Targeting Growing Ranks Of Obese Pregnant Women
Pregnancy has been a time when a woman sometimes feels entitled to indulge in a second piece of chocolate cake for dessert or anything she wants. After all, she is "eating for two." If she gained too many pounds during pregnancy– or if she was overweight or obese before becoming pregnant – physicians often looked the other way.
A new program is flipping that attitude on its ear. The number of obese women of child-bearing age is climbing. And research is mounting that shows excess weight in pregnancy has serious consequences for the long-term health of the unborn child and the mother.
The Northwestern Comprehensive Center on Obesity is tackling the growing health problem with a unique program for obese pregnant women. A team of health professionals -- a physician, dietitian, exercise physiologist and clinical psychologist --will help the women develop better nutrition for optimal weight gain, counsel them on how to increase physical activity and offer psychological counseling to develop strategies for a healthier pregnancy. Each woman will have a program tailored to her individual needs.
There will be a special emphasis on treating low-income minority women, who have the highest prevalence of obesity in pregnancy. The Northwestern program has a grant to provide care to these underserved women.
The new program -- Healthy for You, Healthy for 2 -- is available to women who plan to give birth at Northwestern Memorial's Prentice Women's Hospital. The obesity pregnancy program is a project of Northwestern Memorial Hospital, Northwestern University and Northwestern Medical Faculty Foundation.
“Pregnant women have always been hands off,” said Robert Kushner, MD, clinical director of the Northwestern Comprehensive Center on Obesity and professor of medicine at the Feinberg School. “People have always been afraid to intervene in pregnancy because you may do harm. What we are finding is by doing nothing, we are probably doing more harm.”
New evidence indicates that a woman's excessive weight gain during pregnancy affects the intrauterine environment and turns on certain genes in the fetus that can result in childhood obesity and diabetes, said Alan Peaceman, MD, co-director of the obesity in pregnancy program.
"It's not just that the kids gain weight because they acquire the eating habits of their parents and sit in front of the TV, but their risk for obesity is programmed before they are born," said Peaceman, chief of maternal fetal medicine at Northwestern Memorial Hospital and professor of obstetrics and gynecology at the Feinberg School of Medicine.
"Obesity in pregnancy may be contributing to the epidemic of childhood obesity and diabetes that we are seeing today," Peaceman said.
The prevalence of obese women of child-bearing age is rising. An estimated 23.6 percent of women ages 18 to 44 in the United States were obese in 2007 compared to 14.5 percent in 1997, according to the March of Dimes Perinatal Data Center and the Behavioral Risk Factor Surveillance System of the Centers for Disease Control.
In Illinois, 21.4 percent of women 18-44 are obese. Black women in this age group have the highest rate of obesity at 36.8 percent followed by Hispanic and Latino women at 24.7 percent, according to 2007 statistics from the Illinois Department of Public Health. Obesity is defined as having a Body Mass Index (BMI), a measure based on a person's height and weight, of 30 or higher. In recent years, more than half of the women who gave birth at Prentice Women’s Hospital were overweight.
Excessive weight gain also compromises the health of the mother. Many women who gain excessive weight don't lose it, hiking their risk for diabetes and cardiovascular disease. Peaceman said obese pregnant women also have a higher rate of gestational diabetes, hypertension and blood clots as well as cesarean sections.
A nutritional counselor from Healthy for You, Healthy for 2 will tailor a woman's diet to manage her calories but make sure she is getting the necessary nutrients and food for the baby.
"Most women don't get nutritional counseling during pregnancy, and, if they do, it's relatively cursory," Peaceman said. "We're not trying to get them to lose weight, we are trying to get them to gain appropriately. Some women who are overweight don't need to gain anything at all."
Kushner said it's time to be more aggressive and therapeutic with obese pregnant women. “We are butting up against traditional thinking that this is the time you can do anything you want, eat anything you want,” Kushner said. “That’s what’s gotten us in trouble. We have to challenge those beliefs and guide women to what really is healthier."
To be eligible for the program, women must meet one of these criteria: have a body mass index of 30 or higher, have retained 40 pounds of weight gain from a previous pregnancy, had gestational diabetes or had previous weight loss from bariatric surgery.