The obesity rate among women of childbearing age is increasing right along with the overall obesity rate. It’s estimated that in the United States, 23.6 percent of women between the age of 18 and 44 are obese. One out of every five women who give birth is obese.
Obesity Dangerous for Mother and Child
Obesity creates significant problems for women before, during, and after pregnancy.
Obesity can make it much more difficult for a woman to become pregnant, and once an obese woman does conceive, she is at a significantly higher risk for a wide range of serious complications. The most serious of these are preeclampsia, gestational diabetes, cesarean section, and post-partum infection. But obese women are also much more prone to lesser ailments like headaches, heartburn and chest infections while they are pregnant. They also have a three-times greater risk of a malady of the pelvic joints (symphysis-pubis dysfunction), which can make walking difficult.
Cesarean deliveries are notably more frequent among obese women, and mothers who are obese have a higher risk of death—they represent more than a third of pregnancy-related mortalities.
The children of obese mothers also face a number of increased health risks. In addition to the danger it presents for the mother, gestational diabetes puts the unborn child at risk for excess weight during development. This in turn can make it difficult to deliver the child vaginally, and increase the likelihood of a C-section. Obese pregnant mothers are more likely to have babies with heart defects, and their children are also at greater risk of neural tube defects like spina bifida and anencephaly. These children are also much 20 percent more likely to be obese themselves by the age of four.
Weight Loss Surgery Reduces Risks
Even minimal weight loss can radically reduce the risk of health problems during pregnancy. And while diet and exercise may be the ideal way to accomplish this, there is increasing evidence that obesity surgery also reduces pregnancy risks without increased complications.
Previous studies had indicated that diabetes and hypertension rates tend to drop quite dramatically after weight loss surgery (“Pregnancy Outcome of Patients with Gestational Diabetes Mellitus following Bariatric Surgery,” Richard N. Wissler, Obstetric Anesthesia Digest: September 2006 – Volume 26 – Issue 3 – pp 134-135.)
A 2008 research survey from the Rand Corporation’s Southern California Evidence-Based Practice Center has confirmed that weight loss surgery before pregnancy can lower the risk of health problems for both mother and child. The report, “Pregnancy and Fertility Following Bariatric Surgery,” summarized the findings of 75 studies and concluded that for women who had weight loss surgery:
- Fertility rates improved, making conception more likely following surgery.
- Gestational diabetes and preeclampsia rates were nearly as low as for women who had never been obese.
- Health problems in the child were even more greatly reduced: premature birth, low birth weight and excessive birth weight were all less prevalent than among obese women, and were in fact identical with non-obese control groups.
Lead author Melinda A. Maggard, M.D., concludes, “Obese women who undergo bariatric surgery and lose weight prior to becoming pregnant may improve their own health, as well as their children’s health.”
Medical experts agree that women should postpone pregnancy for 12 to 18 months following weight loss surgery. They also encourage women to include their bariatric surgeons in their prenatal care team, since obstetricians may not recognize some potential weight-loss connected complications. But despite some risks, the majority of women can have normal, successful pregnancies after bariatric surgery.
An abstract of the Rand study, “Pregnancy and Fertility Following Bariatric Surgery: A Systematic Review,” by Melinda A. Maggard, MD, MSHS; Irina Yermilov, MD, MPH; Zhaoping Li, MD, PhD; Margaret Maglione, MPP; Sydne Newberry, PhD; Marika Suttorp, MS; Lara Hilton, BA; Heena P. Santry, MD; John M. Morton, MD, MPH; Edward H. Livingston, MD; Paul G. Shekelle, MD, PhD. JAMA. 2008; 300 (19):2286-2296, is available here.