The Centers for Disease Control and Prevention (CDC) recently reported (Callaghan et al, Obstetrics & Gynecology, Nov 2012) that serious complications during childbirth such as heart attack, stroke, hemorrhage, and kidney failure are up 75% (yes SEVENTY FIVE PERCENT) in 2008-2009 compared to a decade ago. Post delivery complications rose 114% (one hundred fourteen percent) in the same time frame.
In one of the richest nations in the world, with ready access to prenatal and delivery care, how could this be?
Some of this may be due to advances in healthcare that allow women with serious medical conditions, such as congenital heart defects to survive long enough to have children.
However, experts believe that many of these complications may be self-inflicted. Although women are having babies at older ages and advancing age does increase the risks of pregnancy, far greater risks result from women having babies who are not healthy. One of the most prevalent health issues affecting Americans today is excess weight and obesity, which has reached epidemic proportions in almost all demographic groups, including women of child-bearing age. Over 50% of Americans are overweight and over a third meet the medical definition for obesity. These numbers have increased dramatically – almost doubling – in the last decade.
Although some of childbirth risks may be due to laudable advances in medical technology, for example, technology that helps previously infertile people to conceive, or technology that allows cancer survivors to have a family, etc, much of the increased risks may be avoided if Americans took their own health much more seriously.
The Institute of Medicine guidelines for weight gain during pregnancy recommends no more than 25 pounds of weight gain through the entire pregnancy for women who conceive at a normal weight. On the other hand, for women who are overweight, the IOM recommends no more than 11 to 20 pounds of weight gain. In my own practice in New Jersey, the average weight gain I have seen in our patient population is approximately 40 to 50 pounds. Overweight women who become pregnant will have a significantly higher risk for miscarriage, birth defects, diabetes, high blood pressure and potentially complications of the heart and the kidneys. Hemorrhage during childbirth is significantly greater in obese women and is birth injury to the child, the rate of cesarean section and even, neonatal death.
A recent study on autism demonstrated a link between maternal obesity and autism (Krakowiak et al. Pediatrics. May 2012). In addition, women with obesity have much more difficulty getting pregnant – with significantly higher rates of ovulatory infertility.
What can you do about your risks? Eat a healthy diet, get regular exercise, move closer to or maintain a normal weight. Other proactive measure – quit smoking and don’t hang out with people who smoke – second hand smoke can be deadly and is associated with infertility in both females and males. Get at least 100% of the RDA for folic acid- 0.4 milligrams a day or 400 micrograms a day. Taking a multivitamin is an easy way to do this. Women who are obese – a BMI over 30 – should consider taking higher doses of folic acid as their risk for a group of birth defects known as neural tube defects (spina bifida) is increased and higher doses of folic acid may lower that risk. This should be discussed with your doctor before taking higher doses.
Most women in the USA have healthy pregnancies and healthy babies, but there are things that we can do to improve our chances for a healthy pregnancy and lower our risks. The good news is that improving the health of your pregnancy will improve your short and long term personal health as well.
Copyright Serena H. Chen, MD 2012