A consultant obstetrician and gynaecologist, Dr Muiz Ogungbe, talks to GODFREY GEORGE about the management of obesity in pregnancy
When can we say someone is obese?
We have a well-recognised definition of obesity from the World Health Organisation which is based on the body mass index. This means the weight of a person in kilogrammes divided by the square of one’s height in metres. Ordinarily, it is expected for one to be between the ranges of 19 to 24.5. When we start having 25 to 29.9, the person is said to be overweight. By the time it comes to 30 and above, it means one is obese. Obesity is further divided into classes. Class one is between 30 and 34.5. Class two is between 35 to 39.5 and class three is 40 and above.
Is this different for pregnant women?
The definition of obesity in pregnant women is not any different. Every obstetrician knows that obesity is a very big problem because it is associated with a lot of complications. In every trimester of pregnancy, obesity is a problem. Obesity doesn’t even favour fertility. A lot of obese women have infertility issues. When they eventually get pregnant, they tend to miscarry a lot. There are also a lot of diseases and complications of pregnancy that can also come in along the line when one is obese. Very common among them are pregnancy-induced hypertension and gestational diabetes mellitus. They are also predisposed to having a preterm birth. The risk of having a malformed baby is also increased in these kinds of women. In delivery, there are a lot of issues that may hamper the delivery. They tend to have dysfunctional labour. They are at a very high risk of operative intervention. This may include using instrumental delivery or caesarean section because the labour tends to fail a lot. By the time we talk about these sections, there may also be issues.
Monitoring these women, even though they may have some underlying conditions may also be an issue. Unfortunately, one of the methods of surveillance, the ultrasound scan, is also problematic because the anterior abdominal wall in them is very thick and that may affect the signal. The signal that is supposed to go down to the baby is oftentimes permeated or absorbed by the thick fact from the anterior abdominal wall such that the vision may not be clear enough for surveillance to be done. Since they may have pregnancy-induced hypertension, one may need to monitor their bodies regularly but to do so is a problem. Oftentimes, the cuff size of the speedometer used in measuring their blood pressure is very hard to get because their arms may be too wide. The machine that you may use for others may not be suitable for them, and that is a problem.
What kind of issues may arise in a caesarean section?
Not every surgical centre has an adequate bed size to be used for such women. To even transfer them to the theatre is a lot of problem for hospital workers. Doing the surgery itself is another cup of tea. They have a thick abdominal wall so cutting through that wall is often associated with blood loss. Apart from that, one may need extra hands to retract the abdomen before the incision site can be better exposed. The surgery itself may be difficult, and when the surgery is over, there are still a lot of post-surgical complications such as uterine atony. The uterus wall may not contract easily after birth. There are other complications like the infection of the wound and there may even be wound breakdown along the line. Wound healing may be compromised. They may also tend to have postpartum sepsis. They may also have clotting of blood in their veins which may also turn fatal if care is not taken.
How does this affect the foetus in the womb?
Their babies may also be affected. If this hypertension caused by obesity is severe, they may tend to have a restriction which would not make the baby develop well. The baby may be tiny. If the pregnancy is affected by gestational diabetes mellitus, they may have very big babies. Either way, there is a problem. For big babies, the women may have repeated low blood sugar. If no eyes are put on the babies, they may just die silently shortly after birth. Because obese women tend to have diabetes, this condition can be passed down to children. Their blood sugar tends to crash and may need optimisation. If you take your eyes off these babies after delivery, they may pass away without your knowing. The babies also tend to have electrolyte issues, jaundice and the like. Apart from that, they may be predisposed to obesity and hypertension later in life.
Some women who are fat during pregnancy may not have been fat before it. Can this be an issue?
The truth is some people may be fat and say they are not obese because, according to them, it is just fat. That is an untrue myth. One thing is that it is difficult to access someone’s body mass index merely by looking at them. Some people may have a lot of bone mass such that even though you are not seeing a lot of fat, the bone mass is quite a lot. They tend to weigh more than is expected. The truth of the matter is that the one that is obviously fat when you look at them may tend to be obese. Although saying someone is fat is relative; one who is fat to me may not be fat to you. Being obese is a function of not just weight but height. A short person may not need to be so big before they fall into obesity.
Is obesity hereditary?
There is a hereditary predisposition to being obese. As I told you, some people are primed right inside their mother to be obese later in life. If one’s parents are obese, one is likely going to be obese as well. This is the same as diabetes and hypertension.
What are other risk factors that can predispose pregnant women to be obese?
The most important risk factor apart from heredity is a sedentary lifestyle. Life has become so easy that everything is done with a simple click. This can be a problem for pregnant women. They may feel they do not have any reason to move about anymore. This is why we advocate exercising and all that. Apart from that, there are very unhealthy eating habits these women may cultivate that may be a problem. The intake of fatty and sugary foods can make one obese.
What kind of food do you think pregnant women should avoid?
Oftentimes, obesity precedes pregnancy. It is not as though it immediately happens during pregnancy. One is usually obese before taking in. That is why it is advisable for one to check all these before pregnancy. It is called preconception care. It is not often done in this country. People only come around when they are pregnant. In advanced countries, this is something one plans for. When one has decided to conceive, one must attend a preconception care class. There is a specialised package of care for them. This is where those who are obese would be counselled about the adverse effects of being obese and how to help them lose significant weight before they embark on pregnancy. This is to foreclose all the risks associated with obesity in pregnancy. Those who are diabetic would have their blood sugar checked before they are allowed to embark on pregnancy. There is a level of obesity that makes getting pregnant a wrong decision. If the body mass is above 30, pregnancy should not be considered at all at this time. We also try to incorporate nutritionists. There is an amount of care that pregnant women are expected to take in a day and the composition of such foods depends on the body mass index of that woman. The nutritionist would counsel them and advise them in that regard.
What is the place of smoking and alcohol when a woman is obese and pregnant?
Smoking and alcoholism are dangerous during pregnancy. By the time they are combined with obesity, it is a double or triple jeopardy. Pregnancy does not mean people should not do exercise. There are recommended exercises for pregnancies so they can burn these calories. Refined carbohydrates, sugars, energy drinks, and fatty food should be avoided. If taken at all, it should be regulated. Someone needs to guide them on that journey.
Many women, when they get pregnant, begin to put on weight which leads many of them to go on a diet. Does this affect the nutrition of the foetus in the womb?
The only problem is when this is done as a sort of self-prescription. As I told you, individual assessments of their bodies are very subjective. Once pregnant women begin to add weight, they may begin to watch their weight. This may be a dangerous practice. That is the problem with self-prescription. If it is something that is established, then cutting down on their diet is very important as it will not affect the wellbeing of the baby.
There is a myth that if one consumes a lot of beverages and milk, one’s babies might become very big. How true is this?
That is another problem. When one is pregnant, one needs to eat a balanced diet and nutritious food. Because of the fear of going through CS, a lot of women may tend to go into some form of starvation. Whatever gets to the baby is also a function of what the mother is taking. There is a system that regulates this. For a woman who has gestational diabetes, their babies tend to gain a lot of weight. The fact that one does not want one’s baby to be big doesn’t mean one should not eat well. Everything should be done moderately.
This content was originally published here.