Qn of the Month: Does It Matter What I Weigh Before I Get Pregnant?

A: Ladies, regardless of whether you are underweight or overweight, your pre-pregnancy weight status does matter! It can affect your fertility, increase your risk of poorer birth outcomes compared to those of a normal or healthier weight status going into pregnancy, and also impact your post-partum health.

Firstly, what determines overweight or underweight? According to national and international authoritative bodies like the World Health Organization (WHO) and the United States Centers for Disease Control and Prevention (CDC), weight status is categorized using the Body Mass Index (BMI). Underweight is defined as a BMI less than 18.5, a healthy or ‘normal’ status is 18.5 – 24.9, overweight is defined as a BMI between 25 and 29.9, and obesity as a BMI greater than or equal to 30. Note that BMI is calculated by dividing weight in kilograms by height in meters squared. Obesity status is further subdivided into 3 classes depending on the BMI level of an individual.

From a recent Maternal Nutrition Intensive Course that I attended, the consequences of being overweight or obese in terms of pregnancy outcomes were discussed in detail. These included an increased chance of lower fertility, a lower success of ART (assisted reproductive technology), a tendency for increased likelihood of getting gestational hypertension and pre-eclampsia, as well as gestational diabetes. Obesity prior to pregnancy increased the risk of pre-eclampsia 3 to 8 fold. More alarmingly, if a woman has gestational hypertension and pre-eclampsia during pregnancy, they have double the risk of getting type 2 diabetes in the future. A high pre-pregnancy weight is also associated with more postpartum depression 6-8 weeks after delivery and a greater chance of postpartum weight retention.

A mother’s high pre-pregnancy weight can also affect her newborns in a variety of ways. For instance, during pregnancy, obese women are about twice as likely to need induction of labor, and congenital anomalies are more common in babies born to overweight and obese women. These include neural tube defects like spina bifida (even after controlling for folate intake), cardiac defects and limb reduction. For obese women, the birthweight of full-term infants tend to follow a ‘U’ shaped curve; there is an increased likelihood of either low birthweight or large for gestational age babies. Pre-term birth rates are also higher among obese women. This may be due to mothers having to be medically induced as a necessity due to high blood pressure or diabetes, or due to spontaneous pre-term births as a result of infection or inflammation.   Research is ongoing in this important area.

While a smaller proportion of the population have a prepregnancy underweight status, this is still a cause for concern as such women tend to be at higher risk for having low birth weight (LBW), small for gestational age (SGA), and  preterm infants.

So what is the take home message? For the best health for you and your baby, aim to get to a healthier weight prepregnancy if you are overweight or underweight. This means a BMI as much in the healthy weight range as possible. This can be achieved by eating as much as possible a whole foods plant-based diet and being regularly physically active.

(Sources:

  1. About Adult BMI. Centers for Disease Control and Prevention. https://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/. Reviewed and updated May 15, 2015. Accessed July 26, 2017.
  2. Gaillard R, Durmuş B, Hofman A, Mackenbach JP, Steegers EA, Jaddoe VW. Risk factors and outcomes of maternal obesity and excessive weight gain during pregnancy. Obesity (Silver Spring). 2013 May;21(5):1046-1055.
  3. Schummers L, Hutcheon JA, Bodnar LM, Lieberman E, Himes KP. Risk of adverse pregnancy outcomes by prepregnancy body mass index: a population-based study to inform prepregnancy weight loss counseling. Obstet Gynecol. 2015 Jan;125(1):133-143. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4285688/. Accessed July 26, 2017.)
  4. Papachatzi E, Dimitriou G, Dimitropoulos K, Vantarakis A. Pre-pregnancy obesity: maternal, neonatal and childhood outcomes. J Neonatal Perinatal Med. 2013;6(3):203-216. DOI: 10.3233/NPM-1370313.
  5. Stothard KJ, Tennant PW, Bell R, Rankin J. Maternal overweight and obesity and the risk of congenital anomalies: a systematic review and meta-analysis. JAMA. 2009 Feb 11;301(6):636-650. doi: 10.1001/jama.2009.113.
  6. Waller DK, Shaw GM, Rasmussen SA, Hobbs CA, Canfield MA, Siega-Riz AM, et al.; National Birth Defects Prevention Study. Prepregnancy obesity as a risk factor for structural birth defects. Arch Pediatr Adolesc Med. 2007 Aug;161(8):745-750.
  7. Carmichael SL, Rasmussen SA, Shaw GM. Prepregnancy obesity: a complex risk factor for selected birth defects. Birth Defects Res A Clin Mol Teratol. 2010 Oct;88(10):804-810.)
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Qn of the Month: Are there Physical Activity Guidelines for Post-Pregnancy?

