Thursday, September 01, 2005

ACOG Issues Guidelines for Obese Pregnant Women

In this month's Green Journal, the American College of Obestetricians and Gynecologists (ACOG) has issued strong warnings and treatment guidelines for physicians treating obese pregnant women.

As reported in the Globe and Mail: The U.S. guidelines make for chilling reading, detailing a long list of complications an overweight mother-to-be can expect for herself and her infant.

Among the laundry list of complications and risks, obese pregnant women face higher risks for:

  • Miscarriage
  • Gestational Diabetes
  • Pre-eclampsia (high blood pressure)
  • Fetal Macrosomia (high birth weight)
  • Higher incidence of birth defects (noteably neural tube defects such as spina bifida)
  • Significantly higher incidence of c-section delivery
  • Infection following c-section
  • Maternal death

The new guidelines strongly recommend that women who want to become pregnant try to reach a normal weight (a BMI of less than 25) before doing so, with "diet, exercise and behaviour modification." Women who are obese should also be advised not to seek fertility treatments because the rate of miscarriage and complications is so high.

At the same time, the group representing obstetricians and gynecologists warned strongly that women should not diet during pregnancy unless the regime is carefully monitored by a dietician.

According to the guidelines, a woman of normal weight should gain 25 to 35 pounds during pregnancy, while an overweight woman should gain 15 to 25 pounds, and an obese woman should gain no more than 15 pounds.

These guidelines are not meant to scare women, but women should be aware of the higher risks associated with obesity in pregnancy and take necessary steps to ensure their pregnancy is as uncomplicated as possible. That means eating a diet that is nutrient-dense and avoiding all junk foods to boost intake of essential nutrients over empty calories. While not specifically in the guidelines, this also should include elimination of sweetened beverages in favor of water to increase nutrients from food instead of nutritionally bankrupt calories in sodas and sweetened beverages.

All pregnant women are advised to take a folic acid supplement to provide 400mcg each day - the new guidelines suggest obese women take a higher amount each day.

In addition the new guidelines strongly advise screening for diabetes early in the pregnancy - as early as the initial prenatal visit, to identify and manage existing diabetes not previously diagnoised - and additional screening again sometime in the first trimester to identify the possible development of gestational diabetes earlier than the current guideline of 28-weeks gestation (which remains in effect for normal weight pregnant women). These guidelines for obese women are in place to reduce the risks of gestational diabetes in the pregnancy.

I can't stress how important it is to eat well when you're pregnant. In the first trimester it is easy to think you're eating for two and start eating increased amounts of food - but the reality is you're not eating for two...calorie requirements do not start to increase until the second trimester, and even then it is not a significant amount of additional calories required - just about 300-calories more per day.

The quality of your diet is critical - don't squander calories on junk!

Eliminate all foods that contain:

  • any trans-fats (ingredients that include - shortening, partially hydrogenated oils, margarine)
  • high amounts of sweeteners - sugar, high fructose corn syrup, corn syrup, corn syrup solids
  • foods with damaged fats - especially deep fried foods
  • beverages high in sweeteners, especially high fructose corn syrup

Eating well is the best thing you can do for your unborn child - and while you may want to have that banana split topped with all the fixings, remember this - your unborn baby is depending on you to eat well and provide all the essential nutrients you need and s/he needs too! And that means eating the best you can afford and making your choices real, whole foods that are nutrient-dense!

Throughout pregnancy, controlling carbohydrate through carefully selecting the carbohydrate foods you do eat is a good way to start eating a nutrient-dense diet. Selecting only whole foods from the carbohydrate category is a good first step:

  • non-starchy vegetables should make up the highest volume of food you eat in a day - they offer nutrient-density, fiber and help sate appetite
  • starchy selections should be carefully selected and included in smaller amounts if you want to include something like a sweet potato or corn
  • whole grains should be 100% whole grain with an emphasis on 100% whole grain cereals such as steel cut oatmeal over more processed selections like instant oatmeal
  • low "glycemic-load" fruits offer incredibly high amounts of antioxidants - specifically berries along with melons like canteloupe and honeydew and other fruits like cherries and plums
  • higher "glycemic-load" fruits are still an option - just have a small banana instead of the largest one!
  • nuts are low in carbohydrate and pack in essential fatty acids
  • legumes offer fiber, nutrients and protein


  1. Great Post! I found this same one and just posted it yesterday at our site. Thanks again, and top notch site you run here!

    Tyler Knott Gregson
    Fit Express Blog

  2. Regina, I agree with just about everything in your piece. I did, though, want to bring up another point that relates to this. The test for GD is actually somewhat questionable, at least some people find in questionable. Blood sugar numbers naturally go up as pregnancy progresses, so when you take the test has an effect on your numbers. Pushing the test up actually makes it easier to pass! While preexisting medical conditions like diabetes and obesity should be monitored and viewed appropriately as risk factors, I think it's all too easy to label a woman "high risk" because of one or two factors without looking at the entire forest.

    As I think you know, in our own experience, we were labeled GD because of a test that was done later than usual (and due to inherent limitations of the test like the fact that you have to sit in one spot instead of moving around as you would normally, etc.). This label then caused one doctor to assert that we would have to be induced at 40 weeks no matter what, due to feer that the baby would be too big. Not that they would even take other factors into consideration and try to figure out if the baby was "too" big. As you know we ended up with another caregiver and went much later and our baby was a measly 7lbs 3oz. The other ridiculousness involved was a nutritionist who decided that in order to adhere to the ADA, we had to eat butloads of carbs, and if this meant that we would have to actually start using insulin because of it, so be it - it was more important to get all those critical carbs!

    I realize a lot of this is due to the screwed up insurance/litigation system we have, but there you have it. Anyway, not to minimize real risk from obesity, diabetese, etc. when it comes to pregnancy, but also you should educate yourself so that you aren't being labeled high risk because of one test whose premise may not be firmly grounded at least for a large portion of people for whom it's been used to label them as high risk with all that entails...