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Big Moms, Big Problems

For Obese and Overweight Women, Pregnancy Ups Risks To Selves, Babies

By Suz Redfearn
Special to The Washington Post
Tuesday, February 22, 2005; Page HE01

Tonja Schnelle's first pregnancy was progressing normally -- until she hit 32 weeks.

Then the Belair, Md., resident was diagnosed with preeclampsia -- pregnancy-induced hypertension -- that put her child at risk. Schnelle, considered obese at 190 pounds with a body mass index (BMI) of 30 before pregnancy, was put on bed rest. The plan was to deliver the baby early.

After losing a pregnancy 15 months ago to preeclampsia, a condition associated with obesity, Tonja Schnelle of Belair, Md., has worked to control her weight during pregnancy this time around. (Grant L. Gursky For The Washington Post)

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But just before Schnelle's scheduled cesarean section at 37 weeks, she felt explosive pain high in her abdomen. Monitors showed that the baby's heartbeat was dropping precipitously.

The last thing Schnelle remembers was doctors searching frantically for a fetal heartbeat. While they rushed to operate, the placenta ripped away from the wall of the uterus, cutting off the baby's oxygen and causing Schnelle to hemorrhage. When Schnelle awoke from anesthesia, the baby girl had died.

"I was stripped of motherhood," said Schnelle, now 30. "It was devastating." Fifteen months later, Schnelle is again expecting a girl. This time Schnelle is working hard to reduce risk factors for preeclampsia. At 18 weeks, she saw a nutritionist who prescribed a 2,000-calorie-a-day diet spread out among six healthy meals. Schnelle is also making an effort to be more active.

"Weight is one of the major risk factors for preeclampsia and one of the few things you can do something about," said Schnelle emphatically. "So you have to do everything you can to control it."

Somehow, the spotlight on the national obesity epidemic has missed its powerful impact on one particular subgroup -- women expecting a child. Experts estimate that of the 6 million U.S. women who are pregnant at any given time, about 3 million are overweight or obese. These women are at increased risk for preeclampsia, gestational diabetes and cesarean sections, and their offspring are more likely to be obese themselves. The babies are also more likely to be born prematurely, to have birth defects or to be stillborn.

While few major public health efforts have addressed the issue to date, the problem is recognized as a serious one.

"[Obesity] has a major impact on pregnancy outcomes," said Laura Riley, director of obstetrics and gynecology and infectious disease at Massachusetts General Hospital and assistant professor of obstetrics and gynecology and reproductive pathology at Harvard Medical School. "It's a hugely important medical problem."

Packing It On

At a time when 65 percent of U.S. adults are overweight (defined as having a BMI of 25 to 29.9) or obese (a BMI of 30 or higher), according to the Centers for Disease Control and Prevention (CDC), it's not surprising that many women of childbearing age would be affected. But the size -- and cost -- of the impact are daunting.

More than half of all women age 20 to 39 are overweight or obese, according to 2001-2002 data from the National Health and Nutrition Examination Survey (NHANES), which since 1960 has measured overweight in the U.S. population.

Add unrestricted food intake during pregnancy to that, and you have women exposing themselves to serious risks. The Institute of Medicine recommends that women of a healthy weight gain 25 to 35 pounds during pregnancy, that overweight women gain 15 to 25 pounds and that obese women gain no more than 15 pounds. The longstanding advice to "eat for two" was revoked by the American College of Obstetricians and Gynecologists (ACOG) in 1982. In 2002, according to the CDC, 21 percent of all pregnant women gained 40 pounds or more with their pregnancies. That's up from 15 percent in 1989.

A recent study by the University of North Carolina and the National Institute of Child Health and Human Development found that 69 percent of healthy-weight women gained "excessive" amounts during their pregnancies; among overweight women, the figure was 85 percent; among the obese, 79 percent.

"The timing on this couldn't be worse," said Riley. "It dovetails with the disturbing obesity epidemic and unhealthy foods being super-sized."

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