This is a summary of an article on excess weight in pregnancy authored by Rooney Brenda and Charles Schauberger in 2002. The authors explore how nutrition and physical activity and how these parameters complement one another to influence the overall outcome of both the mother and the growing fetus. The article does not only focus on how this topic underpins broader social health determinants in among but also offers and critiques how larger influences of environmental public health achieve equity or inequalities in the domains of life science issues within this population.
According to this article, obesity connotes a condition in which the ratio of weight in kilograms and Height in meter squared yields ≥30 (Rooney & Schauberger, 2002). Further classifications of obesity give an obese class I (BMI of 30-34.9), obese class II (BMI of 35-39.9) and obese class III (BMI of ≥40). The authors emphasize that use of BMI classification is one of the simplest and easiest methods of determining an individual nutrition status, and health status so to speak. It is important to note that BMI, however, has some limitations particularly in highly active people such as athletes whose BMI is not necessarily reflective of their nutrition/health status. The weight gain in athletes is as a result of mass muscle increment but not fat mass (Malina, 2007).
Obesity and Maternal Complications
Maternal obesity predisposes women to various pregnancy complications such as preeclampsia, gestational diabetes mellitus, and cesarean delivery. Excessive weight gain in the course of pregnancy and its retention postpartum puts women at higher risks of obesity later in life (Rooney & Schauberger, 2002). The excessive weight during pregnancy can influence a pregnant woman’s health status, which will in turn influence the utero environment of the growing fetus in a negative manner leading to fetal developmental problems and undesirable health consequences of the child later in life (Leddy, Power, & Schulkin, 2008).
There is a strong link between the first trimester in obese mothers and obesity in the children they carry. In a study done by Whitaker (Whitaker, 2004), results indicated that likelihood that the unborn child will be obese during the first trimester is 2, 1.7-2.3 by the time child is two years, 2.3 at three years, 2.3 by the fourth year. The birth of the child also been shown to have a link to the BMI during adult life (Oken & Gillman, 2003).
It is quite obvious that there are mechanisms that are behind these relationships. The first school of thought postulates that utero fetal programming responds highly to nutritional stimuli. The growing fetuses develop an adaptation to the supply of nutriments via the placenta, whether in abundant, overabundant or in deficit. Whatever the case, it is believed that that the adaptations may permanently alter the physiology and metabolism of the unborn child even in later stages of life (de Boo & Harding, 2006). The changes which are programmed during prenatal development are linked to the genesis of an array of diseases and conditions that may be present later in life including heart conditions, high blood pressure, non-insulin dependent diabetes and systemic inflammation and faster aging; to mention just but a few. Though unconfirmed, it is feared female children born to obese women are highly likely to become obese and even have obese descendants (World Health Organization, 2000).
Impact of Obesity on Obstetric Outcomes
Most women are best assessed between the 18th and 22nd weeks of pregnancy for the fetal morphological features. The ability of the sonographer to carry out a good evaluation is influenced maternal size. Nearly 15% of the visible structures will appear suboptimally when the BMI is slightly more than the 90th percentile. Women whose BMI is slightly 97.5th percentile, only 63% of the anatomical features are also seen. The fetal anatomical features including heart, spine, kidneys, and diaphragm are not usually seen by the sonographers. Therefore, the obstetric care process needs to take care of the BMI of the mother when planning for anatomic fetal assessment, particularly during the second trimester. The problem of fetal ultrasound in excessively obese mothers is further made difficult by the increased incidences of fetal abnormalities (Verschuren et al., 2009).
The study recruited a convenience sample of women during their first trimester. These women did have any complications at the time of recruitment. To reduce errors associated with self-reported weight gain, the women were weighed during each visit using the standard weighing machine. During each visit, the women completed surveys that targeted specific parameters before and after delivery. The main parameter of the study was weight gain since their first visit and the effects that accompanied the weight. Data collected was analyzed using SAS to determine frequencies and cross tabulations.
Results and Discussions
The results indicated that average weight gain before pregnancy and after postpartum was about 1.7 kg and 6.7 kg in the long term. The most important predictors of weight gain or loss at long-term as indicated long term follow-up included weigh gain during pregnancy, weight retention complementary feeding and the dietary habits of the mothers. The women who gained more weight that recommended during pregnancy showed higher chances of weight gain weight gain at long-run as opposed to whose weight was just average.
In conclusion, the authors recommended close monitoring of maternal weight gain during pregnancy through dietary and physical activity approaches. Keeping the weight in check has greater benefits including safe delivery, average postpartum weight and reduced risks of diabetes in pregnancy.
Malina, R. M. (2007). Body composition in athletes: assessment and estimated fatness. Clinics in sports medicine, 26(1), 37-68.
Oken E. & Gillman M. W. (2003). Fetal origins of obesity. Obesity Res. 11:496–506.
Rooney B. & Schauberger C. (2002). Excess pregnancy weight gain and long-term obesity: one decade later. Obstet Gynecol ;100:245–252.
Verschuren, L., Kooistra, T., Bernhagen, J., Voshol, P. J., Ouwens, D. M., van Erk, M., & Kleemann, R. (2009). MIF deficiency reduces chronic inflammation in white adipose tissue and impairs the development of insulin resistance, glucose intolerance, and associated atherosclerotic disease. Circulation research, 105(1), 99-107.
Whitaker R. C. (2004). Predicting preschooler obesity at birth: the role of maternal obesity in early pregnancy. Pediatrics. 114:e29–e36
World Health Organization. (2000). Obesity: preventing and managing the global epidemic (No. 894). World Health Organization.