by Wenjie Sun
As an obstetrician and gynecologist in Howard County, I have participated in the care of many women and their pregnancies and I was excited to read about the new shift in perspective toward diet and pregnancy in the Baltimore Sun article, “Diets suggested for more pregnant women.” It saddens me to see that some women gain 60-70 pounds in pregnancy. Many fail to lose the weight afterwards. This may be due to the continuation of unhealthy eating habits that began either during or prior to the pregnancy. With a newborn in the house, less sleep, more stress and lack of time make exercise and eating healthy difficult.
Obesity is an epidemic in America. Approximately 34 percent of Americans over the age of 20 are obese according to the Centers for Disease Control and Prevention, including about 36 percent of non-pregnant females. This is a 10 percent increase from 15 years ago. Obesity is defined as having a body mass index (BMI) of greater than 30. Another 34 percent of American Adults are overweight, as defined by a BMI of 25-30, and nearly six percent are extremely obese with a BMI of greater than 40.
While weight gain is a normal part of pregnancy, gaining 60-70 pounds is excessive. According to the American College of Obstetrics and Gynecology, the recommended weight gain during a pregnancy should be 25-35 pounds for normal weight women, 15-25 pounds for overweight women and 15 pounds or less for obese women. Unfortunately, many women do experience cravings during their pregnancy and many feel it is okay to indulge during pregnancy since “you are eating for two.” This is a misleading and antiquated attitude. Many women also are more sedentary in pregnancy due to the surge of hormones, weight gain and anemia. Over-eating and decreased exercise feed into the vicious cycle.
Obesity in pregnancy can lead to higher risk of gestational hypertension, gestational diabetes, preeclampsia, macrosomia, difficulty with fetal monitoring, higher Caesarean-section rates, and increased surgical and anesthesia complication rates. There also is increased fetal risk of neural tube defect, prematurity and stillbirth.
While the Baltimore Sun article talked about weight loss for obese women in pregnancy, it is important to note that currently there are no studies proving that weight loss is safe during pregnancy. Dieting is not the solution in pregnancy; instead, a healthy diet should be stressed. Additionally, an active lifestyle during pregnancy is encouraged for most healthy patients. Walking, running, stationary bicycling, swimming, low impact aerobics and prenatal exercise are not only safe during most pregnancies, but recommended.
More young women are undergoing bariatric surgery than ever before. While this surgery may be the only solution for some women to get to a healthy weight, it is important to point out that bariatric surgery is not without risk. Those patients who have a past history of bariatric surgery should not consider pregnancy during the initial 12-18 months after surgery. Most bariatric patients are nutrition deficient in B 12, folate, calcium and iron. Pregnancy complications are increased in these women; however, it is important to note that diabetes and hypertension are reduced.
Ideally, women should get into the habit of healthy eating and achieve a healthy weight prior to pregnancy. Portion-controlled eating, choosing more fresh vegetables, lean meat, complex carbohydrates and less processed food are the desired ways to keep the weight in check. Exercise further revs up the metabolism. In the end, it is more difficult to lose the weight postpartum than it is to limit weight gain in the first place.
Wenjie Sun, M.D. is a graduate from Wofford College, Summa Cum Laude in Chemistry Science. She earned her M.D. from University of South Carolina, School of Medicine. She then entered residency at Wake Forest University in Winston-Salem, North Carolina. She joined the Signature OB/GYN practice in 2007. She was Board Certified in 2010 and was named to the Chesapeake Family Magazine's 2011 List of Favorite Doctors!