Why Cant I Get Pregnant

Planning Pregnancy

Obesity increases the risk of pregnancy

The American College of Obstetricians and Gynecologists (ACOG) warns that obesity during pregnancy increases the risk of several complications, including hypertension, a condition called pre-eclampsia and gestational diabetes. The ACOG opinion, published in September of Gynecology and Obstetrics, said obese women are also more likely to have an abortion, the need for a caesarean, and have excessive bleeding and infection after caesarean section. The babies of obese women are more likely to be stillborn, to be born prematurely and spinal cord defects called neural tube defects. The risks to Women with a body mass index (BMI) of 25-30, and are even higher for women with a BMI over 30.

Issues Guidance ACOG for Ob / gyns on the impact of obesity during pregnancy

Washington, DC - The American College of Obstetricians and Gynecologists (ACOG) today issued its opinion of the Commission for the first time in obesity during pregnancy, an important issue crucial, because one third of adult women in the United States are obese. The ACOG document, "Obesity during pregnancy," explains the known risks that obesity accounts for pregnant women and their babies and is published in the September issue of Obstetrics and Gynecology.

"Obesity has become an epidemic," said Gary DV Hankins, MD, chairman of the ACOG Committee on Obstetric Practice, which prepared the document. "At this stage, 49% of non-Hispanic black women are obese, 38% of Mexican-American women are obese and 31% of non-Hispanic white women. And all that we in obstetrics is more difficult and complex for obesity * in the use of external monitors to perform surgery. "

According to ACOG, some studies show that obesity is an independent risk factor for false layer in women undergoing fertility treatment. The data is also linked to obesity among women who conceived naturally error. Obesity has been associated with an increased risk of gestational hypertension, preeclampsia and gestational diabetes. And more index body mass index (BMI) is a woman, the more you will need a cesarean.

Other studies show that obese women have more complications during and after cesarean surgery, including excessive blood loss, operating time of two hours, and wound infection. Surgery in obese women also challenges anesthesia, including placement of epidural and difficult problems breathing difficult intubation.

Risks high Babies of obese women are stillborn, prematurity, macrosomia (large for gestational age), neural tube defects, and higher rates of childhood obesity.

"A large number of ob-GO seems no weight with patients," said Laura E. Riley, MD, past president of the ACOG committee on obstetric practice. "We are waiting to open dialogue between patient and doctor so that patients come to understand that maintaining a healthy weight is not only on how you look, but it also has implications actual health. "

Vivian M. Dickerson, MD, former president of ACOG, said that the time to start talking frankly overweight before pregnancy is achieved. "During visits before conception, we talk with patients about genetic risks and immunity to Rubella but rarely Once we discuss your weight or diet and exercise, Dr. Dickerson said. "But optimizing your weight before design is one of the most important things you can do to have a healthy baby. "

ACOG recommends the following ob-GO obese patients:

• Tell patients to the Institute of Medicine (IOM) recommendations for prenatal weight gain: 25-35 lbs. for women of normal weight, 15-25 pounds. for overweight women, and 15 pounds. for obese women.
• Record height and weight of all women the first prenatal visit to calculate BMI.
• provides nutrition counseling for all obese women and encourage them to pursue a program exercise. This will continue after the baby is born and before attempting another pregnancy.
• Consider screening obese pregnant women gestational diabetes during the first quarter and repeated later in pregnancy if initial screening is negative.
• Discuss the possible complications of pregnancy such as the difficulty in estimating fetal weight and obtaining the fetal heart rate.
• - Suggest that patients consult an anesthesiologist prior to delivery or at the latest, in early labor because they are at high risk of emergency cesarean.

To fight against obesity, more people are turning to bariatric surgery. But after the surgery, many patients who later become pregnant can see a number of complications such as gastrointestinal bleeding, anemia, delayed intrauterine growth, prematurity and congenital neural tube defects. Surgery can also cause iron deficiency of vitamin B12, folic acid and calcium. In addition, pregnancies after bariatric surgery are often less likely to be complicated by gestational diabetes, hypertension, macrosomia (large babies), and cesarean delivery.

