Risky prepregnancy weight increasing

A growing number of women are overweight or obese when they become pregnant, a condition that is risky to both mother and baby, a study by researchers at the University at Buffalo (N.Y.) has shown.

An analysis of the prepregnancy body mass index of more than 79,000 women who became pregnant between 1999-2003 found that the number who were overweight when they became pregnant increased by 11% and the number who were obese increased by eight percent over that time period. There was a corresponding decrease in the percentage of women who were normal weight or underweight in the prepregnancy period over those five years. The shift applied regardless of age, ethnicity (black or white), education level, type of insurance, previous live births, urbanization status, median family income, and whether or not they smoke.

"Cumulatively, 40.5% of all patients had prepregnancy BMIs in the overweight and obese categories in 2003 compared with 37.1% in 1999," notes John Yeh, professor and chair of the Department of Gynecology-Obstetrics. "This increase in obesity is important to the obstetrician and the patient because obesity can be a high-risk situation in a pregnant woman. Obese patients who become pregnant are at increased risk of developing gestational diabetes, pregnancy-related hypertension, preeclampsia, neonatal death, and labor complications."

A breakdown of data showed that 75% of the women were between the ages of 20-34; 80% were white; 55% had more than a high school education; and 58% had HMOs as their insurance carrier. It was the first live birth for 39%; 64% lived in urban areas; and 80% were nonsmokers.

While half of the total number of women had a body mass index in the normal range, more than a quarter were obese when they became pregnant. Over five years, the percentage of women with a normal BMI dropped from 50.8% in 1999 to 49.2% in 2003. During the same period, the number of overweight women jumped from 13.2% to 14.6%, and the number of obese women rose from 25.1% to 25.9%.

Preeclampsia poses a serious heath threat to the overweight or obese mother and, if not treated properly, can result in death of mother and baby. It causes blood vessels to constrict, resulting in high blood pressure and a decrease in blood flow that can affect many organs, including the liver and kidneys. Less blood flows to the placenta, which can result in poor fetal growth, decreased amniotic fluid, and separation of the placenta from the uterine wall before delivery.

Gestational diabetes, while less serious, is an increase in blood sugar during pregnancy that returns to normal after delivery but heightens the mother's risk of developing Type II diabetes later in life.

Yeh points out that many women gain additional weight during pregnancy, and these pounds often stay with them after the baby is born. "This increases a woman's risk of obesity-related morbidity in the future," he concludes.

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