The Institute of Medicine, the health arm of the National Academy of Sciences, reported last year that more than a third of normal-weight women and more than half of overweight and obese women gain more weight than is recommended during pregnancy. Over all, “fewer than 40 percent of pregnant women gain only the recommended amount of weight during their pregnancy,” Dr. Sylvia R. Karasu and Dr. T. Byram Karasu report in their new book “The Gravity of Weight.”

Not ‘In the Genes’

While genes play a role in weight issues for some people, recent studies indicate thatgenetics is not the main reason babies are born too fat. Rather, the new evidence suggests that in addition to gaining significantly more weight than is recommended during pregnancy, more women now start out fatter before they become pregnant.

The latest study controlled for the effects of genetics by studying consecutive pregnancies among more than half a million women. The analysis, by Janet Currie, a health economist at Columbia University, and Dr. David S. Ludwig of Children’s Hospital Boston, found a consistent association between the amount of weight a woman gained during pregnancy and the birth weight of her babies.

Women who gained more than 53 pounds during a full-term pregnancy with one baby were more than twice as likely to have babies who weighed 9 or more pounds at birth than were women who gained only 18 to 22 pounds. For each kilogram (2.2 pounds) of weight gained by the pregnant mother, the baby’s birth weight increased by 7.35 grams (one-fourth of an ounce).

Because birth weight tends to predict body mass index later in life, “these findings suggest that excessive weight gain during pregnancy could raise the long-term risk of obesity-related disease in offspring,” the authors concluded in their report, published online in The Lancet on Aug. 5.

The analysis sought to rule out the effects of genetics on birth weight by comparing each married woman’s pregnancy weight gain and birth weight of her babies in successive pregnancies that occurred within a few years of each other (and thus were most likely to involve the same father). Although the authors did not know how much the women weighed before becoming pregnant each time, other studies have found that many women fail to lose all their pregnancy weight before they become pregnant again. Thus, they are likely to start out fatter and gain more during the next pregnancy.

In an accompanying editorial, Dr. Neal Halfon and Dr. Michael C. Lu of the Center for Healthier Children, Families and Communities at the University of California, Los Angeles, cited still another study, this one based on data gathered from parents and children in Britain. It found that at age 9, the children of women who had gained more weight than recommended by the Institute of Medicine were fatter than other children, more likely to become overweight, and had several risk factors for heart disease — including higher blood pressure and lower levels of protective HDL cholesterol — as well as poorer immune function.

This study, published in Circulation in June, found that a woman’s weight before pregnancy was even more important than excessive weight gain during pregnancy in predicting a number of risks for the baby: birth complications, excessive baby fat and “metabolic abnormalities associated with poor health outcomes, including childhood obesity,” as the editorial put it.

Dr. Halfon, a pediatrician, said in an interview, “The little changes in children’s metabolism tend to be compounded over time and become big changes in adults.”

The Recommendations

The latest recommendations from the Institute of Medicine, revised last year, suggest these pregnancy weight gains, as determined by a woman’s prepregnancy weight:

¶28 to 40 pounds for thin women, with a B.M.I. of 18.5 or lower.

¶25 to 35 pounds for normal-weight women, with a body mass index of 18.6 to 24.9.

¶15 to 25 pounds for overweight women, with a body mass index of 25 to 29.9.

¶11 to 20 pounds for obese women, with a body mass index of 30 or higher.

Dr. Lu, an obstetrician, said prepregnancy weights in nine states revealed significant increases in overweight and obesity between the periods 1993-94 and 2002-3. Even normal-weight women are now more likely to gain excessive amounts during pregnancy than were women who became pregnant in the 1990s, according to data from the national Centers for Disease Control and Prevention.

According to data from the National Center for Health Statistics, since 1990 proportionately more women have gained more than 40 pounds in a singleton pregnancy.

Higher Birth Weights

The new findings suggest that Americans are now caught in a vicious cycle of increasing fatness, with prospective mothers starting out fatter, gaining more weight during pregnancy and giving birth to babies who are destined to become overweight adults.

“There are a lot more high-birth-weight babies being born,” Dr. Currie said in an interview, “and this may have something to do with the increase in overweight we’re now seeing in the population over all.”

When I was pregnant 40-odd years ago, a normal-weight woman was expected to keep her pregnancy weight gain to within 24 pounds. But, Dr. Currie said, about 20 years ago the concern about too many babies with low birth weights may have prompted many doctors to be less restrictive about how much weight women gained while pregnant.

“We still see a lot of low-birth-weight babies, but the number of high-birth-weight babies has increased quite dramatically,” Dr. Currie said. “There’s no reason for a woman to gain more than 40 pounds with a single baby. We used to think babies in the womb were well protected, but we now know they are influenced by lots of things that will affect them later in life.”

