because we really haven't had enough experience yet with this to make solid conclusions."