Obesity During Pregnancy

Pregnancy, even for “healthy” women, can be difficult. Being overweight or obese adds another risk factor to this complex process.


Pregnancy, even for “healthy” women, can be difficult. Being overweight or obese adds another risk factor to this complex process. In a 2003-2004 National Health and Nutrition Examination Survey, it was estimated that 66% of adults in the United States were either overweight or obese, a figure that is expected to increase (Centers for Disease Control). Individual health risks of being overweight or obese include high blood pressure, coronary heart disease and the potential development of Type II diabetes. Coupled with pregnancy, weight issues carry harmful effects not only for the mother, but they can also impact fetal development. Given the current rise in obesity rates, not only in the United States, but worldwide, nurses need to be aware of pregnancy risks with maternal obesity and should educate women about safe weight gain, nutrition, and pre-pregnancy considerations, to prevent unwanted pregnancy outcomes that can develop from maternal weight issues.
Obesity is associated with numerous health risks for women in all stages of life. During pregnancy, this condition carries with it increased risks of pregnancy induced hypertension, pre-eclampsia, and gestational diabetes mellitus (GDM) (Villamor and Cnattinguis, 2006). During the second half of pregnancy, increased fetal nutrient demands and maternal nutrient ingestion result in higher levels of maternal blood glucose which in turn can lead to maternal insulin resistance (Wong, Perry, Hockenberry, Lowdermilk, Wilson, 2006). During a “normal” pregnancy maternal insulin production increases to compensate for this resistance. When the pancreas is unable to produce sufficient insulin or there is ineffective insulin use, gestational diabetes may result. Obesity increases insulin resistance leading to an even greater risk of GDM. GDM not only affects pregnancy but can result in increased trauma during labor and delivery (Wood, 2004). Macrosomia (large for gestational age), resulting from insulin resistance, puts a woman at an increased risk of perennial lacerations and the need for episiotomy (Wong et al, 2006). Many LGA infants require a cesarean section to be born, placing the mother at increased risk of infection due to impaired skin integrity. Shoulder dystocia is a common birth trauma for the LGA infant delivered vaginally. Educating women on the risks they will face during pregnancy is the first strategy nurses should use.
The next strategy is to educate parents about the risks of obesity to the fetus. Maternal obesity not only affects maternal health, but may also affect the development of the fetus. Maternal obesity before birth has an increased correlation with unwanted pregnancy outcomes, especially neural tube defects such as spina bifida (Watkins, Rasmussen, & Honein, 2003). An association is also indicated between obesity and a risk for omphlocele, heart defects like left ventricular outflow, and infants with multiple anomalies (two or more unrelated birth defects). Metabolic changes, such as hyperglycemia or increased hormone levels, impact fetal growth and development. Furthermore, prepregnancy and prebirth nutrition in obese and overweight woman may be deficient compared to average weight women. Overweight woman have increased requirements for certain nutrients including folic acid, which protects against birth defects. Lack of folic acid increases the risk for neural tube defects. Neonates born to mothers with gestational diabetes have an increased risk for hypoglycemia, hypocalcemia, hyperbilirubinemia, and respiratory distress syndrome (Wong et al, 2006).
In an effort to further prevent unwanted pregnancy outcomes, education of reproductive age women about nutrition and healthy weight gain should be another strategy used by nurses and other health care providers. It is recommended that weight gain is approximately 3 to 6 pounds during the first trimester and 6 to 12 pounds for both the second and third trimesters (Wood, 2004). Weight loss during pregnancy is not advised, as woman, even those who are overweight or obese, need to gain at least enough weight to equal the products of conception (Wong et al, 2006). Furthermore, limiting caloric intake during pregnancy also limits nutrient intake. It should be stressed to pregnant women that they should not eat more than they feel they need to despite the fact that they are told they are “eating for two.” Pregnant women have a recommended intake of 60 grams of dietary protein per day and should eat plenty of fruits and vegetables, which are low in calories but satiate the appetite for longer periods of time. When choosing grain products they should try to eat whole grain products and avoid high glycemic foods such as white bread, cookies, sugary cereals, and other empty calories. Moderate exercise, recommended to control weight during pregnancy, can also lower blood sugar levels and should be an intervention for women with GDM.
Obesity may increase birth complications up to 200% (Villamor and Cnattingius, 2006). Along with interventions for obese women who are pregnant, a final, but perhaps the most important strategy, if for nurses to encourage woman to achieve a healthy weight before becoming pregnant (Watkins, Rasmussen, & Honein, 2003). A study in the American Journal of Perinatology found that prepregnancy obesity and weight gain of more than 34 pounds both significantly increase the risk of adverse pregnancy outcomes. The results of the study support other reports by the Institute of Medicine, which recommend education during preconception with regard to the importance of optimal BMI at the start of pregnancy (Obesity Risk Factors, 2007).
Through education and encouragement of healthy lifestyles, nurses can improve the outcomes of pregnancy for all women, especially those at increased risk, such as women with obesity. By reducing negative outcomes, nurses not only improve the future well being of infants but they are also improving the quality of life of mothers, insuring a healthier life with their new child. Lastly, family life altogether will be improved as the cost of health care for both mothers and children will be reduced due to their improved health status and their reduced risks for other complications in life.


