Coming out of size O BLUES.....

By working risk to you and your baby can be reduced by:

Healthy eating

The amount of weight women may gain during pregnancy can vary greatly. A healthy diet will benefit both you and your baby during pregnancy. You should aim to:

• Base your meals on starchy foods such as potatoes, bread, rice and pasta, choosing wholegrain where possible
•  Do not ‘eat for two’Watch the amount you eat and don't get angry if your partner stops you from a big meal
• Eat a low-fat diet.Eat very little: fried food, drinks and confectionary high in added sugars, and other foods high in fat and sugar
• Eat fibre-rich foods such as oats, beans, lentils, grains, seeds, fruit and vegetables as well as wholegrain bread and brown rice and pasta
• Eat at least five portions of a variety of fruit and vegetables each day, in place of foods higher in fat and calories
• Always eat breakfast

In general you do not need extra calories for the first two thirds of pregnancy and it is only in the last 12 weeks that women need an extra 200kcal a day.   

Don't lose weight by dieting during pregnancy as it may harm the health of your unborn baby. However, by making healthy changes to your diet you may not gain any weight during pregnancy and you may even lose a small amount. This is not harmful.

Exercise

Don't dismiss your doctor by saying that you exercise quite a lot as you have to walk at the work place .   

• Activities like walking, cycling, swimming, low impact aerobics and gardening are good form of recreational exercise.climb stairs instead of the lift.
• Minimise sedentary activities, such as sitting for long periods watching television or at a computer.
• Physical activity will not harm you or your unborn baby. However, if you have not exercised routinely you should begin with no more than 15 minutes of continuous exercise, three times per week, increasing gradually to 30 minute sessions every day. A good guide that you are not overdoing it is that you should still be able to have a conversation while exercising.

An increased dose of folic acid

t. If your BMI is 30 or above you should take a daily dose of 5 mg of folic acid. This is a higher dose than the usual pregnancy dose. Ideally you should start taking this a month before you conceive and continue to take it until you reach your 13th week..

Vitamin D supplements

All pregnant women are advised to take a daily dose of 10 micrograms of vitamin D supplements. However, this is particularly important if you are obese as you are at increased risk of vitamin D deficiency.  

Venous thrombosis

Your risk for thrombosis (blood clots in your legs or lungs) is assessed at your first antenatal appointment and monitored during your pregnancy. You may need to have injections of low molecular weight heparin to reduce your risk of blood clots. This is safe to take during pregnancy.

Gestational diabetes

A oral Glucose tolerance test with 75 gms glucose and with 3 samples is performed between 24 to 28 weeks to detect gestational diabetes and if detected you will be referred to a diabetologist. 

Monitoring for pre-eclampsia  

Your blood pressure will be monitored at each of your appointments. Your risk of pre-eclampsia may be additionally increased if you are over 40 years old, if you had pre-eclampsia in a previous pregnancy, or if your blood pressure is high before pregnancy.

A low dose aspirin  reducesthe risk of developing high blood pressure.

Additional ultrasound scanning

Having a BMI of more than 30 can affect the way the baby develops in the uterus (womb) so you may need additional ultrasound scans. You may also need further scans because it can be more difficult to check that your baby is growing properly or feel which way round your baby is.

Planning for labour and birth

Because of these possible complications, you should have a discussion with your obstetrician  about the safest way of delivery. If you have a BMI of 40 or more, arrangements should be made for you to see an anaesthetist to discuss a specific plan for pain relief during labour and birth. These discussions may include:

Where you give birth

There is an increased chance of your baby needing to be cared for in a (NICU) after birth. .

What happens in early labour

If your BMI is over 40, it may be more difficult for your doctors to insert a cannula (a fine plastic tube which is inserted into the vein to allow drugs and/or fluid to be given directly into your blood stream) into your arm. Your doctors will usually insert this early in labour in case it is needed in an emergency situation.

Pain relief

All types of pain relief are available to you. However, having an epidural (a regional anaesthetic injection given into the space around the nerves in your back to numb the lower body) can be more difficult if you have a BMI over 30. Your anaesthetist should have a discussion with you about the anticipated difficulties. He or she may recommend that you have an epidural early in the course of labour.

Delivering the placenta (afterbirth)

An injection is normally recommended to help with the delivery of the placenta (afterbirth) to reduce the risk of post partum haemorrhage (heavy bleeding).

What happens after birth?

After birth some of your risks continue. By working together with your healthcare professionals, you can minimise the risks in the following ways:

Monitoring blood pressure

You are at increased risk of high blood pressure for a few weeks after the birth of your baby and this will be monitored.

Prevention of thrombosis

You are at increased risk of thrombosis for a few weeks after the birth of your baby. Your risk will be re-assessed. To reduce the risk of a blood clot developing after your baby is born:

Try to be active – avoid sitting still for long periods

• Wear special compression stockings, if you have been advised you need them
• If you have a BMI of 40 or above, you should have low molecular weight heparin treatment for at least a week after the birth of your baby - regardless of whether you deliver vaginally or by caesarean section. It may be necessary to continue taking this for six weeks

Test for diabetes

For many women who have had gestational diabetes, blood sugar levels return to normal after birth and medication is no longer required, but you should be re-tested for diabetes about six weeks after giving birth. Your risk of developing diabetes in later years is increased if you have had gestational diabetes. You should be tested for diabetes by your GP once a year.

Information and support about breastfeeding

Breastfeeding is best for your baby. It is possible to breastfeed successfully if you have a BMI of 30 or above. Extra help should be available if you need it.  

Vitamin D supplements

You should continue to take vitamin D supplements whilst you are breastfeeding. 

Healthy eating and exercise

Continue to follow the advice on healthy eating and exercise. 

Planning for a future pregnancy

Reducing your weight to reach the healthy range

If you have a BMI of 30 or above, whether you are planning your first pregnancy or are between pregnancies, it is advisable to lose weight. If you lose weight:

• You increase your ability to conceive and have a healthy pregnancy
• You reduce  the additional risks to you and your baby during pregnancy
• You reduce your risk of developing diabetes in further pregnancies and in later life

If you have fertility problems it is also advisable to lose weight, since having a BMI of more than 30 may mean you would not be eligible for fertility treatments such as IVF.

Your healthcare professional should offer you a structured weight loss programme. You should aim to lose weight gradually (up to about 1 kg or about 1 to 2 lbs a week). Crash dieting is not good for your health. Remember even a small weight loss can give you significant benefits.

You may be offered a referral to a dietician or an appropriately trained health professional. If you are not yet ready to lose weight, you should be given contact details for support for when you are ready.

An increased dose of folic acid

If you have a BMI of 30 or above, remember to start taking 5 mg of folic acid at least a month before you start trying to conceive. Continue taking this until you reach your 13th week of pregnancy.