Wednesday, December 21, 2011

Myths and Truths of Obesity and Pregnancy


Vitamins, Weight Gain, Preterm Birth and More

Ironically, despite excessive caloric intake, many obese women are deficient in vitamins vital to a healthy pregnancy. This and other startling statistics abound when obesity and pregnancy collide. Together, they present a unique set of challenges that women and their doctors must tackle in order to achieve the best possible outcome for mom and baby.

In the December issue of the journal Seminars in Perinatology, maternal fetal medicine expert Loralei L. Thornburg, M.D., reviews many of the pregnancy-related changes and obstacles obese women may face before giving birth. The following myths and truths highlight some expected and some surprising issues to take into account before, during and after pregnancy.

“I treat obese patients all the time, and while everything may not go exactly as they’d planned, they can have healthy pregnancies,” said Thornburg, who specializes in the care of high-risk pregnancies and conducts research on obesity and pregnancy. “While you can have a successful pregnancy at any size, women need to understand the challenges that their weight will create and be a partner in their own care; they need to talk with their doctors about the best way to optimize their health and the health of their baby.”

Myth or Truth?

Many obese women are vitamin deficient.


Forty percent are deficient in iron, 24 percent in folic acid and 4 percent in B12. This is a concern because certain vitamins, like folic acid, are very important before conception, lowering the risk of cardiac problems and spinal defects in newborns. Other vitamins, such as calcium and iron, are needed throughout pregnancy to help babies grow.

Thornburg says vitamin deficiency has to do with the quality of the diet, not the quantity. Obese women tend to stray away from fortified cereals, fruits and vegetables, and eat more processed foods that are high in calories but low in nutritional value.

“Just like everybody else, women considering pregnancy or currently pregnant should get a healthy mix of fruits and vegetables, lean proteins and good quality carbohydrates. Unfortunately, these are not the foods people lean towards when they overeat,” noted Thornburg. “Women also need to be sure they are taking vitamins containing folic acid before and during pregnancy.”

Obese patients need to gain at least 15 pounds during pregnancy.


In 2009, the Institute of Medicine revised its recommendations for gestational weight gain for obese women from “at least 15 pounds” to “11-20 pounds.” According to past research, obese women with excessive weight gain during pregnancy have a very high risk of complications, including indicated preterm birth, cesarean delivery, failed labor induction, large-for-gestational-age infants and infants with low blood sugar.

If a woman starts her pregnancy overweight or obese, not gaining a lot of weight can actually improve the likelihood of a healthy pregnancy, Thornburg points out. Talking with your doctor about appropriate weight gain for your pregnancy is key, she says.

The risk of spontaneous preterm birth is higher in obese than non-obese women.


Obese women have a greater likelihood of indicated preterm birth – early delivery for a medical reason, such as maternal diabetes or high blood pressure. But, paradoxically, the risk of spontaneous preterm birth – when a woman goes into labor for an unknown reason – is actually 20 percent lower in obese than non-obese women. There is no established explanation for why this is the case, but Thornburg says current thinking suggests that this is probably related to hormone changes in obese women that may decrease the risk of spontaneous preterm birth.

Respiratory disease in obesity – including asthma and obstructive sleep apnea – increases the risk for non-pulmonary pregnancy complications, such as cesarean delivery and preeclampsia (high blood pressure).


Obese women have increased rates of respiratory complications, and up to 30 percent experience an exacerbation of their asthma during pregnancy, a risk almost one-and-a-half times more than non-obese women. According to Thornburg, respiratory complications represent just one piece of the puzzle that adds to poor health in obesity, which increases the likelihood of problems in pregnancy. She stresses the importance of getting asthma and any other respiratory conditions under control before getting pregnant.

Breastfeeding rates are high among obese women.


Breastfeeding rates are poor among obese women, with only 80 percent initiating and less than 50 percent continuing beyond six months, even though it is associated with less postpartum weight retention and should be encouraged as it benefits the health of mom and baby.

Thornburg acknowledges that it can be challenging for obese women to breast feed. It often takes longer for their milk to come in and they can have lower production (breast size has nothing to do with the amount of milk produced). Indicated preterm birth can result in prolonged separations of mom and baby as infants are admitted to the neonatal intensive care unit or NICU. This, coupled with the higher rate of maternal complications and cesarean delivery – up to 50 percent in some studies – in obese women, can make it harder to successfully breast feed.

“Because of these challenges, mothers need to be educated, motivated and work with their doctors, nurses and lactation professionals to give breast feeding their best shot. Even if you can only do partial breastfeeding, that is still better than no breastfeeding at all,” said Thornburg.