"Because we are only beginning to learn about the risks and the upside could be, is a balancing act for doctors and patients, Dr. Dickerson said. "Patients need to proceed with caution, because they really have not had enough experience but with this power draw firm conclusions. "

ACOG recommendations for obese patients who are pregnant or planning to conceive include having a pre-design consultation and tips for losing weight, looking for information about the risks of obesity and pregnancy, and ongoing nutritional advice and programs exercise after childbirth.

What is the reaction of the doctor?

In most pregnancies, so good.

Up to 25% of pregnancies are not routine. Some problems are small and have no long-term effects, others, such as childbirth premature and maternal hypertension (high blood pressure) may endanger the life of the mother, baby or both. screening procedures and current monitoring is useful, but doctors can not always predict or prevent all complications of pregnancy.

A report Today the bonds of a series of problems in pregnancy with one condition, overweight preventable. The risk of problems during the pregnancy is increased among women who are obese (body mass index, or BMI of 25-30) compared to women who are not, and risks are more greater among women who are obese (BMI of 30 or more.)

Overweight and obese women are at increased risk of:

• hypertension Gestational (high blood pressure in pregnancy)
• gestational diabetes (blood glucose increase during pregnancy)
• Pre-eclampsia (leg swelling, blood pressure and kidney disease) or eclampsia (Symptoms similar to preeclampsia, convulsions or coma)
• Caesarean
• excessive bleeding or infection after caesarean
• miscarriage
• birth to a baby with abnormalities of the spinal cord (called neural tube defects)
• birth to a baby is premature or stillborn
• control problems of the health of the child (such as detection of fetal heart rate and calculate the fetal size)

Studies also suggest that children whose mothers were obese during pregnancy have a higher risk the average for childhood obesity.

Obstetricians and gynecologists take note, especially since the incidence of obesity is increasing. According to experts, this important first step: to speak. While doctors regularly review and recommend tests to a number conditions during pregnancy (including German measles, HIV, hepatitis B, syphilis and gonorrhea) is much less common for women pregnant and their doctors to focus on excess weight. These new guidelines aim to change this situation.

What Can I change to do now?

Calculate your body mass index and work hard to avoid excess weight. Although it is generally preferable to have a BMI of less than 25 years, is particularly important to keep it below 30. Talk to your doctor before pregnancy and what you can do to lose those excess pounds. There is no way that works for everybody, but weight loss programs more successful caloric restriction combined (Including the moderation of portion size) and exercise for the phasing and steady weight loss. If your weight is ideal, ask to your doctor about nutritional advice and exercises you can do before, during and after pregnancy.

Whatever your weight before pregnancy weight gain during pregnancy is expected and encouraged, but but for your health and your baby, excessive weight gain should be avoided. Under the current guidelines for weight gain during pregnancy should be routine 25 to 35 pounds, however, women who are obese should aim for a weight gain of 15-25 kg and obese women should aim for a weight gain of 15 pounds.

Despite the risks associated with obesity during pregnancy, I would not recommend bariatric surgery (such as stapling "belly") for all obese women considering pregnancy. Well Some risks can be reduced by profound weight loss, others may increase (eg vitamin deficiency, or intestinal bleeding) - we we need more information about this approach before it can be routinely recommended.

What I can expect a future prospect?

Because the incidence of obesity is increasing dramatically in this country, you can expect a dramatic increase the number of women who become pregnant are overweight or obese. And that means you can expect an increased incidence of complicated pregnancies and deliveries. Sensitize Impact of weight a woman in her pregnancy is an important first step, but only time will tell whether this awareness translates into effective action.

You can expect to researchers curricula that work best to fight against excess weight before pregnancy (including including the option of bariatric surgery) and how best to manage the complications they arise.

In the future, doctors may measure the BMI of more regularly for women planning a pregnancy and to know their patients real risks associated with overweight. It is also likely that doctors recommend the wider review of women overweight or obese who are pregnant so that problems are detected soon as possible. Finally, you can expect referrals for nutritional counseling and exercise programs to become part of routine practice obstetrics.

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