Importance of starting pregnancy at a healthy weight

Smoking and drinking don't mix with pregnancy, but not so with excess weight before and during pregnancy.

Physicians need to be aggressively counseling women about the importance of starting pregnancy at a healthy weight, according to Temple University obstetrician-gynecologist, Vani Dandolu, M.D.

In a recent analysis, Dandolu and colleagues found that obesity, increasingly common in pregnant women, raises the risks to mother and baby. Overweight and obese pregnant women are at higher risk of C-Section, and less likely to breastfeed, while their children are at higher risk of high birth weight and childhood obesity. Specifically, over half of the overweight and obese women gained excessive weight during pregnancy. Further over half of the obese women had a C-section, almost twice the rates of women who were normal BMI (body mass index) before pregnancy.

"While public education campaigns have increased the awareness of adverse effects of smoking and alcohol during pregnancy, there is limited public awareness regarding the harmful effects of high BMI during pregnancy," Dandolu said.

The Institute of Medicine (IOM) recommends that pregnancy weight gain be modified according to pre-pregnancy weight. But Dandolu and colleagues go further recommending that both pre-pregnancy weight and weight gain during pregnancy need to be controlled, stating, "Maternal obesity is a well known risk factor for obesity and chronic disease in childhood and starting pregnancy at ideal body weight will have far reaching benefits."

The researchers offer the following recommendations:

• Body mass index should be measured as part of vital signs at routine annual check-ups and all women of child bearing age should be counseled to achieve and maintain optimal BMI.
• Preconception counseling programs should include education regarding the poor maternal and perinatal outcomes among the obese and overweight.
• Women with high BMI planning a pregnancy should be counseled to participate in intensive nutrition programs aimed to achieve optimum BMI prior to conception.
• Encouraging breastfeeding can partially help to decrease childhood obesity and also help mother to return quickly to pre-pregnancy weight.

The Institute of Medicine recommends the following range of weight gain for pregnancy based on pre-pregnancy BMI:

• For underweight women with a BMI of less than 19.8, a weight gain during pregnancy of 28-40 pounds is recommended.
• For normal weight women with a BMI between 19.8 and 26 the recommended weight gain during pregnancy is 25-35 pounds.
• For overweight women with a BMI between 26.1 and 29 the recommended weight gain during pregnancy is 15-25 pounds.
• For obese women with a BMI greater than 29 the recommended weight gain during pregnancy is about 15 pounds.

In the study, published in the May 2007 issue of the American Journal of Perinatology, Dandolu and colleagues analyzed information from a sample of 7660 women using the New Jersey state Pregnancy Risk Assessment Monitoring System database: 18 percent of mothers were obese, 13 percent were overweight and 16 percent were underweight. Black non-Hispanic mothers were more likely to be obese and overweight than white non-Hispanic mothers. U.S.-born mothers were more likely to be obese and overweight than foreign-born mothers. And older women who'd previously given birth were more likely to be obese than younger women who had not. The study is among the first to show a correlation between high pre-pregnancy weight, excessive pregnancy weight gain and post-partum consequences.