Most plus-size women can expect to have a healthy pregnancy. But if you're carrying extra weight going into pregnancy, you’re more susceptible to pregnancy complications like . Understanding your risk factors will help you do everything you can to .
You're considered overweight if your pre-pregnancy body mass index (BMI) is between 25 and 29.9 and obese if your BMI is 30 or higher. It's healthy to have a BMI between 18.5 and 24.9. (Not sure what yours is? )
Keep in mind that BMI is only a rough estimate of body fat based on your height and weight: It doesn't take genetics or age into consideration, and it isn't a perfect tool for assessing overall fitness. Nevertheless, researchers have consistently found that as BMI increases, so does the risk of many pregnancy and labor complications.
And although having a BMI between 18.5 and 24.9 is considered normal, it isn't typical: More than half of pregnant women in the United States have a BMI of 25 or higher and more than a third have a BMI of 30 and above.
Risk reality check
Doctors and researchers still don't know exactly why weight matters. And it's just one piece of the puzzle – age, genetics, and ethnicity also factor in.
"The impact of obesity is different for every ethnic group," says Gladys Ramos, an ob-gyn who has researched race, weight, and pregnancy complications. "For example, Latina women have a higher rate of gestational diabetes and preeclampsia, compared with Caucasian women. African-American women have a higher rate of c-section than do heavier Caucasian women. Caucasian women tend to form bigger babies, while African-American women do not."
The good news is that most health conditions and situations linked to weight are manageable – and in some cases preventable. So you may not experience any and go on to have a perfectly healthy pregnancy and delivery.
"Most plus-size women have completely normal pregnancies and normal babies," says Cornelia van der Ziel, an ob-gyn and coauthor of Big, Beautiful, and Pregnant: Expert Advice and Comforting Wisdom for the Expecting Plus-Size Woman. "You can be overweight and have a fit pregnancy. Any obese pregnant woman can modify her risks by eating well, exercising, and adhering to weight-gain guidelines."
According to Sujatha Reddy, an ob-gyn in Atlanta, the most important thing you can do is have a conversation with your healthcare provider about your particular risk factors. Do you have a history of high blood pressure or uncontrolled blood sugar? What about a family history of larger babies?
Once you know your personal risk factors, work with your healthcare provider to make sure you have the healthiest pregnancy you can. And don't panic: As Reddy says, "It's not a doom-and-gloom scenario at all."
(Do you think your healthcare provider is treating you with respect? If not, read about .)
Health conditions and situations
Here are some conditions and situations you and your healthcare provider may need to be mindful of during your pregnancy:
Neural tube defects: (NTDs) are problems with how a baby's brain and spinal cord develop. The overall risk is very small (around 1 in 1,000 births, according to the Duke University Center for Human Genetics), but overweight and obese women are twice as likely to have a baby with an NTD as are women at a normal weight.
What you can do: Researchers aren't sure why obese women have higher rates of NTDs, which makes it hard to give specific recommendations. But they do know that folic acid can help to prevent NTDs, and some studies have found that plus-size women may have lower blood folate levels than smaller women. Consider asking your doctor if you should boost your folic acid intake higher than the recommended daily amounts of 400 mcg before conception, and 600 mcg during pregnancy.
You can also ask your healthcare provider for a at 15 weeks to screen for NTDs. If that test suggests a possible problem, ,and can provide more information.
Gestational diabetes: This condition causes elevated blood sugar during pregnancy. Your healthcare provider will evaluate your blood sugar during , which are usually done between 24 and 28 weeks of pregnancy. (They may be done earlier if you're at higher risk.)
Uncontrolled levels of high blood sugar can cause a variety of problems, including hypoglycemia (low blood sugar) in your baby after birth and having a . (These babies may have larger shoulders, which increases the risk of shoulder dystocia – a rare but serious situation in which the baby becomes stuck behind the mother's pubic bone during delivery.) And children of mothers who have gestational diabetes are at higher risk of becoming obese or developing type 2 .
Nearly 5 percent of pregnant women develop diabetes, and the risk increases along with BMI: Overweight women are twice as likely to have gestational diabetes, and obese women are four to eight times as likely to have it.
What you can do: Learn about and how you can . You can also get more information from the American Diabetes Association. Even if you have gestational diabetes, you can have a healthy pregnancy if you follow your healthcare provider's advice and attend all your prenatal appointments.
Preeclampsia: Also known as toxemia, is a serious condition that's diagnosed after 20 weeks of pregnancy if you have high blood pressure along with at least one other symptom. These can include protein in your urine, liver or kidney abnormalities, persistent headaches, or vision changes.