She added, “The next frontier has to be the prepregnancy period. If we really want to improve the health of children, we have to get to mothers before they get pregnant.”

As Dr. Halfon said, “You can’t turn around in the nine months of pregnancy what’s been going on for many years of life. The preconception period is critical to placing pregnancy on a healthier trajectory.”

Personal Health – Gain in Pregnancy Is Linked to Weight Problems in Children – NYTimes.com.

Mothers often say they get confusing advice about exercise during and after pregnancy

Obesity levels among pregnant women have reached epidemic levels, putting the health of their babies at risk, experts say.

The health watchdog NICE has issued new guidelines encouraging women in England to attain a healthy weight before they get pregnant.

It also advises them against eating for two once they conceive.

It says almost half of women of childbearing age are overweight or obese, which could harm their child.

Many women feel they are offered confusing and conflicting advice about their health during pregnancy.

The guidelines from the National Institute for Health and Clinical Excellence are aimed at cutting through that. They discuss weight and exercise before, during and after pregnancy.

Celebrity culture

If a woman is obese during pregnancy, she has an increased risk of developing serious complications like pre-eclampsia, gestational diabetes, miscarriage and stillbirth. She is also more likely to have a Caesarean section.

“It can set a worrying example, by encouraging new mums to embark on drastic weight lost programmes, which are not only unrealistic, but can also be very unhealthy”

NICE says women with a body mass index of more than 30 should be encouraged to lose weight before they become pregnant. During pregnancy, losing weight can be harmful to the unborn child, so women are advised to eat healthily and to do gentle exercise.

After they have given birth, women are told they should lose their baby weight gradually. Experts from NICE say celebrities who regain their pre-baby figures very fast can put unrealistic pressure on ordinary mothers.

“Women should understand that weight loss after birth takes time, and physical activity and gradual weight loss will not affect their ability to breastfeed,” said Professor Mike Kelly, NICE public health director.

“Losing weight gradually can actually help women maintain a healthy weight in the long term.”

NICE also wants local authorities to offer women more opportunities to exercise, at an affordable price, and with creches for their children.

“There’s been an exponential increase in obesity among pregnant women,” said Professor Lucilla Poston, from King’s College, London, who helped develop the guidance. “It’s very worrying, as there are so many potential risks for the mother and her baby.”

The National Childbirth Trust welcomed the move to bring clarity to the issue. Chief executive Belinda Phipps said women were presented with a lot of conflicting advice about exercise.

“It can set a worrying example, by encouraging new mums to embark on drastic weight lost programmes, which are not only unrealistic, but can also be very unhealthy,” she said.

Professor Sir Sabaratnam Arulkumaran, president of the Royal College of Obstetricians and Gynaecologists, said he hoped the new guidelines would be actively promoted by the government.

“We need to support women who are overweight by encouraging them to lead healthier lifestyles. This includes providing them with advice on diet, nutrition and exercise.

“These healthy behaviours should occur throughout a woman’s lifetime and not just when she is considering starting a family or during pregnancy.”

via BBC News – Overweight pregnant women are target of new guidelines.

Overweight women should slim down and have counselling before they get pregnant because being fat poses such a serious risk of them having a premature baby, doctors warn today.

Women carrying excess weight have up to a 30% greater chance of having a baby before it reaches 37 weeks gestation, medical researchers in Canada write in todays British Medical Journal. Premature babies are at much higher risk of dying or suffering a range of illnesses and impairments.

Those who are overweight or obese have an extra 30% risk of having their child induced before 37 weeks, and have a 26% chance of delivering their baby prematurely before it reaches 32 weeks, according to a team of researchers led by Sarah McDonald, an associate professor in the maternal-fetal medicine department at McMaster University in Hamilton, Ontario.

“Ideally, overweight or obese women should have pregnancy counselling so that they are informed of their perinatal risks and can try to optimise their weight before pregnancy,” the authors say.”

Unlike many causes of pre-term birth, maternal overweight and obesity represent a potentially preventable cause of the leading source of neonatal mortality and morbidity and morbidity through childhood,” they add.British doctors who look after pregnant women, mothers and children said they backed the proposals.Professor Sir Sabaratnam Arulkumaran, president of the Royal College of Obstetricians and Gynaecologists, said:

“Maternal obesity is a public health concern as there are consequences for both mother and baby. For the mother, it could lead to cardiac disease, diabetes and pre-eclampsia as pregnancy can aggravate these conditions. These women should therefore receive obstetric care

.”Health professionals, including family doctors, need to work with overweight women to help them slim down before conceiving, added Arulkumaran, the leader of Britains 5,500 maternity care doctors.”We have said in our Maternity Standards document that pre-pregnancy counselling and support, both opportunistic and planned, should be provided to women of childbearing age with serious existing medical conditions including obesity BMI > 30″, he said.”This requires a multi-disciplinary approach with GPs and midwives to encourage women to achieve an appropriate weight level during the pre-conception stage.

