Women who gain more weight than is recommended during pregnancy can increase the risk of serious complications during childbirth, according to a study involving more than half a million births in New York.
The researchers reported in Obstetrics & Gynecology that women who gained more than 20 pounds above the recommended amounts had significantly higher rates of heart failure, severe hypertension and requiring transfusion or ventilation. .
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"We have seen a surge. . . Maternal mortality in this country, and when we look at potentially modifiable risk factors, weight gain during pregnancy is a factor that can change throughout pregnancy, "said Marissa Platner, lead author of Emory Healthcare and from the Emory School of Medicine in Atlanta. Georgia.
In 2009, the National Academy of Medicine revised guidelines for weight gain during pregnancy based on body mass index in women before pregnancy (BMI, a weight / height ratio).
Women with normal BMI between 18.5 and 24.9 are encouraged to take between 25 and 35 pounds during pregnancy. Those with a BMI less than 18.5 should gain 28 to 40 pounds. Women who are overweight before becoming pregnant should earn less during pregnancy: 15 to 25 pounds for those with a BMI between 25 and 29.9 and only 11 to 20 pounds for those with an equal BMI or greater than 30.
In the United States, nearly half of pregnant women earn more than recommended, especially those who are overweight or obese before pregnancy.
"It's really important to optimize your nutrition, diet and exercise before you become pregnant, and then during your pregnancy," Platner said in a phone interview. "It's one of the most important things you can do to influence the outcome of your pregnancy."
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For the new study, researchers analyzed 515,148 unique births using data from 2008 in New York including information on pre-pregnancy weight and weight gain during pregnancy, as well as serious complications related to pregnancy. Childbirth such as procedures or death.
About one-quarter of the women had lower-than-recommended gains, one-third within recommended limits, another one-third gained 1 to 19 pounds more than recommended, and 8% took more than 20 pounds over recommended values for their BMI before pregnancy.
Overall, the rates of complications at delivery were higher in both groups whose weight gain was greater than the recommended range. For example, these women were nearly four times more likely to suffer from heart failure during a procedure and about two and a half times more likely to require ventilation.
"We found that the increase affected women of all weights for all pre-pregnancy weights," said Platner. "Many doctors and women focus on weight gain only in groups of overweight or obese people, but it is important that everyone talks about it and does not hide it because they are thin before pregnancy."
Women with pre-pregnancy BMI lower than normal had the highest risks with weight gain greater than the recommended range. However, apart from weight gain during pregnancy, the rates of serious complications were highest among women whose pre-pregnancy BMI was in the obesity range.
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Women and their doctors need to know these guidelines for gaining weight during pregnancy, said Dr. Michelle Kominiarek, a specialist in maternal and fetal medicine at Northwestern Medicine in Chicago, who was not involved in the study.
"A discussion of weight gain goals and methods for achieving these goals should be a priority for providers with their patients," she said by e-mail.
Platner and her team are looking for the best ways to talk to women about their diet and exercises during pregnancy. For example, a healthy increase in calorie intake is about 250 per day, she said.
"A healthy diet benefits both mother and baby," said Dr. Sarka Lisonkova of the University of British Columbia in Vancouver, who did not participate in the study.
"Pregnancy is an important motivator for starting or continuing a healthy lifestyle, including a well-balanced diet with lots of fruits and vegetables," Lisonkova said via e-mail. "This way of life should continue beyond pregnancy."