Thursday, December 15, 2011

Majority take prescription drugs during pregnancy


Almost two-thirds of women in British Columbia filled at least one prescription at some point in their pregnancy, including drugs with potential risks, according to a new study by University of British Columbia researchers.

The study, published online today in the journal Clinical Therapeutics, is the first of its kind in Canada. Researchers analyzed population-based outpatient prescription claims data for patterns of prescription drug use during pregnancy in B.C. from 2001 to 2006.

The researchers found that 63.5 per cent of pregnant women in B.C. filled at least one prescription. One in thirteen – or 7.8 per cent – filled a prescription for a medicine known to be risky in pregnancy – most often for select medicines for anxiety, insomnia and depression. Drugs that are strictly contraindicated pregnancy, however, were filled in less than 0.5% of pregnancies.

“Although much remains to be understood about the appropriateness of medicine use that actually occurs among pregnant women in B.C., one encouraging finding from our study is that existing use of medicines with known risks declines dramatically when women become pregnant,” says co-author Steve Morgan, an associate professor in the School of Population and Public Health (SPPH) and Associate Director of the Centre for Health Services and Policy Research (CHSPR).

On average, pregnant women filled 2.6 different types of drugs, while 15 per cent used five or more prescription medications during their pregnancy. Prescriptions most frequently filled during pregnancy were for antibiotics (30.5 per cent), respiratory drugs (25.7 per cent), dermatologics (13.4 per cent), and drugs that act on the nervous system (12.8 per cent).

Other study findings include:

- The use of medicines in pregnancy slightly increased over time, going from 63 per cent of women in 2001 to 66 per cent in 2006.
- Women aged 20 years or younger were most likely to take prescription drugs during pregnancy (69 per cent) while the lowest rate occurred among those aged 30 to 35 years (62 per cent).
- Prescription medication use was also high in the first three months immediately following delivery, a period when women may be breastfeeding, with 61.3 per cent of women filling prescriptions.

“Since pregnant women are normally excluded from clinical trials of new drugs and post-market study is limited, there is little evidence on the risks and benefits of many of the most commonly used drugs in pregnancy,” says lead author Jamie Daw, a researcher at CHSPR, part of SPPH. “Given the prevalence of prescription drug use, more research is needed to help pregnant women and their physicians make informed decisions.”

Wednesday, December 14, 2011

Cold Medications in Pregnancy


Experts in pregnancy and breastfeeding health at the California Teratogen Information Service (CTIS) Pregnancy Health Information Line warn expectant moms about the potential dangers of common cold medicines during pregnancy. CTIS is a California non-profit housed at the University of California, San Diego that educates the public about exposures during pregnancy and breastfeeding.

"Every year around this time, we get a significant number of calls from pregnant and breastfeeding women in California who are battling colds and are worried about which meds they can and can't take," said Christina Chambers, PhD, MPH, professor of pediatrics at UC San Diego and CTIS program director.

"The callers I’ve personally spoken to have valid concerns because there are certain ingredients in over-the-counter medications they need to watch out for that could be harmful to their developing babies," explained Sonia Alvarado, CTIS supervising counselor who takes calls through the service’s toll-free hotline and online chat service. As a result of the potential for harm, Dr. Chambers and Alvarado have compiled a list of helpful tips for moms and moms-to-be battling colds this holiday season.

Top Five Cold Remedy Tips During Pregnancy:

1. Less is More. Remember that “less is more," or rather, less is more recommendable when it comes to treating colds during pregnancy. Take only those medications that are needed for your specific symptoms. Many cold remedies have three to six ingredients, some of which you (and your developing baby) do not need. If your major complaint is a cough, for example, then avoid a combination drug that includes a nasal decongestant, an extra medication you can do without.

2. Oral Decongestion Alternatives. While the majority of studies looking at oral decongestants during pregnancy are reassuring with first trimester use, it's still best to avoid them in the first trimester due to a possible very low risk for vascular issues in the fetus. Pregnant women could consider saline drops or a short-term nasal spray decongestant alternative.

3. Herbal Ingredient Warning. Watch out for herbal ingredients in many over-the-counter medications. Chances are they have not been studied in pregnancy.

4. Throat Lozenges and Vitamin Overload. Throat lozenges contain mostly sugar, however, some may contain other ingredients such as zinc or vitamin C. When taking vitamin C, the recommended daily allowance during pregnancy is 80-100 mg per day and zinc is only 11 mg per day.

5. Cough Syrups and Alcohol. Some cough syrups contain up to 10 percent alcohol. Get alcohol-free cough syrup. Your developing baby doesn’t need the alcohol exposure in addition to the other medications.