Dec. 08--Pregnant women -- Put down that extra doughnut.
Experts are warning that "eating for two" doesn't mean eating twice as much food anymore.
As Americans continue to get heavier, health care increasingly is focusing on the effects of obesity and excessive weight gain before, during and after pregnancy.
"The No. 1 concern of ob-gyns today in pregnant women is obesity," said Dr. Vivian von Gruenigen, director of women's health services for Summa Health System. "The problem is that obese women can have higher complications in their pregnancies. In addition, it's a marker for their cardiovascular disease in the future."
A national Institute of Medicine committee last year issued the first revised recommendations for weight gain during pregnancy in nearly two decades.
The guidelines say women who are considered overweight (based on a body-mass index, or BMI, of 25 to 29.9) should gain between 15 and 25 pounds. Those who are obese (with a BMI of 30 or higher) are encouraged to limit weight gain to 11 to 20 pounds.
Women who start off obese have higher rates of complications -- particularly gestational diabetes, high blood pressure, Caesarean sections, neural tube defects and larger babies weighing 10 pounds or more, said Dr. Angela Silber, a high-risk obstetrician at Akron Children's Hospital's Division of Maternal-Fetal Medicine.
It's a common concern.
Among women ages 20 to 39 -- prime childbirth years -- about one-third are obese, said Karen Gil, senior research scientist in obstetrics and gynecology at Akron General Medical Center.
"The obesity status for a woman, even before she gets pregnant, is the biggest risk factor," said Dr. Patrick Catalano, chairman of obstetrics and gynecology at MetroHealth Medical Center in Cleveland.
Catalano served on the National Institute of Medicine committee that developed the revised guidelines for weight gain during pregnancy.
Obese women who exceed the recommended weight gain are more likely to keep the excessive weight after delivery, he said.
The cumulative effect after one or more pregnancies can mean an overweight woman becomes obese or a slightly obese woman ends up with a higher BMI and more health problems.
For the average 71/2-pound baby, mothers also gain 1.3 pounds from the placenta, 1.8 pounds in amniotic fluid, 2.2 pounds from the uterus, almost a pound in breast growth, 2.6 pounds in blood, 3.7 pounds in water and 7.3 pounds of fat, according to Silber.
Patients with a higher amount of body fat can limit weight to the recommended levels without harming the baby, she said. "As long as the baby is growing, it's not detrimental."
Still, Akron General's Gil estimates 75 percent of overweight women gain more than the recommended amount during pregnancy. Among women with BMIs considered normal, half gain more than recommended.
Study to begin
Akron General is launching a study in January in which participating physicians will give pregnant women a chart to track their own weight gain compared to the national recommendations.
Participants also will get tips on portion control, walking and avoiding high-calorie foods with low nutritional values.
"This will empower them to monitor their weight and keep track of their weight," Gil said.
Shaunna Popeko, 33, of Akron already was focusing on losing weight when she became pregnant with her second child.
"My weight has always fluctuated," she said. " . . . When you're a single mom and you work a lot, you don't want to eat a lot of fast food, but sometimes it's easier."
Before she became pregnant, she had been working out at the Art of Karate in Barberton and dropped below 300 pounds.
During her pregnancy, the staff at the Summa Women's Health Center helped her learn how to eat a more balanced diet, particularly after she developed gestational diabetes. Staffers gave her tips, such as using a smaller plate and methods for baking foods instead of frying them.
She managed to avoid gaining much weight until the last few weeks of her pregnancy, when she started retaining water because of high blood pressure.
"I was very careful," she said. "The least I could do was make it healthy for him while he was in my body."
Since her son, Brody Piccard, was born weighing 6 pounds, 12 ounces, a little more than a month ago, Popeko has already dropped below her pre-pregnancy weight of 280 pounds.
"I've never been a label watcher until now," she said.
A time of learning
Pregnancy can be a "teachable moment" when women are more open to embracing healthier lifestyles that include eating balanced diets with less processed foods and getting active, Summa's von Gruenigen said. If women avoid excessive weight gain during pregnancy, they can work on weight loss after delivery.
"It's not a time to diet, but it is a time to engage in positive lifestyle change," she said.
Silber of Children's Hospital said she plans to work with researchers at Summa next year to examine adverse outcomes in pregnancy and childbirth related to obesity among local expectant mothers.
In addition, MetroHealth's Catalano is recruiting participants for a study to examine whether fish oil supplements taken by overweight or obese expectant mothers can reduce obesity in their babies.
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Cheryl Powell can be reached at 330-996-3902 or chpowell@thebeaconjournal.com.
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