A few days ago, a doctor with an Instagram profile of one of the hospitals published a controversial entry. In it, she appealed to pregnant women to close the refrigerator and to “be like Ewa” – a neonatologist who is still slim at 30 weeks of pregnancy. Fasting was perceived as an attack on obese pregnant women. Is pregnancy and overweight a bad combination? We talk to gynecologist Rafał Baran from the Superior Medical Center in Krakow about obesity in pregnancy.
- «Close the refrigerator and eat for two, not for two. You will make life easier for us and for yourself »- this sentence caused a stir in social media. It was perceived as an attack on women struggling with obesity
- Pregnancy, when mum’s BMI is above 30, is actually more risky. The very conception of a child may be a problem
- Difficulties may also arise during pregnancy, childbirth, and the puerperium.
- E mafai ona maua nisi fa'amatalaga ile itulau autu ole Onet.
He graduated from the Medical University of Silesia in Katowice, and currently works at the Gynecological Endocrinology and Gynecology Clinic of the University Hospital in Krakow. On a daily basis, he conducts classes with foreign students of medicine at the Clinic, as part of the School for Foreigners of the Collegium Medicum of the Jagiellonian University. He is also active in research.
His main professional interests are prevention and treatment of diseases of the reproductive organ, infertility and ultrasound diagnostics.
Agnieszka Mazur-Puchała, Medonet: Pregnant “close the fridge and eat for two, not for two. Make life easier for us and for yourself ”- we read in the controversial post on the profile of the County Hospital Complex in Oleśnica. Is an obese woman really a burden for medical staff?
Bow. Rafał Baran, gynecologist: This post was a bit unfortunate. I sincerely hope that the doctor who published it was not intended to discriminate against obese patients. In such cases, the risk of complications during pregnancy, birth and puerperium is actually increased. Obesity can also make it difficult to get pregnant. However, our task, as doctors, is, above all, to pay attention to this problem and to take care of the obese patient in the best possible way, and certainly not to stigmatize her.
Let’s break it down into prime factors. How overweight and obesity make it difficult to get pregnant?
First, we need to understand what is overweight and what is obesity. This breakdown is based on the BMI, which is the ratio of weight to height. In the case of a BMI over 25, we are talking about overweight. BMI at the level of 30 – 35 is obesity of the 35st degree, between 40 and 40 obesity of the 35nd degree, and over XNUMX is obesity of the XNUMXrd degree. If a patient planning pregnancy has a disease such as obesity, we must take special care of her and explain that problems with conception may arise. They can have different backgrounds. Obesity itself with a BMI above XNUMX is a risk factor, but also diseases that often accompany it, such as polycystic ovary syndrome or hypothyroidism, which may cause ovulation disorders, and in such a situation it is difficult to get pregnant. On the other hand, being overweight does not significantly affect fertility.
What kind of complications of pregnancy may occur in an obese patient?
First, there is a greater risk of gestational diabetes or high blood pressure, including pre-eclampsia. Secondly, there may also be thromboembolic complications, and unfortunately the most serious complication, i.e. sudden intrauterine death of the fetus.
Due to these risk factors, we recommend obese women who plan to become pregnant to contact a specialist first. The patient should have a defined lipid profile, complete diagnosis for diabetes and insulin resistance, assessment of thyroid and circulatory system functioning, measured arterial blood pressure and an ECG. A proper diet under the supervision of a dietitian and physical activity are also recommended.
What if an obese woman is already pregnant? Is weight reduction still an option then?
Yes, but under the supervision of a dietitian. It cannot be a restrictive or elimination diet. It should be well balanced. The recommendation is to limit the energy value of the meals consumed to 2. kcal per day. However, if this consumption before pregnancy was very high, the reduction must be made gradually – by no more than 30%. The diet of an obese pregnant woman should consist of three main meals and three smaller ones, with carbohydrates with the lowest glycemic index to prevent insulin spikes. In addition, we also recommend physical activity – at least three times a week for 15 minutes, which will fuel your metabolism and facilitate weight loss.
What are the difficulties of giving birth in an obese woman?
Childbirth in an obese patient is very demanding and involves a higher risk. You have to prepare for it properly. The key is, first of all, the correct assessment of the child’s weight in order to rule out macrosomia, which is unfortunately difficult due to the fact that the adipose tissue does not have a good transparency for the ultrasound wave. Also, monitoring the well-being of the fetus by means of CTG is technically more difficult and involves a higher risk of error. In patients with obesity, fetal macrosomia is more often diagnosed – then the baby is simply too big for its gestational age. And if it is too large, vaginal delivery may be associated with such complications as shoulder dystocia, various types of perinatal injuries in the child and mother, or the lack of progress in labor, which is an indication for an accelerated or emergency caesarean section.
So maternal obesity is not a direct indication for Caesarean delivery?
Is not. And it is even better that a pregnant woman with obesity should give birth through nature. A caesarean section is a major operation in itself, and in an obese patient we also risk thromboembolic complications. Moreover, the very passage through the abdominal wall to the uterus is difficult. Later, the cut wound also heals worse.
Are there any other diseases, apart from macrosomia, of an obese woman?
Pregnant obesity increases the risk of meconium aspiration syndrome. It is also possible hypoglycaemia, hyperbilirubinemia or breathing disorders in the newborn. Especially if a caesarean section is necessary. It is worth noting that in the case of obese pregnant women, unlike macrosomia, fetal hypotrophy may also develop, especially when the pregnancy is complicated by hypertension.
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O mea o loʻo i totonu o le upega tafaʻilagi medTvoiLokony ua faʻamoemoe e faʻaleleia, ae le o le suia, le fesoʻotaʻiga i le va o le Tagata Faʻaoga Upega Tafaʻilagi ma a latou fomaʻi. O le upega tafa'ilagi ua fa'amoemoe mo na'o fa'amatalaga fa'aa'oa'oga. Aʻo leʻi mulimuli i le poto faʻapitoa, aemaise fautuaga faʻafomaʻi, o loʻo i luga o la matou Upega Tafaʻilagi, e tatau ona e faʻafesoʻotaʻi se fomaʻi. E leai se a'afiaga a le Pule e mafua mai i le fa'aogaina o fa'amatalaga o lo'o i luga ole Upega Tafa'ilagi. E te mana'omia se fa'atalanoaga fa'afoma'i po'o se fa'amatalaga fa'akomepiuta? Alu i le halodoctor.pl, e te maua ai le fesoasoani i luga ole laiga – vave, saogalemu ma e aunoa ma le tuua o lou fale.