It is something which needs to be handled sensitively but we need to point out to women the long-term benefits of a healthy lifestyle for them and their children.”However, the Royal College of Midwives suggested that mere exhortation of would-be mothers to keep their weight in check may not work.Janet Fyle, the unions professional policy advisor, said:

“There is a public health message that needs to be conveyed to women considering becoming pregnant, of the potential impact of being overweight when pregnant.”Of course midwives know that they need to provide women with the information and support about eating healthily and exercise in pregnancy. We can tell women about the right diet and exercise, but this has to be done within the context of their lives.”Can they afford the right food? Can they get access to gyms or swimming pools? There are social contexts to consider and one size does not fit all.”Tam Fry, of the National Obesity Forum, said: “It is absolutely crucial that a woman who is serious about childbirth gets herself into shape before conception. If she doesnt, she is running the risk not only of endangering her own health but also that of her intended child.

“Not only is it a tragedy to have to have a Caesarean section delivery if you are a very overweight woman, because its the safest way of getting the baby out, but it could adversely affect the childs health and be crippling to NHS maternity services.”

via Obese women should slim before conceiving | Life and style | The Guardian.

Children whose mothers developed diabetes while pregnant are at increased risk of being overweight by age 11, a new study shows.

The study also found that children born to obese mothers are more likely to have a weight problem than children born to lean mothers.

“The best advice is to get lean and fit before you get pregnant,” Dr. Lois Jovanovic of the Sansum Diabetes Research Institute in Santa Barbara, California, who was not involved in the study, told Reuters Health.

Earlier this week, First Lady Michelle Obama launched an action plan to combat childhood obesity. Number one in the list of recommendations was the need to stress the importance of starting a pregnancy at a healthy weight and maintaining a healthy weight throughout.

The new study, Jovanovic said, offers elegantly measured data to support this recommendation. “In order to prevent obesity in the next generation we have to do a whole lot for women in their childbearing years,” she said.

Diabetes that develops during pregnancy when there is no history of the disease is called gestational diabetes. Up to 8 percent of pregnant women will develop gestational diabetes. Being overweight, when combined with the “right” genes, is an important risk factor.

Children born to mothers with gestational diabetes are often heavier at birth than children born to mothers without pregnancy-related diabetes. In the current study, Dr. Sandra Hummel and colleagues at the Technical University of Munich, Germany set out to determine the impact of mom’s gestational diabetes and weight status on the child’s risk of being overweight in childhood and becoming “insulin resistant” — a precursor to full blown diabetes.

They examined data from two large German studies involving 1,420 children born between 1989 and 2000. Two hundred thirty-two children were born to mothers with gestational diabetes, 757 to mothers with Type 1, or “insulin-dependent,” diabetes and 431 to non-diabetic mothers. Blood samples and body measurements were taken several times until the children were 14 years old.

The researchers found that mother’s weight early in pregnancy was the strongest predictor of her child’s overweight status and resulting insulin resistance.

At age 2, 8 and 11, far more children of obese mothers were overweight than children of non-obese moms, the researchers report in the journal Diabetes Care. At age 11, for example, 46 percent of children of obese moms were overweight compared with 12 percent of children of non-obese moms.

Nearly a third (31 percent) of the children born to women with gestational diabetes were overweight by age 11 compared to less than 16 percent of the children of non-diabetic moms and moms with type 1 diabetes.

The fact that a mom was diabetic only partially explained her child’s tendency to be overweight. Adding obesity to the equation made a big difference leading the researchers to conclude that children born to obese women with gestational diabetes may be programed in the womb to be overweight and prone to type 2 diabetes.

The increased risk of being overweight seen in children of mothers with gestational diabetes (mainly seen in obese mothers) may be due to “a combination of genetic inheritance as well as prenatal programing,” Hummel noted in an email to Reuters Health.

Because of the nature of the data, the study could not speak to the role lifestyle played in childhood obesity. More study is needed to determine that, Hummel said.

“The environment (dietary habits and physical activity shared between mothers and offspring) may be an important risk factor, which we guess is much more pronounced in later childhood/adolescence,” she added.

Jovanovic said the study’s findings offer a clear message to doctors.

“You don’t want to tell an obese woman she can’t get pregnant but if a doctor has an opportunity to help her get lean and fit before she gets pregnant — that would be the best message from this paper,” she said.

via Combating childhood obesity may start in the womb | Reuters .

Using a database of births in New York State over a decade, researchers found that obese women were 11 percent more likely than normal-weight women to have a baby with a congenital heart defect.

