Weight Gain Between Pregnancies

About Our Expert

Kara M. Coassolo, M.D., is a maternal-fetal medicine specialist with Lehigh Valley Health Network.

• I knew that gaining too much weight during pregnancy was unhealthy, but now a study shows women who gained weight between pregnancies increased their risk of complications. Can you tell me more about this?
• Are these findings applicable to women in the United States?
• So if I am planning a pregnancy, what should I do to minimize my risk of complications?

Q: I knew that gaining too much weight during pregnancy was unhealthy, but now a study shows women who gained weight between pregnancies increased their risk of complications. Can you tell me more about this?

A: The study examined the health records of 150,000 women in Sweden who gave birth to their first and second children between 1992 and 2001. Women who gained even as little as seven pounds increased their risk for complications during pregnancy and delivery, even if the weight gain did not put them in the overweight category on the Body Mass Index (BMI). Those women had higher rates of hypertension, diabetes, Cesarean section, stillbirth and delivering a large baby. The rates of complications increased proportionally in women who gained more weight and decreased in women who lost weight.

Q: Are these findings applicable to women in the United States?

A: Since our population is much more diverse than Sweden’s, we cannot assume these findings would be exactly the same if we were to do a similar study here. The research looked at medical records, and did not gather information from women while they were actually between pregnancies, so other factors may have been overlooked. More research needs to be done, and that research may show that women in this country who gain weight between pregnancies may have even higher rates of complications. This is because the general population in Sweden is healthier than that of the United States. We have much higher rates of obesity, hypertension, diabetes and pregnancy complications to begin with. I see this study is a wake-up call for women in the United States who are planning a pregnancy.

Q: So if I am planning a pregnancy, what should I do to minimize my risk of complications?

A: Discuss your intentions with your family physician or gynecologist. Evaluate any health problems you already have. If you are overweight, lose weight before becoming pregnant. Improve your overall health by eating a balanced diet and getting exercise each day. Women who breastfeed their babies lose weight quicker and easier than women who don’t.

Speaking Out

March of Dimes Ambassadors— Susan and Mike Aboulhouda and their children, Michael, 12, and Catharine, 5, travel the country to raise awareness of preterm birth. Catharine was born so early her big brother had to wait weeks before he could visit her at Lehigh Valley Hospital-Cedar Crest. Now it’s clear they’re best pals.

Warning Signs of Preterm Labor

• Contractions every 10 minutes or less
• Change in vaginal discharge
• Pelvic pressure
• Low, dull backache
• Menstrual-like cramps
• Abdominal cramps with or without diarrhea

If you have even one of these symptoms, call your doctor or go to the hospital right away. If given promptly, medications can slow or stop labor or help protect the baby.

She was born on the Fourth of July, although that wasn’t the plan—Catharine Aboulhouda came into this world 16 weeks early. She weighed a mere 1 pound, 10 ounces, and “her footprint was the size of my thumbprint,” says her mother, Susan Aboulhouda of Allentown. Catharine spent her first 113 days of life in the neonatal intensive care unit (NICU) at Lehigh Valley Hospital-Cedar Crest, being treated for jaundice, bleeding in the brain and heart problems.

Five years later, Catharine is a healthy, vibrant little girl. As the 2008 National Ambassador for the March of Dimes, Catharine travels the country with her family to raise public awareness of the organization and its Campaign to Reduce Preterm Birth.

“Catharine represents a growing number of babies,” says Lorraine Dickey, M.D., a neonatologist (specialist in ill newborns) at the hospital. Nationally, more than 500,000 newborns—1 in 8— are premature. (Northampton and Lehigh counties do slightly better, at 1 in 10 and 1 in 12, respectively.) Normal gestation is about 40 weeks; any baby born before 37 weeks is considered preterm.

“Preemies often have heart, breathing, digestive and vision problems,” Dickey says. The effects can be lasting, including a higher risk for childhood death, delayed development and learning problems.

