Key News in Family Medicine March 15, 2019 (7 of 7)

Women who gain more weight than is recommended during pregnancy may increase their risk of serious complications during delivery, according to a study of more than half a million births in New York, NY.

In particular, 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, researchers said on Wednesday. 1st of March Obstetrics and Gynecology.

"We have seen a huge increase in […] 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 Dr. Marissa Platner, lead author of Emory Healthcare and the Emory School of Medicine of Atlanta, GEORGIA.

In 2009, the National Academy of Medicine revised the guidelines for weight gain during pregnancy based on the body mbad index (BMI) of women before pregnancy. 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, the authors note. "It's really important to optimize your nutrition, your diet, and your physical activity before you become pregnant, and then during your pregnancy," Platner said during a phone interview. "It's one of the most important things you can do to influence the outcome of your pregnancy."

For the new study, the researchers badyzed 515,148 unique births using the 2008-2012 data from New York, NY, which included information on pre-pregnancy weight and gestational weight gain, as well as complications related to pregnancy. l & # 39; childbirth. About a quarter of women earned less than recommended, one-third in the recommended range, another third, 1 to 19 pounds more than the recommended dose, and 8%, more than 20 pounds above 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 this increase affected all women, regardless of weight, before pregnancy," said Platner. "Many doctors and women focus on gaining weight only in groups of overweight or obese people, but it's 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.

Women and their physicians need to know these guidelines for weight gain 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 to achieve 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 caloric intake is about 250 calories a day, she said. "A healthy diet benefits both the mother and the baby," said Dr. Sarka Lisonkova of the University of British Columbia in Vancouver, who did not participate in the program. study.

"Pregnancy is an important motivator to start or continue 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."

-Carolyn Crist