It causes blood vessels to constrict, which raises your blood pressure and decreases blood flow through your body.
Preeclampsia can range from mild to severe and progress slowly or rapidly. In severe cases, it can cause organ damage to you and problems for your baby, such as poor growth, less amniotic fluid, and . Severe cases can lead to seizures, a condition called eclampsia. Women with severe preeclampsia are given antiseizure medication.
Reddy notes that while weight is a major risk factor, other factors – such as age – are more significant. "If you're under age 35 and overweight, you're at a lower risk for preeclampsia than a woman at a healthy weight who's 35 or older," Reddy says.
Research shows that about 6 to 12 percent of overweight and obese women will be diagnosed with preeclampsia, while about 4 percent of women with a BMI in the normal range will be diagnosed.
What you can do: Attend all your prenatal appointments, so your healthcare provider can check your blood pressure. If your blood pressure is high, your provider will test your urine for protein.
Call your healthcare provider right away if you experience puffiness or swelling in your face, swelling in your extremities, a severe or persistent headache, rapid weight gain, intense pain or tenderness in your upper abdomen, or vision changes (like double vision, blurriness, spots or flashing lights, sensitivity to light, or a temporary loss of vision). Learn more about and how it's managed.
Gestational hypertension: If you develop high blood pressure (a reading of 140 over 90 or higher – even if only one of the numbers is elevated) after 20 weeks of pregnancy but don't have any symptoms of preeclampsia, you'll be diagnosed with , sometimes called pregnancy-induced hypertension.
If you had high blood pressure before pregnancy, or are diagnosed with it before 20 weeks of pregnancy, that's called chronic hypertension. Chronic hypertension is a heart risk, but gestational hypertension is usually mild and probably won't cause any noticeable problems for you or your baby. However, it does put you at higher risk for , , , , and stillbirth.
Several studies have shown that roughly 10 percent of obese women have gestational hypertension, versus around 4 percent of women with normal BMI.
What you can do: Go to all your prenatal appointments – your healthcare provider will take your blood pressure at each visit. If you have either type of hypertension, she will monitor your health closely and possibly put you on blood-pressure-lowering medication. Learn more about and how it's managed.
Large baby: While most plus-size women have average-size babies (around 7 pounds), obesity is considered a risk factor for , or having a large baby (at least 9 pounds, 15 ounces). About 1 percent of babies are macrosomic. Your baby is more likely to be large if you have undiagnosed or poorly managed gestational diabetes, have a family history of large babies, or go past your due date.
If your fundal measurements – the distance from your pubic bone to the top of your uterus – indicate you're , that may mean you're carrying a large baby, but it could also be due to a large amount of amniotic fluid ( in plus-size women). An ultrasound is a more accurate estimate of fetal size. However, the only real proof of a macrosomic baby is the postbirth weigh-in.
What you can do: If you have gestational diabetes, work with a nutritionist to keep your blood sugar levels in check and talk with your provider. If your healthcare provider suspects your baby is large, ask her about your options. Depending on your situation, she may suggest a trial of labor to see if vaginal delivery is possible before turning to a cesarean, or she may recommend a planned c-section. Learn more about .
Longer labor: Several studies have found that higher BMI is linked to longer . For women in the highest ranges for BMI, the first stage of labor typically lasts more than an hour longer than it does for normal-weight women. But this doesn't necessarily mean you will be in labor longer, says van der Ziel.
What you can do: Exercising, eating a sensible diet, and gaining the appropriate amount of weight may affect the length of labor, says van der Ziel. Prepare yourself for labor with and , and consider hiring a . A positive mindset also helps, van der Ziel adds – so go into labor with confidence in your body's ability to handle it.
Labor complications: A number of studies have shown that overweight and obese women are more likely to be induced or have a delivery. Obese women also may have more difficulty getting effective pain relief from an epidural or spinal block.
Recent studies have found that overweight women are roughly 50 percent more likely to have a c-section than women who are at a normal weight, and obese women are twice as likely to have a cesarean.
This is likely due to the other factors that can be associated with being plus-size and pregnant: If you're in labor for a long time, or have preeclampsia, gestational hypertension, or other health complications, your healthcare provider may be more likely to recommend a c-section, either scheduled or as an intervention if problems arise during labor.
What you can do: Talk to your healthcare provider. Does she consider you at high risk for a c-section? If so, why? Ask about her c-section rate and her philosophy about c-sections in general.
If you have no serious health problems, is she fine with trying vaginal delivery? During a vaginal delivery, what might cause her to order a c-section intervention?
Also, you may lower your odds of having a c-section by following your doctor's recommendations for weight gain, exercising during pregnancy, and taking . Learn more about and what the .
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