Weighing the Risk

Another emerging consequence of the obesity epidemic is the increase of high-risk pregnancies

Smokers who had resigned themselves to being stuck an unbreakable habit have sometimes been surprised to find that pregnancy finally gave them the strength to ditch their old ways forever. Today that unique, selfless resolve to do what is best for the coming child is needed more than ever for those suffering from obesity.

“Maternal weight is an important predictor of fetal outcome,” says perinatologist Wilbert Fortson, Jr., MD. (Perinatology is an obstetrical subspecialty focusing on higher risk pregnancies.) “Obesity can increase the risk of several things, including an overly large fetus, the need for a C-section, birth trauma, and even stillbirth.”

Wilbert Fortson, Jr., MDThough the research is still underway, there is another troubling trend seen in pregnant women who are obese—fetal birth defects.

“It is not yet clear why, but these patients have a 3 to 4-times higher risk for birth defects than those within a healthy weight range,” Fortson says.

Dr. Fortson believes that obese women who want to get pregnant should seriously consider a weight-loss program or other intervention before trying to conceive. Such a step usually involves a time commitment that can cause concern in women who are approaching or have already passed the starting line for advanced maternal age. But since both conditions place the patient at the same increased risk, weight reduction is still recommended to avoid compounding the problems that advanced maternal age can create.

“Patients have to weigh the risk of being obese compared to their age and the odds of getting pregnant,” Fortson says. “Both conditions increase the chance of the mother developing diabetes or hypertension disorders.”

For obese women who are already pregnant, there are still ways to work towards a successful outcome. The focus is on limiting the additional weight gain during the pregnancy.

“The patients should not necessarily diet, but we do want to limit weight gain to between 10 and 20 pounds throughout the entire pregnancy,” Fortson says. “That’s the bottom line.”
 
Coping with the high anxiety of being high risk

The words “high risk” invoke a labor pain all their own—the anxiety that comes with such a diagnosis. One of Dr. Fortson’s primary goals in dealing with high risk patients is managing their anxiety level, and patient education is one of his most effective tools in this regard.

“One message that I want to communicate to women is that the selection criteria for being high-risk includes any pregnancy that puts the mother or the baby at an increased risk for adverse outcomes,” Fortson says. “Simply put, that’s a lot of different things.”Weighing the risk

Dr. Fortson assesses patients according to different risk stratifications, depending on the woman’s disease state or the specific complication with the baby. But no matter what level of risk the patient is placed in, the physician will have a plan ready to address it.

“Some patients are very high-risk and need a lot of input, which we are able to provide through co-management of the problem with the OB/GYN,” Fortson says. “Others only need a one-time consultation, where we let them know about particular problems they need to look for. A follow-up visit with us isn’t always necessary for a successful pregnancy.”
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