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Being Overweight is a Pregnancy Complication
Friday, November 06, 2009 - Byron Richards, CCN
Women considering pregnancy should do everything in their power to reach and maintain an optimal body weight prior to conception. A new study finds that being overweight is linked to a 14% less chance of a successful pregnancy, jumping to 28% for obese women.
“The results are not surprising; obesity is a state of inflammation and is not a good environment for conception or fetal development,” said Barbara Luke, lead researcher. “The key message is to lose weight, prior to conception, and focus on pre-conception health issues.”
Obese women were up to 35% less likely to become pregnant even with fertility assistance. *Of the obese women who were able to become pregnant, the odds of stillbirth were increased more than twofold,” Luke said. “Among live births, the odds of premature birth significantly paralleled increasing obesity: from 16 percent for overweight women to 34 percent for women at Class 3 [the most obese studies].”
Can weight impact your ability to get pregnant?
Obesity has reached epidemic proportions in this country, with 31 percent of white, 38 percent of Hispanic, and 49 percent of African American women considered overweight or obese (2002 Statistics). Obesity is defined as a body mass index (BMI) greater than 30kg/m2 while overweight is defined as a BMI of 25 –30 kg/m2.
Obesity has been linked to multiple medical problems including infertility. Infertility in obese and overweight women is primarily related to ovulatory dysfunction. Anovulation often results in irregular menstrual cycles. Indeed, studies have shown that 30 percent to 47 percent of obese women will have irregular menstrual cycles. The likelihood of irregular menstrual cycles increases in direct proportion to increases in weight. Furthermore, it has been demonstrated that weight reduction often leads to resumption of normal menses and increased pregnancy rates.
Polycystic ovary syndrome (PCOS) is a specific medical condition associated with irregular menstrual cycles, anovulation, obesity and elevated levels of male hormones. While some obese women have PCOS, many do not have this condition. In addition to anovulation, there may be other mechanisms by which obesity interferes with the ability to achieve pregnancy. For example, in one study, it took obese women undergoing intrauterine inseminations with donor sperm longer to conceive than normal weight women. There is limited data that obesity negatively affects male fertility as well. Hormonal changes in obese men and increased scrotal temperature are potential underlying causes of impaired semen parameters.
What can women do?
First line treatment for obesity-related infertility is weight loss and lifestyle modification. While any amount of weight loss in obese women may improve fertility, a loss of 5 percent to 10 percent in overall body weight can result in spontaneous ovulation in 60 percent of patients. Efforts should be made to restrict calories to 1000 to 1200kcal/day, and to exercise at moderate intensity for at least 30 minutes, three times a week. Participation in a formal weight loss program can be very helpful. Weight loss medications and bariatric surgery (gastric bypass or gastric banding) may be recommended as well, if lifestyle modifications fail to result in sufficient weight loss.
Apart from weight loss, treatments for infertility in obese women do not differ substantially from treatments in non-obese women. For anovulation, first line treatment generally consists of ovulation induction with oral medications such as clomiphene citrate. Women who fail to achieve pregnancy with oral medications are often treated with injectable ovulation induction agents such as recombinant or urinary gonadotropins. In vitro fertilization is often performed if these treatments fail or if there are other factors contributing to infertility.
It has been shown that obesity is associated with a longer duration of treatment, increased dosage of medication, and an increased risk of treatment cancellation due to poor response. Studies have also shown that pregnancy rates are approximately 30 percent lower in obese women undergoing IVF compared to women of normal weight. It has been proposed that the IVF is less successful for several reasons. Some of these include impaired absorption of medication due to increased fat stores, limited ability to visualize ovaries during ultrasound monitoring, and more challenging egg retrieval.
Moreover, once pregnancy occurs, obese women have a higher rate of pregnancy loss. In fact, studies show they have up to a two-fold higher risk of miscarriage compared to normal weight women. It is not clear why this occurs. Nonetheless, weight loss can dramatically decrease the risk of miscarriage.
