Tailored approach to fight pregnancy pounds

NORTHWESTERN (US)—Mounting evidence suggests excess weight in pregnancy has serious consequences for the long-term health of the unborn child and mother. A new program at Northwestern University offers a tailored approach to help obese pregnant women manage their weight and stay active.

The Northwestern Comprehensive Center on Obesity is coordinating the clinical research effort. A team of health professionals—a physician, dietitian, exercise physiologist, and clinical psychologist—will help women develop better nutrition for optimal weight gain, counsel them on how to increase physical activity, and offer psychological counseling to develop strategies for a healthier pregnancy. Each woman will have a program tailored to her individual needs.

The program, Healthy for You, Healthy for 2, is available to women who plan to give birth at Northwestern Memorial’s Prentice Women’s Hospital, with a special emphasis on treating low-income minority women. The obesity pregnancy program is a project of Northwestern University, Northwestern Memorial Hospital, and Northwestern Medical Faculty Foundation.

“Pregnant women have always been hands off,” says Robert Kushner, the center’s clinical director and professor of medicine at Northwestern University’s Feinberg School of Medicine. “People have always been afraid to intervene in pregnancy because you may do harm. What we are finding is by doing nothing, we are probably doing more harm.”

New evidence indicates that a woman’s excessive weight gain during pregnancy affects the intrauterine environment and turns on certain genes in the fetus that can result in childhood obesity and diabetes, says Alan Peaceman, codirector of the obesity in pregnancy program.

“It’s not just that the kids gain weight because they acquire the eating habits of their parents and sit in front of the TV, but their risk for obesity is programmed before they are born,” adds Peaceman, a professor of obstetrics and gynecology and chief of maternal fetal medicine at the Feinberg School and Northwestern Memorial Hospital.

“Obesity in pregnancy may be contributing to the epidemic of childhood obesity and diabetes that we are seeing today,” Peaceman says.

The prevalence of obese women of child-bearing age is rising. An estimated 23.6 percent of women ages 18 to 44 in the United States were obese in 2007 compared to 14.5 percent in 1997, according to the March of Dimes Perinatal Data Center and the Behavioral Risk Factor Surveillance System of the Centers for Disease Control. Obesity is defined as having a Body Mass Index (BMI), a measure based on a person’s height and weight, of 30 or higher.

Excessive weight gain also compromises the health of the mother. Many women who gain excessive weight don’t lose it, hiking their risk for diabetes and cardiovascular disease. Peaceman asys obese pregnant women also have a higher rate of gestational diabetes, hypertension, and blood clots as well as cesarean sections.

A nutritional counselor from Healthy for You, Healthy for 2 will tailor a woman’s diet to manage her calories but make sure she is getting the necessary nutrients and food for the baby.

“Most women don’t get nutritional counseling during pregnancy, and, if they do, it’s relatively cursory,” Peaceman adds. “We’re not trying to get them to lose weight, we are trying to get them to gain appropriately. Some women who are overweight don’t need to gain anything at all.”

Kushner says it’s time to be more aggressive and therapeutic with obese pregnant women. “We are butting up against traditional thinking that this is the time you can do anything you want, eat anything you want,” Kushner adds. “That’s what’s gotten us in trouble. We have to challenge those beliefs and guide women to what really is healthier.”

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