Doctors revise ‘eating for two’ mentality

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About one-third of women of reproductive age in the United States are obese, according to federal statistics, reflecting a growing trend that has prompted some health professionals to revise traditional advice about “eating for two.”

They now recommend healthy diets, little or no weight gain, and even bariatric surgery for obese women before they get pregnant.

“We see more of them (obese women) in the population that’s becoming or wanting to become pregnant,” said Maridee Shogren, clinical instructor and certified nurse midwife with the UND College of Nursing.

An estimated one in five pregnant women in the U.S. is obese, government data show.

They are at increased risk of miscarriage, high blood pressure, diabetes, pre-term delivery, stillbirth, delivery by cesarean section and other problems. Their babies are harder to see on an ultrasound and can be more difficult to deliver.

“It’s hard to get accurate readings with ultrasound and may be more difficult to get a good signal from fetal monitoring,” said Jenny Senti, perinatal clinical nurse specialist with Altru Health System in Grand Forks.

Health threats

Obesity puts women in a high-risk condition — such as high blood pressure, gestational diabetes and potential for a difficult delivery, she said.

At Altru Clinic, obstetrics personnel are seeing more high-risk patients.

“It used to be, years ago, that these women couldn’t get pregnant or were advised not to get pregnant,” Senti said.

“Now, we have more ways to better manage those conditions. Women who’ve had difficulty before, now can get assistance with getting pregnant.”

Preconception counseling can help obese women “to be in their best health to assure a healthy pregnancy,” she said.

Shogren said, “The United States does not do a good job of preconception care. We need to increase discussion with patients on matters such as healthy weight gain in pregnancy.”

Conventional advice for these women since 2009 has been to gain 11 to 20 pounds, reflecting guidance from the Institute of Medicine, the influential federal advisory panel. Normal-weight women are told to gain 25 to 35 pounds.

If the pregnancy is managed properly, many obese women do not gain weight and actually lose weight, said Dr. Robert Beattie, chairman of family and community medicine at the UND School of Medicine and Health Sciences.

Although obesity poses challenges in pregnancy, women who are obese can have healthy, viable pregnancies and births, he said.

Individualized care

“There always needs to be individualized care,” Shogren said. Patients should work with their health care providers.

“We want them to have a healthy diet, but we don’t want them to diet during pregnancy.”

Pregnant women only need 300 more calories a day, she said, “and that’s after the first trimester.”

Many women don’t realize that their insurance could cover consultation with nutritionists or diabetes educators, she said.

Some women think they should start exercising when they get pregnant, Shogren said. “Actually we’d like to see an established exercise pattern in place before they become pregnant.”

For those obese patients who’ve undergone bariatric surgery, a banding procedure or gastric bypass, Shogren recommends delaying pregnancy for a year or a year-and-a-half.

People who’ve had those kinds of interventions are not in the healthiest condition; the body needs to stabilize before pregnancy, she said. “Those procedures change the diet so severely…

“Sadly, some (women) do gain a lot of weight” after surgery, she said.

“We’d like to have a stable weight pattern for a good three months before they get pregnant. That’s the healthiest approach.”

Bottom line: education and appropriate health care are critical to a successful pregnancy, she said.

It’s important that obese women have preconception counseling, prenatal care and post-partum care, she said.

Her field, midwifery, views post-partum as a full year in duration, not just six weeks, as commonly thought.

“There’s been a major change to your body. Your whole life has been changed.”

Meredith Cohn of The Baltimore Sun contributed to this article. Call Knudson at (701) 780-1107; (800) 477-6572, ext. 1107; or send e-mail to pknudson@gfherald.com.

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