Meanwhile, women who were morbidly obese — or about 100 pounds over their ideal weight — had a 33 percent higher risk than normal-weight women did.

Congenital heart defects are structural abnormalities of the heart that range from mild to life-threatening. The defects affect roughly eight in every 1,000 newborns, so, despite the relatively higher risk associated with mothers’ obesity, most infants born to obese women will not have a heart defect.

Still, the researchers say their findings should give obese women more incentive to lose weight before becoming pregnant.

“If a woman is obese, it makes sense for her to try to lose weight before becoming pregnant,” lead researcher Dr. James L. Mills, of the National Institute of Child Health and Human Development (NICHD), said in a written statement from the agency.

“Not only will weight loss improve her own health and that of her infant,” Mills said, “it is likely to have the added benefit of reducing the infant’s risk for heart defects.”

The study, published in the American Journal of Clinical Nutrition, used data from a New York State registry tracking birth defects. Mills and his colleagues identified 7,392 infants born with a heart defect between 1993 and 2003, and compared them with 56,300 unaffected infants.

Among newborns with heart defects, roughly 15 percent of mothers were obese before pregnancy, while 3 percent were morbidly obese. Those rates in the comparison group were 13 percent and just over 2 percent, respectively.

When the researchers accounted for other factors — such as mothers’ age, race, education level and smoking habits — obesity itself was still connected to the risk of newborn heart defects.

Women who were overweight, but not obese, before pregnancy showed no increased risk.

Exactly why maternal obesity is linked to newborn heart defects is not clear.

Diabetes, which is closely associated with obesity, is known to raise the odds of birth defects, Mills and his colleagues note. However, the researchers analyzed women with and without diabetes both separately and together, and the excess risk linked to obesity remained stable.

Mills and his colleagues speculate that the “wide range of abnormalities” obesity can produce — from alterations in sugar and fat metabolism to changes in hormone activity — may be at work. They say that future studies should also look at the potential roles of diet habits during pregnancy and genetics.

The study does not prove that obese women who lose weight before pregnancy will lower their newborns’ risk of heart defects. But for now, “it is reasonable to assume” such benefits, according to the researchers.

“The current findings strongly suggest that by losing weight before they become pregnant, obese women may reduce the chances that their infants will be born with heart defects,” Dr. Alan E. Guttmacher, acting director of NICHD, said in the statement.

Previous studies have established links between mothers’ obesity and certain pregnancy complications and newborn health risks — such as pregnancy-related high blood pressure and diabetes, and other types of birth defects, including malformations of the spine and brain.

In the U.S., an estimated 20 percent of women are obese when they become pregnant, according to NICHD.

via Mothers’ obesity tied to newborn heart defects | Reuters .

Obese or morbidly obese women are more likely to give birth to a baby who has a congenital heart defect than overweight or healthy women. That’s the conclusion of a new study conducted by researchers at the Eunice Kennedy Shriver National Institute of Child Health and Human Development.

Using data collected from all the women who gave birth in New York state (excluding New York City) from January 1, 1993, to December 31, 2003, the researchers found that mothers who were obese before becoming pregnant had a 15 percent increased risk of delivering a baby with a heart defect. There was no similar risk for women who were overweight.

“There are already a number of reasons why being obese is a bad thing if you’re trying to have children and this is one more important one,” says the study’s first author, Dr. James L. Mills, a senior investigator with the NICHD’s Division of Epidemiology, Statistics and Prevention Research.

“The more obese a woman was before she became pregnant, the greater her risk of having a baby with any congenital heart defects.”

The researchers looked at more than 7,000 cases of congenital heart defects as part of the study. Using body mass index measurements from right before they became pregnant, the researchers found that women who were moderately obese, with a BMI of 30 to 39.9, had an 11 percent increased risk of delivering a baby with any congenital heart defect. That risk jumped to 33 percent when the women were morbidly obese, with a BMI of more than 40.

They concluded that obesity could account for roughly 1500 cases of congenital heart defects in newborns every year. However the study does not state that obesity is the direct cause of some specific defects, like the dangerous hypoplastic left heart syndrome. Yet Dr. Mills suspects that losing weight may decrease a mother’s chance of having a baby with such defects.

“We suspect that if you lose weight, you can decrease your risk,” says  Mills.

Other doctors within the medical community agree with that hypothesis. “This should be a wake-up call for any woman of

childbearing age who plans to have kids in the next ten years – get healthy now,” says Dr. Paul Matherne, division head of Pediatrics Cardiology at the University of Virginia, who was not affiliated with the study.

“In the end, this study points to the fact that the less healthy you are, the more downstream effects you will have from not being healthy.”

via Obese moms increase newborns’ heart risk – Paging Dr. Gupta – CNN.com Blogs.