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Pregnancy Complications

How the Fastest Growing Pregnancy Complications Are Closely Related
by Charles Hux, MD

It should come as no surprise that the obesity and diabetes epidemic in this country is having a significant effect on the population of pregnant women. Nearly 70% of all pregnancy complications can be traced to both morbid obesity and diabetes.

The percentage of young women becoming diabetic at a younger age is rising yearly. This is in great part due to poor eating habits and lack of exercise. The human body controls blood sugar from the insulin released from the pancreas. As your weight increases, the need for more and more insulin rises per hour. Women who are obese are wearing out their pancreas at a younger age so that less and less insulin is being produced. This results in adult onset Type II diabetes.

The rate of pregnant women who are classified as obese (more than 20% above their ideal body weight) has risen to more than 40% of all pregnant women. Of these women, 50% are morbidly obese, which is a body weight of more than 190 lbs or a body mass index (BMI) of 30 or greater.

Morbid obesity carries a much higher incidence of complications for both mother and baby. This includes a 2-3 times greater risk of miscarriage as well as a 2-4 times greater risk for hypertension, preeclampsia, birth defects, preterm birth, stillbirth, and the need for a cesarean section. In addition, women who are pregnant, over 35, and significantly overweight have a 30 times greater risk of having a heart attack during the pregnancy or during the first six months after delivery.

The American College of Obstetricians and Gynecologists has changed how much weight a pregnant women needs to gain if she is obese. A woman who is obese only needs to gain about 10-15 lbs during pregnancy. In fact a women who is obese does not need to gain any weight and can actually lose a few pounds without any harm to the baby. Unfortunately, many pregnant women who are obese do not believe this fact and continue to eat in the same manner they did before.

Routinely pregnant women are tested at 28 weeks gestation for gestational diabetes. Gestational diabetes is unique to pregnancy because the body's sensitivity to its own insulin production is decreased due to blood pregnancy hormone. If a woman tests positive for gestational diabetes and is morbidly obese or has a strong family history of diabetes, she may in fact really have undiagnosed adult onset Type II diabetes. While gestational diabetes usually does not pose a problem to a pregnancy, it can when the baby is very large (macrosomic). A large baby can have shoulder dystocia especially during a vaginal delivery and may need to be admitted to the Neonatal Intensive Care Unit (NICU). Type II diabetes can cause both large and small babies and a host of other complications to both the mother and the baby. Risks to the baby include a 2-3 times increase of birth defects such as heart defects and neurological abnormalities, preterm birth and stillbirth. The mother is at an increased risk of developing hypertension, preeclampsia, and vascular disease.

Because of the rise of adult onset Type II diabetes in the younger population, the American College of Obstetricians and Gynecologists as well as the American Diabetic Association are recommending a hemoglobin A1C blood test at a woman's first prenatal visit. This will determine if a woman has had high blood sugars prior to becoming pregnant and already has Type II diabetes, which can then be treated throughout the pregnancy by diabetic standards. However, until this type of testing becomes standard practice, any women who is diagnosed with gestational diabetes needs to be tested 3-6 months following delivery to make sure blood sugar levels have returned to normal.

The most important thing any woman can do who is overweight and thinking about becoming pregnant is to get a thorough physical exam and be counseled about the importance of eating a healthy diet for both the health of the woman and her future children. Recent studies on animals and humans have shown that what a pregnant woman eats directly affects the future dietary habits of her children. If the mother eats foods high in sugar and fat, her children are likely to do the same resulting in obesity and diabetes at a young age.

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The future health of our children really does begin with having a healthy mother. A mother who begins her pregnancy at a healthy weight and eats a healthy diet during her pregnancy is less likely to experience pregnancy complications. In addition, a mother who cares about the food she eats herself is more likely to feed her children a healthy diet as well. This will result in healthier children and healthier adults. It is our role as parents to give our children the best possible start in life. Our children also deserve to have parents that are going to be around a long time. It is a win-win proposition.

About the Author:
Dr. Charles Hux attended Case Western Reserve School of Medicine and completed his residency in obstetrics and gynecology and a fellowship in maternal-fetal medicine at Thomas Jefferson University. He received a master's degree in genetics from Rutgers University. He maintains a private practice in Sea Girt, NJ and is primarily affiliated with Monmouth Medical Center in Long Branch, NJ. His articles have appeared in American Journal of Obstetrics/Gynecology, Prenatal Diagnosis, New England Journal of Medicine and Genetics.

A well-known media resource, Dr. Hux has been interviewed on national and regional television, quoted in various newspapers and has talked on topics of pregnancy at over 300 conferences to both physicians and the general public. He is for the last eight years, the current resident "multiples doctor" on The Learning Channel's A Baby Story. For more information, visit http://huxmd.yourmd.com.

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