Recently, the American College of Obstetricians and Gynecologists published a bulletin concerning obesity in pregnancy. It stated that obesity is the most common health care problem in women of reproductive age. It is so common that its implications related to pregnancy are often unrecognized, overlooked or ignored. For those who are obese, the negative effects of obesity on pregnancy and on fertility serve as good reasons for losing weight while pregnant, and before.
The management of obesity requires long-term approaches that range from public health education to individual nutritional, behavioral or surgical interventions. Understanding the management of obesity during pregnancy is essential, and it should begin before conception and continue through the postpartum period. A report from the American Society for Reproductive Medicine Practice Committee explains why some people need to lose weight to get pregnant.
Although the primary care of the obese woman during pregnancy is provided by the obstetrician or infertility specialist, other health care professionals, such as nutritionists, can offer specific expertise on weight management.
The following recommendations were made in the bulletin:
Body mass index (BMI >30 is obese) calculated at the first office visit should be used to provide diet and exercise counseling
Obese women who have even small weight reductions before pregnancy may have improved pregnancy outcomes
Weight loss between pregnancies in obese women may decrease the risk of a large-for-gestational age newborn in a subsequent pregnancy
Obese women should be counseled about the limitations of ultrasound in identifying structural abnormalities
Consultation with an anesthesia service should be considered for obese women because they are at an increased risk of hypoxemia (decreased oxygen), hypercapnia (increased carbon dioxide) and sudden death
Early pregnancy screening for glucose intolerance should be based on risk factors including BMI of 30 or greater, known impaired glucose metabolism or previous gestational diabetes
Stillbirth rates are higher in obese women, but a recommendation cannot be made for or against routine prenatal fetal surveillance in obese pregnant women
At InVia Fertility Specialists, we have had great success with the Ideal Protein Diet for weight loss. It is a meal replacement program where patients are supplied with their breakfast, lunch and snacks. For dinner they are permitted a small portion of protein with veggies. Our patients work with a "coach" who supervises the weight loss with weekly meetings. Patients are losing 3 - 4 lb. a week without feeling hungry or tired. Weight loss is also associated with an increase in pregnancy rates with infertility treatment.
Janet Chiaramonte joined the staff of Invia Fertility as a registered nurse in 2005. Years ago (too many to count), she received her Bachelor's Degree in Psychology, and then worked for a decade at Children's Memorial Hospital in an administrative position. She always wanted to be part of the patient care side of medicine though, so she went back to school and received an Associate's Degree in Nursing.