MH900427748A: Yes! In the United States, postpartum physical activity recommendations come from two main sources: the American Congress of Obstetricians and Gynecologists (ACOG) and the U.S. Department of Health and Human Services 2008 Physical Activity Guidelines for Americans. In the United Kingdom, recommendations come from a 2006 statement issued by the Royal College of Obstetricians and Gynaecologists. Guidelines from the 2008 U.S. Physical Activity Guidelines for Americans are to aim for a minimum of 30 minutes of physical activity most days of the week (so at least 150 minutes a week) of at least moderate intensity. The good news is that this amount can be spread out into 10 minute blocks of moderate intensity activity throughout the day. Much more manageable if you’re handling a young infant!

A recent study reviewed the physical activity guidelines similarities and differences among 5 countries (Australia, Canada, Norway, United Kingdom, and United States).  Although there are quite a few variations between the country-specific guidelines, one thing is clear: physical activity is good post-pregnancy and brings a host of benefits! Advantages for mothers can include an improved mood, improved weight control, increased weight loss, maintenance of cardiorespiratory fitness, reduced depression and anxiety. Recommended types of physical activities from these different country guidelines are aerobic, pelvic floor exercises, strengthening, stretching and walking. Overall, it may be best to build up the intensity of exercise gradually in the postpartum period depending on your body. If you’ve had a cesarean birth, it is likely best to speak with a health care provider first, before resuming previous physical activity levels.

Hopefully in the future, there can be more consistency across countries and more specifics provided within each guideline to help postpartum women.

(Sources: ACOG. Exercise during pregnancy and the postpartum period. ACOG Committee Opinion No. 267. Obstet Gynecol. 2002; 99(1):171–3. [PubMed: 11777528]

U.S. Department of Health and Human Services. 2008 Physical Activity Guidelines for Americans.Washington, D.C.: 2008. ODPHP Publication No. U0036. http://health.gov/paguidelines/. Accessed September 25, 2015.

Evenson KR, Mottola MF, Owe KM, Rousham EK, Brown WJ. Summary of International Guidelines for Physical Activity Following Pregnancy Obstet Gynecol Surv. Obstet Gynecol Surv. 2014 Jul; 69(7): 407–414. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4134098/pdf/nihms-616584.pdf. Accessed September 19, 2015.)

Qn of the Month: I Had Gestational Diabetes in Pregnancy. Can I Forget About Blood Sugars Now That Baby’s Out?

Not quite – let me explain why.

Like me, you may have had gestational diabetes (GDM) during pregnancy, or you are currently experiencing it. Regardless, no one likes it, but it’s something we endure for the sake of delivering a healthy baby. The worst part I found was not so much that I had to constantly watch what I ate, but because I had to poke my finger to check the blood glucose level at least four times a day. The best part though is post-delivery when blood glucose levels often quickly improve and you can enjoy high carbohydrate foods again. But before you sigh with relief, forget all about blood glucose checking and throw away your testing kit, there are still a few things you should know now that you have a history of GDM.

As you may already know, gestational diabetes carries risks for both the mother and the developing fetus within the womb, as well as to the post-natal infant immediately after delivery. Women who have gestational diabetes are also at a higher risk of developing type 2 diabetes later in life. I was given some differing bits of advice from different countries. When I was in the United Kingdom (UK), a midwife told me that after the baby was born, to check my blood glucose level every year on baby’s birthday. In Singapore, however, my OBGYN doctor told me to randomly check my blood glucose level once in a while after a high carbohydrate meal.

So what should really be done now that baby’s out? In the United States, the American Diabetes Association (ADA) provides some guidelines for post-partum women who have had a history of GDM. Recommendations call for women with a history of gestational diabetes to be tested at the 6-12 weeks post-partum check-up for persistent diabetes. This should be done using the oral glucose tolerance test (OGTT) involving a standard glucose load and comparing the results to non-pregnancy diagnostic criteria. The reason for this is because while most women’s blood glucose levels return to normal post-delivery, some women may continue to have high blood glucose levels.

