Do we say to someone with higher than normal blood pressure, Well done! Your blood pressure is high? Or if someone has high blood sugar and fat, we encourage him. Obesity is a disease of the last century.
Remember that adipose tissue is an active tissue that secretes hormonal and chemical substances and is a source of inflammatory cytokines (adipokine) that may lead to vascular endothelial disorders in the mother and placenta and cause pregnancy complications. In obesity, insulin, androgen, and leptin increase, which can be destructive.
One of the pre-pregnancy preparations is weight preparation, which means that a woman should enter the pregnancy stage with a suitable weight and gain a balanced and appropriate weight during the nine months of pregnancy, neither less nor more.
What is the right weight before pregnancy?
It means that the body mass index is in the range of 19-25.
Calculation of body mass index: weight in kilograms divided by the square of the value in meters H2/W
How does weight affect fertility?
Obese women have less fertility, primarily due to ovarian dysfunction, and these people are more prone to miscarriage even when they get pregnant with infertility treatment. In obese people, when their ovarian function is normal, their fertility is lower than in thin women. When these people lose weight (at least 5 to 10% weight loss), their fertility is more complicated. They need more medicine. Follicle growth and number of oocytes. Lower. Obesity harms the outcome of IVH and increases the chance of treatment failure. They may be more prone to ovarian hyperstimulation and multiples.
Fat men also have less fertility, their sperm quality is lower, their mobility is more downward, and gonadotropin, free testosterone, and total serum are reduced.
Effects of obesity on pregnancy:
Whether a person is obese and pregnant or has a healthy weight and gains more than usual weight during pregnancy, he is more exposed to these 27 complications, meaning he has more chances of suffering from these complications than people with average weight.
Problems of obese women before pregnancy
1- The chance of spontaneous fraternal twins is higher in these people. Twin pregnancy is high risk.
2- The chance of miscarriage is higher in these people, not due to chromosomal disorder but related to the egg’s poor quality and the endometrium’s inappropriateness.
3- The chance of urinary infection is higher in obese women, especially when they become pregnant (twice as much).
4- These people have a higher probability of impaired glucose tolerance tests.
5- The chance of converting the impaired glucose tolerance test to type 2 diabetes is higher. (2 times)
6- The probability of gestational diabetes in obese people is three times higher than in normal-weight people.
Those who weigh more than 90 kilos are 6-13 times more exposed to gestational diabetes. Also, those whose weight increased a lot from the beginning of pregnancy to 20 weeks are more likely to be affected by this disease.
7- Obese people are more susceptible to gestational hypertension due to vascular disorders, hyperlipidemia, insulin resistance, and subclinical chronic inflammation.
8- Premature delivery is more likely in obese women due to complications such as gestational diabetes, preeclampsia, office infection, and multiple births.
9- Obesity during pregnancy is a favorable factor for blood clots in the vessels. In general, one of the factors that causes obesity is inactivity, which is one of the factors that causes thrombophlebitis.
10- The probability of abnormality in obese mothers (especially vertebral column closure disorders) is higher, perhaps due to hyperinsulinemia. This probability is not reduced by prescribing the usual amount of folic acid before pregnancy, and they should take a higher amount.
11- Stillbirth is more common in obese women because of 1- hyperlipidemia, which reduces prostacyclin production. 2- Sleep apnea that reduces fetal oxygenation. 3- The presence of fetal abnormalities, 4- Diabetes, 5- High blood pressure, 6- And the mother not noticing the decrease in fetal movements.
Obese women’s problems during childbirth
1- There is a greater chance of prolonged labor in obese women; the uterine muscle of these people has less contraction power due to the abnormal position of the multiple fetuses. The large fetus is polyhydramnios (a lot of amniotic fluid), the fat deposition in the pelvis’s soft tissue is more prolonged, and the duration of labor is longer. It prolongs, especially in the first phase of work. These people have a greater need for induction of labor with oxytocin and even have a greater chance of not responding to oxytocin.
2- Such people are more prone to shoulder dystocia during childbirth due to macrosomia and abnormal appearance
3- These people are more prone to cesarean section, either because of maternal problems and inactivity or because of the fetus
4- There is more inappropriate weight in their fetuses. Sometimes, they are fat, and sometimes, they are thin due to accompanying vascular complications, both abnormal.
5- C-section of obese women is more complicated. Epidural failure (7 times more) and difficult intubation are more common in these people.
6- Respiratory depression in pregnancy and respiratory depression after cesarean section are more common in these people. Although respiratory apnea is a rare phenomenon, it is a fundamental problem because it delays fetal growth and has many complications.
7- Delivery by machine and deliveries with perineal tears, especially the fourth degree, are more common in these.
Postpartum problems in obese people
1- The chance of bleeding after delivery is higher. Macrosomia, long labor is one of the influential factors.
2- They are more exposed to postpartum infection or wound infection.
3- There are more days of their hospitalization.
4- Breastfeeding disorders are more common in obese women because their prolactin response to fetal sucking is less, and their milk may not flow in the first days.
5- Loosening of tissues in the bladder, vagina, chest, abdomen, and pregnancy cracks are more common in these people.
6- Mortality of the baby of an obese mother is more common due to being large (birth shocks – sugar and calcium disorders in the first hours) and the causes due to which they were born prematurely. For example, in multiples, diabetes, preeclampsia, urinary infection, and premature birth are more common.
7- There is a higher chance that the child of an obese mother will suffer from obesity in the future. In extensive epidemiological studies, a relationship has been shown between maternal obesity before pregnancy and intellectual disability in children. In another study, obesity was more common in mothers of children with autism, diabetes, and high blood pressure.
8- Chances of natural childbirth after cesarean section are lower in obese women.
People whose obesity is due to hypothyroidism-Gushing and diabetes have more problems during this period. Weight gain between two pregnancies in a person, if it is 9 kilos, increases the chance of complications, especially complications such as preeclampsia, large fetus, fetal death, and cesarean section; even if with this amount of weight gain, the person’s weight is still within the normal range. And have a normal BMI. On the contrary, reducing weight in obese people between two pregnancies, even 6 kg, minimizes the chance of a large fetus and cesarean section.
Therefore, it is strongly recommended to all people, especially women, and especially women who are of childbearing age, to keep their weight within the normal range, avoid overeating, poor eating, and inactivity so as not to suffer from the dreaded and complicated disease of the century. It is expected that the medical team consulted before pregnancy, midwives, general practitioners, and gynecologists will pay special attention to this critical issue, in addition to helping the community’s health to reduce the cesarean section rate for these reasons. Since the World Health Organization emphasizes reducing the cesarean section rate, we need enough parking and walking space to help improve women’s health.
