Plus-Size and Pregnant

Health Risks

Sharon Biddinger, 24, now pregnant with her second child, was almost 50 pounds heavier going into this pregnancy than she was the first time around. She attributes the weight gain after her first child to a lack of exercise and eating whatever she wanted. The extra weight really took a toll on Sharon emotionally. She would often inspire insensitive comments like, "When are you going to lose that baby weight?" "It was a horrible and depressing time," she says.

Sharon has since come to terms with the emotional side effects of her weight gain and the fact that her larger size has very real medical implications. At 198 pounds and 5 feet, 3 inches, Sharon is clinically obese. That diagnosis means this pregnancy carries a lot more risk than her first one.

A Growing Problem

You might think a diagnosis of obesity is reserved only for extreme cases. But according to the most recent National Health and Nutrition Examination Survey, 3 of 10 women are clinically obese, meaning they have a body mass index (BMI) of 30 or above. BMI, which is a measure of your weight in comparison to your height, is the tool doctors use to identify obesity. Sadly, the percentage of women entering pregnancy obese parallels the national statistic.

But while most women are keyed in to the emotional and aesthetic aspects of being plus-size and pregnant, few really understand the medical reality of obesity. "You can be shapely and healthy, but it is not possible to be obese and healthy," says Laura Riley, MD, medical director of labor and delivery at Massachusetts General Hospital, in Boston. "We are talking about a medical disorder that has major implications for 1) your pregnancy, 2) your fetus, and 3) your life," she says.

Risks to You and Your Fetus

According to a recently published article from the American College of Obstetricians and Gynecologists, during pregnancy, obese women have a higher risk for miscarriage, preeclampsia, gestational diabetes, and hypertension.

As a result, many also are more likely to need a cesarean delivery. When you have gestational diabetes, you are more likely to have a larger baby. "There is definitely an epidemic of babies getting bigger, and bigger babies mean more c-sections. It carries down," says Jacques Moritz, MD, director of gynecology at St. Luke's-Roosevelt Hospital Center, in New York City. Hypertension and preeclampsia also increase the chance of cesarean section. If the mother's blood pressure rises during delivery, she could suffer a stroke, and the baby could be deprived of his blood supply. To prevent these consequences, the doctor has no choice but to perform a cesarean, says Dr. Moritz.

Cesarean surgery also can be more complicated for an obese woman. Extra fat under the skin makes it more difficult to find the right placement for spinal anesthesia and harder to find a vein for an intravenous line, says Naomi Torgerson, MD, assistant chief of obstetrics and gynecology at Kaiser Permanente, in Richmond, California. It also is harder to transfer a heavy patient if she needs to be moved, a real problem in an emergency.

There also are serious risks to the babies, including a greater chance of neural tube defects, stillbirth, large-for-gestational-age, and higher rates of childhood obesity. The higher rate of neural tube defects may be due to poor nutrition, says Dr. Moritz. It is possible to be overweight and undernourished if you eat a lot of empty calories. And, he says, bigger babies are more likely to be stillborn.