The bottom line:
Obesity is a major health problem that is associated with infertility and miscarriage. Weight loss is extremely valuable in the management of such patients and can enhance fertility and decrease miscarriage rates.
Weight and Fertility
One in seven couples in the United States experiences fertility problems, which can stem from a variety of health issues. One health issue associated with infertility is a woman’s weight. Being overweight or underweight can greatly affect her ability to conceive.
How does being overweight affect fertility?
Women who are overweight or obese may have imbalances in reproductive hormones that affect menstrual cycles and prevent ovulation.
Clarisa Gracia, MD, a reproductive endocrinologist at Penn Fertility Care states, “The relationship between obesity and reproductive problems is complicated. However, insulin resistance and estrogen production from fat cells can affect the ovaries and prevent eggs from being released every month. This condition is called anovulation. If an egg is released, the egg may not be healthy enough to result in a pregnancy.
“Fertility problems related to weight usually affect women who are at least 10 percent over their ideal body weight. While fertility treatments are available to improve the chances of becoming pregnant, weight loss alone may correct infertility in some cases,” Dr. Gracia said.
A condition known as polycystic ovary syndrome (PCOS) is also associated with obesity and affects a woman’s ability to conceive. PCOS results from a hormonal imbalance that leads to excess production of androgens by the ovary, which can prevent or delay ovulation.
Symptoms of PCOS:
- Irregular, scanty or absent menstrual periods
- Increased levels of male hormones
- Obesity or weight gain
- Insulin resistance
- Excess hair growth (hirsutism)
- High blood pressure (over 140/90)
- Male pattern baldness
- Dark patches of skin on back of neck, under arms, groin
Weight reduction is an important factor in the treatment of PCOS. Maintaining good general health through careful food choices and exercise can help eliminate the complications of obesity and diabetes in women with PCOS. Weight loss may improve fertility and pregnancy outcomes.
How can I tell if I am at a healthy weight?
A good way to assess your weight is to calculate your Body Mass Index (BMI). Your BMI estimates can tell you if you are at a healthy weight. Use our BMI calculator to find out if you are in a healthy weight range.
Below 18.5 = Underweight
18.5 - 24.9 = Healthy
25.0 - 29.9 = Overweight
30.0 - 39.9 = Obese
Over 40 = Morbidly Obese
In general, the term “overweight” refers to a weight that is 10 percent above the expected body weight for height and build. The term “obese” refers a weight 20 percent over the target weight range.
Can weighing too little lower my chances of getting pregnant?
The degree to which weight loss affects fertility will vary. The American Society for Reproductive Medicine (ASRM) says: “In mild cases, the ovaries may still produce and release eggs, but the lining of the uterus may not be ready to receive a fertilized egg because of inadequate ovarian hormone production.
“In more severe cases, ovulation does not occur, and menstrual cycles are irregular or absent. In men, low weight or weight loss may lead to decreased sperm function or sperm count. If low weight or weight loss has been identified as the cause of one's infertility, the preferred treatment would be to stop losing weight or even to gain weight if needed.”
If a woman is dealing with an eating disorder, she should talk with her health care provider to determine her best course of achieving a healthy lifestyle and the return of her fertility.
A variety of fertility medications are available and may be used as an alternate treatment for fertility issues related to a woman being over or underweight.
Dr. Gracia advises, “In general, these medications stimulate the production and release of eggs from the ovaries. These medications are often followed by inseminating sperm into the uterus to improve the chances of pregnancy. If these methods do not result in pregnancy it may be necessary for a woman to pursue in vitro fertilization.”
While fertility drugs may help a woman become pregnant, the use of these drugs can be complicated, at times expensive and can cause multiple pregnancies.
Why being overweight can stop you having children
Losing a baby is tragic but all too common, with one in five UK pregnancies ending in miscarriage.
Trying to figure out what went wrong can be heartbreaking and often futile for parents, so the more scientific research done into the causes of miscarriage the better.
Being overweight is a factor we’ve long suspected of raising the risk of miscarriage and now a new study has confirmed the link. It found that being fat makes women more likely to miscarry healthy babies.
