Monday 26 September 2016

The hidden risks of being overweight and pregnant

Doctors are treating rapidly increasing numbers of mums-to-be for problems related to their weight, but their babies could be affected too.

Ailin Quinlan

Published 29/05/2015 | 00:00

All clear: Emma Maye, with her son William, has been tested for gestational diabetes three times, with negative results. Photo: Mark Condren
All clear: Emma Maye, with her son William, has been tested for gestational diabetes three times, with negative results. Photo: Mark Condren
Donal O'Shea

Would you lodge a formal complaint against a doctor who attempted to discuss your weight with you?

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People do, says obesity expert Donal O'Shea - which is testament to a lack of public awareness about the health risks posed by excess weight, particularly to pregnant women and their babies.

But did you know your baby's future weight problem can actually begin in the womb?

Or that your excess weight, both before and during pregnancy, can impact on your foetus to such an extent that after birth it becomes fat too?

The very significant problems faced by pregnant obese women and their babies made international headlines this week.

A study published yesterday by researchers at Trinity College and two other universities warned of an array of increased health risks, including gestational diabetes, high blood pressure and depression. These problems don't just affect women who are obese during pregnancy, but their babies too.

Earlier this week the UK's top paediatrician caused a furore when she warned that the country's National Health Service was wasting millions on anti-obesity strategies targeting young people rather than pregnant women.

In fact, declared Professor Neena Modi, babies actually begin to become fat in the womb.

Here too, it seems, there's increasing concern about the numbers of overweight mothers-to-be showing up in our maternity clinics.

"At the moment babies are being born on a trajectory that's firing them into adult obesity rates of what are predicted to be up to 70pc, 80pc and 90pc by 2030," warns O'Shea.

Overweight and obesity in mothers-to-be is the main driver for gestational diabetes (diabetes which is first diagnosed during pregnancy), which in turn causes complications - and results, he warns, in a bigger baby.

However excess weight is also a factor for would-be dads, emphasises Professor O'Shea.

"The sperm of physically fit and active men is healthier, and sets the baby off on a better trajectory, as does the egg of a fit and healthy mother-to-be."

"If you're overweight or obese in pregnancy, you're insulin-resistant and if that's the case, your baby's body-fat distribution is different - the way the baby's appetite is formed and its eating patterns are driven by insulin and insulin resistance.

"This is now an established fact and the challenge is how to address it, given that we have such a toxic environment."

But in the past five years, there's been a significant increase in the numbers of pregnant women presenting with a high Body Mass Index (the measure of body fat based on height and weight) according to Dr Mary McCaffrey, a consultant obstetrician/gynaecologist at Kerry General Hospital.

"What we're noticing is a significant increase in the number of women with a high BMI in pregnancy; of over 30.

"About 75pc of women in our unit fall into the category of needing to be screened for diabetes, and without a shadow of a doubt there are more pregnant women with a high BMI.

"This puts the women at risk of gestational diabetes."

Excess weight in pregnancy exposes the baby to an increased risk of overweight or obesity in childhood, warns Professor Fionnuala McAuliffe, Professor of Obstetrics and Gynaecology at UCD, who has been carrying out research into healthy lifestyles in pregnancy.

"People have a tendency to put on too much weight in pregnancy and this increases the blood-sugar level of the mother-to-be, which in turn increases the blood-sugar level of the baby and predisposes it to be large at birth - and to potentially be at increased risk of overweight in childhood."

The number of pregnant women screening positive for gestational diabetes is rising, warns the Master of the Rotunda Hospital, Dr Sam Coulter-Smith, who adds that there's been a "huge" increase in the numbers of pregnant women attending the Rotunda's maternity/diabetic service.

"Carrying additional weight into pregnancy brings with it lots of complications. By maintaining a healthy weight you reduce the chances of getting gestational diabetes," he says.

