Sun, Jul 11, 2004 - Page 9 News List

Size at pregnancy is a weighty matter

As medical advice on prenatal weight gain has changed over time, so have women, more and more of whose body weights indicate serious risks



I remember well the days when women were told to gain no more than 11kg in the nine months of pregnancy. I remember too being terrified at my routine obstetrical visit the month I gained 3kg, not realizing at the time that I was carrying twins.

Some women took the restrictions on weight gain to an extreme and failed to gain enough to produce a full-size baby. So obstetricians eventually relaxed their warnings, advising women that it was OK to gain as much as 18kg with a singleton pregnancy.

This license to gain weight, however, prompted two women I know to put on 27kg in the course of their pregnancies. One was carrying twins, the other just one baby. Both thought they were doing the right thing to foster the growth of their unborn children. Both were mistaken, although they were fortunate in avoiding the many complications associated with excessive pregnancy weight gain.

Not so for a growing number of women, many of whom are already overweight or obese at the start of their pregnancies. For them, gaining even the 11kg formerly recommended can be too much if they want the best chance that their pregnancies will proceed without serious medical glitches.

Weight-related problems can compromise the mother's and the baby's health and may even lead to pregnancy loss or stillbirth, said Dr. Laura Riley, an obstetrician at Massachusetts General Hospital who is chairwoman of the committee on obstetric practice at the American College of Obstetricians and Gynecologists.

At a recent news conference convened by the March of Dimes, Riley, who sees about two dozen pregnant patients each workday, said: "Obesity and being overweight is the toughest topic to discuss with patients. Patients think of weight as a cosmetic issue, not a health issue."

Such was the case, she said, with Liz, 26 and 1.63m tall, a patient who arrived for her first prenatal visit eight weeks pregnant and already weighing 131kg, giving her a body mass index (BMI) close to 40. A normal BMI is 20 to 24.

Riley said Liz should have had a consultation before becoming pregnant to provide advice on nutrition and exercise and to urge her to lose excess weight before the pregnancy.

"If you're 25 and really overweight, it's best to wait, lose the weight, then get pregnant at 27," Riley said.

She added that obstetricians should not be reluctant to discuss weight with patients, because "obesity is a medical disease" that should be treated before a woman becomes pregnant, not after.

For women who are already pregnant, pregnancy is no time to try to lose weight, Riley said. But weight gain should be based on pre-pregnancy weight.

The Institute of Medicine of the National Academy of Sciences recommends a gain of 11kg to 16kg for women of normal weight, 13kg to 18kg for those who start out underweight, 7kg to 11kg for women initially overweight and a maximum of 7kg for obese women with BMIs more than 29.

Riley added that regular exercise should be part of pregnancy weight control. She recommended a daily 40-minute walk.

The major obstetrical concern used to be excessive weight gain in pregnancy. Now that is combined with starting a pregnancy already significantly overweight. This is much more serious and should be a far greater concern to women than losing excess weight after childbirth.

Riley discussed the serious risks associated with being overweight or obese in pregnancy. As one might expect, the risks increase with the weight and are highest in women like Liz, with BMIs of 30 and above.

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