Centers for Disease Control (2007) Overweight and Obesity Trends Among Adults. Retrieved October 23, 2007, from http://www.cdc.gov/nccdphp/dnpa/obesity/trend/index.htm

Obesity Risk Factors; New Obesity risk factors findings from N.J. Jain and co-researchers published. (2007, August). Women’s Health Weekly, 171. Retrieved November 26, 2007, from Proquest database.

Villamor, E. and Cnattingius, S. (2006). Interpregnancy weight change and risk of adverse pregnancy outcomes: a population-based study. The Lancet 368(9542), 1164-1170. Retrieved April 12, 2007, from Expanded Academic ASAP database.

Watkins, M., Rasmussen, S., Honein, M. et al (2003).Maternal obesity and risk for birth defects. Pediatrics, 111(5), 1152-1158. Retrieved April 21, 2007, from Expanded Academic ASAP database.

Wong D., Perry S., Hockenberry, M., Lowdermilk, D., and Wilson, D. (2006) Maternal Child Care Nursing Third Edition. St. Louis, Missouri: Mosby Elsevier.

Wood, S. (2004). A weighty issue. Baby Talk, 69(3), 54-58. Retrieved April 12, 2007, from Proquest database.


Intervention 1: Educate women about the risks of obesity on fetal development
Disadvantage 1: Not all women seek prenatal care.
Despite increased access to prenatal health care, several factors including; socio-economic status, language barriers, and knowledge deficits, prevent many woman from seeking prenatal health care. In a 2002 study only 68% of black non-Hispanic and Hispanic women received early and adequate prenatal care compared with 79% of white non-Hispanic women. A study specific to pregnant women on Medicaid found that only 20% to 42% of minority women received private care, where as 52% of white women did. The ability to find prenatal care also varies based on proximity to health care providers. Generally, fewer health care providers are found in rural areas, requiring that pregnant women in rural areas travel outside their county to obtain needed services. Limited access to private health care decreases the likelihood of women following up with a health care provider (Adams, Gavin, And Benedict, 2005).
Adams, E., Gavin, N, and Benedict, M. (2005). Access for Pregnant Women on Medicaid: Variation by Race and Ethnicity. Journal of Health Care for the Poor and Underserved, 16(1), 74-95. Retrieved February 5, 2008 from Proquest database.

Disadvantage 2: Education alone does not guarantee change.
Despite an increasing awareness of the growing obesity epidemic and its causes, promoting public health requires more than simply educating the public about the risks of obesity. Educating about risk factors does not guarantee that women will be motivated to make life-style changes that can reduce the risks associated with obesity and pregnancy. Furthermore, while it is important that woman know the risks of obesity and their pregnancy, this information can result in increased psychological stress. Rather than educate about risks, the focus should be on promoting small life-style changes that can improve the health of pregnant women, such as a healthy diet and physical activity (Obesity research, 2007)

Obesity Research; Getting people to move is one of the challenges in promoting physical activity (2007, January 13). Obesity, Fitness & Wellness Week, 6. Retrieved February 4, 2008, from Proquest database.






Intervention 2: Encourage women to achieve a healthy preconception weight.
Disadvantage 1: Conception is not planned in all cases.
The time before a woman becomes pregnant is crucial to reducing the risk of birth defects, however, nearly half of all pregnancies are unintended. Limited access by many women to health care prevents regular access to a health care provider prior to conception. Furthermore, as advanced prenatal care has improved maternal and infant health, preconception care has slowed (Prenatal Care; Preconception, 2006).
Prenatal Care; Preconception care crucial to improving maternal and infant health (2006, October 22). Medical Letter on the CDC & FDA, 86. Retrieved February 4, 2008, from Proquest database.

Disadvantage 2: Delaying pregnancy may place women at other risks for future pregnancy.
In the developed world, an increasing proportion of births are attributable to women of advanced maternal age. Advanced maternal age has been associated with an increased risk for stillbirth. For women who are obese and of an advanced maternal age, delaying pregnancy to achieve a healthy preconception weight may negate the beneficial effects of weight loss. “Prepregnancy counseling for patients who delay childbearing into their late 30s may be too late to inform decisions about preventing pregnancy risks” (Benzies, 2008).

Benzies, K. (2008). Advanced maternal age: Are decisions about the timing of child-bearing a failure to understand the risks? Canadian Medical Association Journal, 178(2) 183-184. Retrieved February 5, 2008, from Proquest database.