According to the HSE, there are no figures available on the actual prevalence of gestational diabetes in Ireland, although the condition is said to affect about 12pc of pregnant women.

However the issue is not solely one for pregnancy - women really need to start working on getting their weight down before they even become pregnant, warns McCaffrey.

"There's a real lack of awareness about the need to be a healthy weight prior to and during pregnancy," she says, adding that she believes the issue should be addressed in the second-level school curriculum.

"The key issue has to be that women need to be healthier, to lose weight before they conceive or we will not tackle this cycle of childhood obesity."

That womb environment is to a large extent determined both in early pregnancy and before the woman conceives, she warns.

Yet, McCaffrey observes, an atmosphere of 'political correctness' has made it difficult for doctors to talk openly to patients about their weight, "because people become defensive and angry and health care professionals are not necessarily equipped to deal with that."

A major challenge, says Dr Sam Coulter-Smith, is the lack of systematic early intervention.

"One of the problems we have is that in the maternity services we don't see women until they become pregnant, and our service is not resourced for pre-conception care.

"We don't have enough dieticians and midwives so we cannot educate people pre-natally. The whole process need to start early in life so people are educated about their health and diet."

We're not addressing the issue early enough, agrees weight-loss expert Dr Eva Orsmond, who runs clinics in Dublin, Galway and Kilkenny.

"There's now enough evidence to show that the only way we can stop obesity increasing is to devote our attention to the prevention of overweight and obesity among young girls, who are tomorrow's mothers," she says.

Orsmond points to a recent study in Finland which showed that high maternal BMI increased the risk, not only of Type 2 Diabetes, but also of Cardiovascular disease in the offspring."

Orsmond says overweight women who become pregnant are "selfish": "We have enough evidence to show the adverse reaction for the baby and its future health."

With nearly 51pc of Irish women over the age of 20, 66pc of Irish men over and one in four primary school children now considered to be overweight or obese, it's a big issue.

"Gestational diabetes is a very real concern that is more prevalent now than ever and is typically associated with pregnant women carrying excess weight," says Laura Haugh, mum-in-residence for the MummyPages.ie website.

"In addition, Ireland's rising childhood obesity crisis has been medically linked to overweight parents as far back as when the baby is in the womb."

However there was no response from the HSE on the existence of campaigns highlighting the potential hazards of excess weight to mothers-to-be, or how much money was being spent on such initiatives.

"Even the World Health Organisation is now saying we have to get future parents aware of the obesogenic environment and the need to be fitter and healthier," says O'Shea (pictured).

However, as Professor McAuliffe points out, it's not fair to solely target mums-to-be on this issue:

"What we're seeing in the maternity hospitals is a reflection of what's happening in the world around us," she says, adding that everyone in society needs to recognise the importance of a healthy, active lifestyle.

'It's hard to eat healthily when you're a working mum-of-three'

Company director Emma Maye is due to give birth to her fourth child in September.

In the next few weeks she is due to be tested - for the third time - for gestational diabetes.

The Foxrock-based businesswoman was tested for the condition when she was pregnant with her second and third babies.

The tests were carried out she recalls, partly because her very healthy babies tended to be large at birth - usually weighing in at around 9 lbs 5oz - and also had a tendency to arrive early.

Another reason Emma's been tested for the condition is because her BMI is in the early to mid-30s and she's about a stone overweight.

However, each time, the results have been negative.

The managing director of a Dublin property company, the mother-of-three, soon to be four, and all under the age of six, works full-time, and she says she finds it difficult to keep her diet as healthy as it should be, particularly during the working week.

"You're trying to work full-time as well as balancing childcare and the school runs," explains the 39-year-old.

However, to complicate matters even further, Emma has suffered from extreme hyperemesis gravidarum, or extreme vomiting, in each of her pregnancies to date.

"As a result, when I eat, I tend to veer towards comfort carbohydrates and sugary foods. I'll be tested again shortly and I hope it will be negative."

Irish Independent

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