Women who took part in the research and had a body mass index (BMI) of over 25 (considered overweight) were more likely to lose babies in early pregnancy than women of a normal weight.
The study, by Stanford University School of Medicine, looked at which babies had chromosomal abnormalities – a major cause of miscarriage – and which were healthy.
The most important finding was that more than half of the babies miscarried by overweight women were normal – a much higher percentage than they found in slimmer women. In other words, the overweight women lost far more healthy babies.
This new report comes just weeks after another US study found that overweight women were two thirds more likely to have a miscarriage than those considered a healthy weight.
What this research shows is that a BMI of over 25 is a risk factor for miscarriage. I suggest if you’re trying for a baby, ask your doctor to measure your BMI.
Why could excess weight trigger miscarriage?
The truth is, we don’t yet know. The new study didn’t examine this. What we do know is that some overweight women have polycystic ovary syndrome, which reduces fertility and increases miscarriage risk. Overweight women who have diabetes and become pregnant also experience a higher miscarriage risk.
Overweight and pregnant: the risks
The heavier you are before pregnancy, the greater your risk of a range of health complications, including…
- Difficulty conceiving: One study found that it takes an obese woman an average of 11 months to become pregnant, compared to only seven months for a woman of normal weight.
- Diabetes during pregnancy: Overweight women are more likely to develop pregnancy diabetes which can lead to pregnancy, labour and delivery problems.
- Raised blood pressure: Being overweight increases the possibility of blood pressure problems during pregnancy which can lead to pre-eclampsia in severe cases. This condition can cause foetal distress, seizures, premature delivery and sometimes death.
- Dangerous blood clot: Overweight and obese women are more than twice as likely to suffer a life-threatening blood clot in the lungs during pregnancy,
- A difficult birth: Heavy women are more likely to carry a larger baby, which can result in birth complications and the possible need for an emergency caesarean.
- Birth defects: Research last year found that women who are overweight or obese are a third more likely to deliver a baby with a major birth defect of the brain, heart or digestive system.
- A child with weight problems: Children of mothers who are obese while pregnant are more likely to go on to be overweight at seven, a study from the University of Pennsylvania School of Medicine revealed last year.
7 steps to get your body baby-ready
I hope this research will help encourage women who are overweight and trying to conceive to make some lifestyle changes, so they have a greater chance of carrying their much-longed-for baby full term.
(1) Have a pre-pregnancy screening: If you’re thinking of trying for a baby, your first call should be to your GP. He or she will check you for rubella (German measles) immunity, make sure your smear tests are up to date and assess your general health. This is also the time to get screened for any sexually-transmitted infections if you need to.
(2) Get health problems under control: You should also talk to your doctor about any pre-existing medical conditions you have, such as diabetes or high blood pressure, that may affect your pregnancy and need to be monitored. Ask whether any medication you take is safe to continue while pregnant.
(3) Be weight wise: It’s better to reach a healthy weight before becoming pregnant. Ditch the weight now with a healthy diet and exercise plan. But avoid crash diets as they can play havoc with your hormones and affect ovulation.
(4) Wise up on nutrition: It’s important to follow a nutrient-packed, balanced diet with plenty of fruit and vegetables, wholegrains and lean protein to boost your fertility. You should also start taking a folic acid supplement as soon as you begin trying, or three months before if possible. This reduces the risk of your baby having spina bifida.
(5) Ditch contraception: Stop taking the Pill at least a month before trying to conceive and allow your body to have a period to ensure that you are ovulating normally.
(6)Stop smoking and drinking: Cigarettes are linked to reduced fertility, miscarriage and stillbirth, while alcohol is a poison that can damage eggs and sperm. Give up both BEFORE you start trying.
(7) Avoid potential hazards: Keep away from cat litter trays (to avoid the miscarriage-causing toxoplasmosis virus), X-rays, pesticides or solvents and anything else that could affect your ability to get pregnant or maintain a healthy pregnancy.