It is also recommended that women with a history of GDM should have lifelong screening for the development of diabetes or prediabetes at least every 3 years. In those found subsequently to have prediabetes (i.e., results indicating they are on the borderline of being diagnosed with type 2 diabetes), ADA recommends these women to receive lifestyle interventions or the medication named metformin to prevent diabetes.

So if you’ve have a history of GDM, you can relax…but not too much. It is still important to take care of your health and body, and to a certain extent be somewhat mindful of what you are eating. This means being aware of and possibly limiting high carbohydrate nutrient poor foods, avoiding excessively large portion sizes, having regular spaced meals/snacks during the day and staying active. And you’ll still need to periodically have your blood glucose levels checked!

(Source: American Diabetes Association. Standards of Medical Care in Diabetes – 2014. Diabetes Care. Jan 2014; 37 Suppl 1: S14-S80. http://care.diabetesjournals.org/content/37/Supplement_1/S14.long#sec-22. Accessed May 30, 2014. Note that there is a correction published for one of the sections within this article at http://care.diabetesjournals.org/content/37/3/887.1)

Qn of the Month: What are Calisthenics?

Veering slightly away from the usual nutrition slant, this month I decided to answer a question of my own. This came off of the back of a health assessment I did recently (see post ‘Step it Up!’) which piqued my own interest in exercise and how to get more active (while being a working mother of a toddler). After all, real health is not just about nutrition. It’s nutrition plus being physically active. That’s when I discovered Calisthenics.

What is it exactly? It’s a word I’ve heard of sporadically and knew it was connected to exercise but never really took the time to delve more deeply into until now. Here’s a simple definition (courtesy of the Merriam-Webster dictionary):  “Systemic rhythmic bodily exercises done without special equipment.” Sounds good and simple to me! Calisthenics can be counted as part of strength training, which is recommended in a 10-20 min segment 2-3 times a week. Strength training (also called weight or resistance training) is just as important as stretching as it helps to build and maintain muscle as well as bone density (especially important for keeping strong bones ladies!).

I find calisthenics exciting because it seems easy to implement, doesn’t require much space or extra expensive equipment, and could probably also be done during toddler waking hours. The best part is, depending on the intensity and length of the session, doing a few circuits of exercises as part of a calisthenics workout daily should get the heart pumping and would probably also count towards the 20-30 minutes of moderate activity recommended every day! A great way to achieve two goals with one!

See these videos for many examples of different exercises you can do (with modifications if desired). Just pick a few exercises to put together your own Calisthenics workout routine. As always, start gradually and then build up the length and intensity of the routine over time. Enjoy!

Step it Up!

I recently took an online health assessment promoted by my insurance company and received a score of 86 (which was compared to my peers scoring 89). Was I surprised? Yes, more than slightly. My husband, incidentally, got a 94 on his assessment!

Upon deeper reflection, I guess I  really shouldn’t be surprised since I currently don’t do any regular physical activity. Between working and taking care of a toddler, I haven’t had much time lately to invest in activities that I enjoy and that will also make me move more (like dancing, my favorite!). I think subconsciously I also thought that my daily stretches, playtime with my toddler, and moving around doing house chores to keep the house tidy would suffice. Not quite. This assessment was a good wake up call.

The health assessment reminded me that physical activity doesn’t have to be all in one 30-minute or more session a day. It can actually be broken up into 3 10-minute sessions of moderate activity to have the same health benefits. However, the lower the intensity of the physical activity, the longer a session you would need to aim for. See this helpful chart provided at the end of the assessment:

 

Intensity level Sample activities Minutes/day
Low Slow walking, light gardening, recreational volleyball 45-60
Moderate Brisk walking, raking leaves, swimming, cycling 20-30
Vigorous Running, lap swimming, fast cycling, snow shoveling 15-20

Besides increasing general physical activity, the health assessment also recommended aiming for 2-3 strength training sessions (10-20 minutes each) a week. These can be as simple as a regimen of push-ups, sit-ups, pull-ups and calisthenics. And of course, doing  some simple stretching at least 2-3 times a week can maintain your flexibility, as well as reduce possible back aches and injuries from running after a toddler!

With the warmer spring/summer weather approaching, getting more physical activity should become easier. These can be activities that both you and your toddler/child enjoy (e.g., kicking a ball, going for a walk/hike, swimming). So let’s all get moving and stay active for better health!