1. It can trigger a temporary case of diabetes.
One major hiccup plus-size moms-to-be might face is gestational diabetes—overweight women are two to eight times more likely to develop it than women with BMIs under 25. Diabetes during pregnancy is a serious concern, since it increases the risk of preterm labor and c-sections, among other possible complications. But, as was the case with Orlando-based mom Dawn Veselka, 45, it can often be managed with activity, diet and/or medication, says Romy Block, MD. Veselka, who developed gestational diabetes at age 35 when she was plus-size and pregnant with her daughter, kept things in check by taking insulin shots and walking for an hour in the morning and evening. Reducing (not eliminating!) carbohydrates can also help. Block suggests following these guidelines: 30 to 45 grams of carbs at breakfast (try 1 cup of oatmeal and a fruit-flavored yogurt), 45 to 60 grams of carbs at lunch (a turkey sandwich on whole-wheat bread plus an apple), 60 grams at dinner (1 cup of whole-wheat spaghetti with marinara, a side of mixed veggies and a piece of Italian bread), and 15 to 25 grams each for snacks in the mid-morning, afternoon and evening (1 cup of carrot sticks with 2 tablespoons of hummus).
2. It can lead to some very big babies…
Obese moms have about a 14 percent increased risk of having a baby with macrosomia—that’s the fancy way of saying an excessively large baby over 9 pounds. If you’re obese and you develop gestational diabetes, those odds bump up to 20 percent. While making diet tweaks to control blood sugar levels can help prevent this in women with diabetes, some experts believe these dietary changes can also help nondiabetic women avoid having an overly big baby, explains Block. Either way, aim to eat more veggies and lean protein and fewer simple carbs, like sweets, chips or bread.
3. …or (surprise!) multiple babies.
If you’re facing fertility troubles, which obesity can bring on, and you turn to in vitro fertilization (IVF), don’t be surprised if you end up with more babies than you may have bargained for. “When I was 38 years old, I was a size 20, and I’m fairly certain that made it harder to get pregnant,” recalls MaryBeth Reeves, 45, of Norcross, Georgia. So Reeves tried fertility treatments and, happily, not only conceived, but ended up with quadruplets! “Multiple pregnancy is risky for any mom but much more so when a woman is overweight, since it increases the risks for things obese women are already at risk for, like high blood pressure, diabetes, and bleeding or infection during delivery,” says Serena Chen, MD. If you’re pregnant with multiples, don’t panic. Just make sure you get the extra monitoring and care you and babies need by seeing a maternal fetal medicine doctor, in addition to your regular ob-gyn. Another kind of support a mom of multiples should have? Other moms who understand what you're going through. Ask your doctor to refer you to a parents-of-multiples group in your area.
4. It can make the doctor’s office your new second home.
The fact is, excess weight can make pregnancy a bit tougher on your body and your developing baby—and that often means more time logged with your obstetric provider. “Because of my size and gestational diabetes, I had to go for fetal stress tests three times a week where I would be hooked up to a fetal heart monitor for 30 to 45 minutes,” says Veselka. “Factor in regular appointments and testing and it all resulted in taking a lot of additional time out of my week.” As a new mom, there's so much to do—so why not make the most of your time and do some of it in the waiting room? Use that alone time to catch up on your new-mom reading, troll Craigslist and online discounters for baby gear, and even do some stress-relieving meditation. A study a few years ago found that mind-body practices like meditation during pregnancy may help moms have less stress and anxiety, easier births and healthier-sized newborns. So think about that when you’re getting worked up watching the clock tick by in the waiting room.
5. It can be a real pain in the neck…or knee, or back, or pelvis.
Most women can expect some aches and pains during pregnancy—leg cramps, back pain, weird pelvic twinges—but since larger women have more pressure on their joints and ligaments, you may have to deal with even more uncomfortable moments. “My pregnancy was challenging to say the least, and I do blame my weight for a good portion of it,” says Natalie Diaz, 37, author of_ What to Do When You’re Having Two_. “Mobility had never been an issue even at my heaviest, but when I was pregnant, just walking the length of my tiny apartment made me feel like I ran a marathon. I had a ton of round ligament pain and knee pain that you would not believe.” To help relieve some of the pressure on your low back and pelvis, invest in a belly-support belt and try using a heating pad to take the edge off of any back pain.
6. It can open you up to weight shaming.
One goal for any OB working with a plus-size mom-to-be is to help her keep her weight gain down and to minimize complications like the ones above. But, unfortunately, not every doc knows how to broach these topics in a sensitive manner. “My doctor had insisted that because I was already overweight, I was not to gain more than 16 pounds across the entire pregnancy,” says Jennifer Signore, a mom in Pittsburgh. “I was doing pretty well and gaining very slowly until one visit when I was suddenly up 8 pounds in a month, and my doctor told me that perhaps I should ‘consider skipping a meal!’ ”
There’s a social stigma around being overweight, and a natural tendency for doctors and patients to feel uncomfortable discussing it, Chen says. But she believes it’s important to compassionately discuss weight purely for health reasons. If your doctor isn’t as enlightened, Signore has her own tip to share. “My advice to other plus-size pregnant women who are dealing with biased doctors would be to make sure you are your own advocate. Don't be afraid to question what the doctor is saying, especially if you've been doing your research. You know your body well enough to know when a change feels wrong. And, if you still feel you're not receiving the best care because of a bias against your weight, don't hesitate to switch doctors.”
Experts : Romy Block, MD, an endocrinologist who sees patients in a high-risk obstetrics clinic in Chicago; Serena Chen, MD, director of the division of reproductive endocrinology at Saint Barnabas Medical Center in Livingston, New Jersey.
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