Washington, DC—Alarmingly, more than half of all women of reproductive age in the United States are overweight or obese. In fact, obesity is the most common health care problem in women of reproductive age and the risks associated with obesity and pregnancy are significant. Management of these issues are challenging, relative to optimal weight gain, caring for obesity-related complications and postpartum weight control concerns. Today, as part of an ongoing effort to address the obesity epidemic and care for patients, the American College of Obstetricians and Gynecologists (ACOG) issued new recommendations focusing on obesity in pregnancy and physical activity during pregnancy and the postpartum period. Fighting obesity is also part of the ACOG Presidential Task Force set forth by Mark S. DeFrancesco MD, MBA, President of the College.
According to the new Practice Bulletin, "Obesity in Pregnancy," the possible complications associated with obesity and pregnancy are extensive for both mother and fetus. Obesity is associated with an increased risk of miscarriage, premature birth, stillbirth and having a baby with a birth defect. Obese pregnant women are at an increased risk of cardiac problems, sleep apnea, gestational diabetes, preeclampsia and venous thromboembolism (VTE), or blood clotting in the veins. The cesarean delivery rate is also higher for obese women, and cesareans pose greater dangers for obese women than for normal-weight women because of increased risks associated with anesthesia, excessive blood loss, blood clots and infection at the incision site. Moreover, the negative impacts on the fetus are long-term: obesity in pregnancy may cause the newborn to have a medically complicated life, because the fetus is directly impacted by maternal obesity.
The optimal control of obesity begins before conception. For obese women, even small weight reductions prior to pregnancy may improve outcomes. "Maintaining a healthy weight is important to overall health at all times, but it becomes a vital sign when a woman is pregnant or planning a pregnancy," stated Patrick M. Catalano, MD, who helped develop the guidelines. "Ob-gyns are often the only physician women see on a regular basis, therefore we are in the optimal position to help educate women on the importance of fighting obesity."
The revised Committee Opinion, "Physical Activity and Exercise During Pregnancy and the Postpartum Period," advises physicians to encourage their patients to maintain or adopt a healthy lifestyle before, during and beyond pregnancy. The most common risk of obesity in pregnancy is gestational diabetes. Exercise and judicious weight control in obese and overweight pregnant women help to prevent gestational diabetes and improve pregnancy outcomes. Exercise may also reduce the risk of preeclampsia and cesarean deliveries. The Committee Opinion offers more specific examples of safe physical activities during pregnancy, like modified yoga and Pilates, strength training, and running or jogging (see Box 3 of the Committee Opinion for more examples).
"Pregnancy should not be looked at as a state of confinement," stated Raul Artal, MD, the main author of the Committee Opinion. "In fact, it is an ideal time for lifestyle modification. That is because more than any other time in her life, a pregnant woman has the most available access to medical care and supervision." Dr. Artal is a member of a Medical Commission of the International Olympic Committee. The group is currently drafting guidelines for exercise in pregnancy and the postpartum period for elite Olympic athletes.
Practice Bulletin #156, "Obesity in Pregnancy," and Committee Opinion #650, "Physical Activity and Exercise During Pregnancy and the Postpartum Period," are published in the December issue of Obstetrics & Gynecology.
Other recommendations issued in the December Obstetrics & Gynecology:
Committee Opinion #648, Umbilical Cord Blood Banking
ABSTRACT: Once considered a waste product that was discarded with the placenta, umbilical cord blood is now known to contain potentially life-saving hematopoietic stem cells. When used in hematopoietic stem cell transplantation, umbilical cord blood offers several distinct advantages over bone marrow or peripheral stem cells. However, umbilical cord blood collection is not part of routine obstetric care and is not medically indicated. Umbilical cord blood collection should not compromise obstetric or neonatal care or alter routine practice for the timing of umbilical cord clamping. If a patient requests information on umbilical cord blood banking, balanced and accurate information regarding the advantages and disadvantages of public and private umbilical cord blood banking should be provided. The routine storage of umbilical cord blood as “biologic insurance” against future disease is not recommended.
Committee Opinion #649, Racial and Ethnic Disparities in Obstetrics and Gynecology
ABSTRACT: Projections suggest that people of color will represent most of the U.S. population by 2050, and yet significant racial and ethnic disparities persist in women’s health and health care. Although socioeconomic status accounts for some of these disparities, factors at the patient, practitioner, and health care system levels contribute to existing and evolving disparities in women’s health outcomes. The American College of Obstetricians and Gynecologists is committed to the elimination of racial and ethnic disparities in the health and health care of women and encourages obstetrician–gynecologists and other health care providers to engage in activities to help achieve this goal.
Committee Opinion #651, Menstruation in Girls and Adolescents: Using the Menstrual Cycle as a Vital Sign
ABSTRACT: Despite variations worldwide and within the U.S. population, median age at menarche has remained relatively stable—between 12 years and 13 years—across well-nourished populations in developed countries. Environmental factors, including socioeconomic conditions, nutrition, and access to preventive health care, may influence the timing and progression of puberty. A number of medical conditions can cause abnormal uterine bleeding, characterized by unpredictable timing and variable amount of flow. Clinicians should educate girls and their caretakers (eg, parents or guardians) about what to expect of a first menstrual period and the range for normal cycle length of subsequent menses. Identification of abnormal menstrual patterns in adolescence may improve early identification of potential health concerns for adulthood. It is important for clinicians to have an understanding of the menstrual patterns of adolescent girls, the ability to differentiate between normal and abnormal menstruation, and the skill to know how to evaluate the adolescent girl patient. By including an evaluation of the menstrual cycle as an additional vital sign, clinicians reinforce its importance in assessing overall health status for patients and caretakers.
The American College of Obstetricians and Gynecologists (The College), a 501(c)(3) organization, is the nation’s leading group of physicians providing health care for women. As a private, voluntary, nonprofit membership organization of approximately 57,000 members, The College strongly advocates for quality health care for women, maintains the highest standards of clinical practice and continuing education of its members, promotes patient education, and increases awareness among its members and the public of the changing issues facing women’s health care. The American Congress of Obstetricians and Gynecologists (ACOG), a 501(c)(6) organization, is its companion organization. www.acog.org