Did you know that 23% of Canadian women over the age of 18 are obese? The fastest rate of growing obesity is in the peak years of fertility, ages 25 to 34. Early in 2007 a Canadian study looked at 370,000 women from 1994 to 2000 who underwent maternal serum screening at week 16 of pregnancy, to look for potential fetal defects. It showed: overweight women rose by 37%, the rate of obese women by 70%, and the proportion of severely obese rose a startling 80%, to 3 out of every 200 women. The Society of Obstetrics and Gynecology of Canada warns that overweight and obese women face personal risks in pregnancy such as: pre-term birth; hypertension during pregnancy (pre-eclampsia); gestational diabetes. The likelihood of requiring a C-section is higher and the surgery is considered riskier in this group. Late fetal death is almost twice as likely to be seen in the most obese compared to women with normal body mass index (BMI). Knowing that weight can make it harder to conceive and increase the risk of complications to the mother is worrisome enough, but an obese pregnant mother puts the health of her baby at greater risk than women at a normal body weight. The risk
A recent article in the Archives of Pediatrics and Adolescent Medicine addressed the impact of pre-pregnancy weight on the risk of what are called ‘structural defects’ in the baby. The structural defects included spina bifida and neural tube defects (despite adequate prenatal folic acid), heart defects, defects of the anal and rectal canal, limb reduction defects and diaphragmatic hernias. It is unclear why the risks exist. Possible explanations may be the way obesity impacts on sugar or glycemic control. | Other studies have shown that physically active women – regardless if obese or not – had a 30% to 50% lower risk for such neural tube defects. In addition, diets to lose weight, fasting diets and eating disorders in the first trimester were associated with an increased risk of delivering offspring with neural tube defects independent of maternal obesity. This might be because there are restricted micronutrients for the fetus. Recommendations
Overweight women are advised to gain less weight during pregnancy than normal or underweight women. Though dieting is never recommended during pregnancy as it can limit nutrients to the baby. Science has yet to unravel all the reasons for why obese women in this study were more likely to have offspring with structural defects. It does however highlight the importance of maternal health and attention to weight, healthy eating and exercise, before embarking on a pregnancy to help ensure the best possible outcome for mother and child. H&L Dr. Marla Shapiro, Assoc. Prof. at the University of Toronto, Dept. of Family and Community Medicine; she's CTV's Medical Consultant on Canada AM; and a regular Globe and Mail health columnist. |
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