Why has the number of preterm births climbed more than 20 percent since 1990? “One theory is the rising use of fertility drugs, which often results in multiple babies born prematurely,” says Dickey’s colleague, maternal-fetal medicine specialist Kara Coassolo, M.D. “Also, more women are having children at a later age, when they’re more likely to have high blood pressure and other conditions linked to preterm birth.”

Preterm labor can happen to any woman, says Patrick McIntyre, M.D., an obstetrician with the hospital. You’re at higher risk if you’ve had a previous premature baby, are pregnant with twins (or more), are obese, or have diabetes, clotting disorder or vaginal disease. The risk also increases for women who smoke, drink, use drugs, suffer abuse, are highly stressed, or spend long hours on their feet during pregnancy. “If you’re considering having a baby,” McIntyre says, “talk to your doctor about your risks.”

A good preventive move: Start taking folic acid right away. Research suggests that taking it for at least a year before pregnancy reduces the risk for preterm labor as well as preventing birth defects. It’s also important to learn the symptoms of preterm labor (see left) so you can get medical help quickly.

Since Susan Aboulhouda had none of the risk factors, she and her husband, Mike, never expected a preemie. “We are honored to be the National Ambassador Family for the March of Dimes,” she says, “and feel fortunate to have a healthy child.”

Published from Healthy You Magazine, July-August 2008

New Mom Beats Cancer

Ovarian Cancer Symptoms

Ovarian cancer can affect women and girls of all ages. Symptoms are usually subtle. See your doctor if any of these symptoms persist for a month or more:

• Pelvic/abdominal pain or discomfort
• Nausea, gas, diarrhea, constipation, pressure, cramps, indigestion
• Frequent urination
• Weight gain or loss
• Pelvic/abdominal swelling, bloating or feeling of fullness
• No appetite
• Abnormal vaginal bleeding
• Ongoing unusual fatigue
• Changes in bowel habits

The September day was brutally hot, and Sarah Blakeley was nervous. But she powered her way through her first-ever triathlon to the cheers of a supportive crowd. It was a triumph in every sense for the 26-year-old Allentown woman who “never let doubt creep in.” She’d met the challenge of a triathlon, new motherhood and ovarian cancer.

In January 2007, Blakeley and her husband, Matt, went for a routine ultrasound. She was nine weeks pregnant. When a large mass was found on her ovary, no one was especially concerned. “Ovarian masses are relatively common,” says obstetrician Patrick McIntyre, M.D., of Lehigh Valley Health Network. “They are usually cysts and can be watched without removing. The mass on Sarah’s ovary had some worrisome features, however.”

Specialists in high-risk pregnancy and gynecologic cancer surgically removed and biopsied the mass. Four weeks later, Blakeley learned she had an aggressive form of ovarian cancer. The case was rare enough that her doctors consulted with other national cancer experts about the best course of treatment.

“Sarah and Matt were faced with very difficult decisions,” says gynecologic oncologist Richard Boulay, M.D. “Balancing the needs of the mother and fetus is challenging when you’re considering chemotherapy.”

The Blakeleys chose to continue the pregnancy and delay treatment until after delivery. Maternal-fetal medicine specialist Kara Coassolo, M.D., monitored mother and baby and administered steroid injections to strengthen the baby’s lungs. The entire team, including neonatologists to care for the newborn, was on hand August 14 when Charlotte (Lotte) Blakeley was delivered by cesarean section.

Less than a month later, Blakeley began chemotherapy. Though it left her very sick, she made it home from the hospital for her first wedding anniversary—and within weeks got the news she was cancer-free. “We always believed the baby would be okay, the chemo would work and the cancer would be gone,” she says. “Lotte was powerful motivation when I needed it.”

During her recovery Blakeley joined Team Survivor, an organization that promotes exercise for women affected by cancer, and began training for the triathlon. “I was a couch potato before,” she says, but the triathlon made her “feel whole again” and she plans to continue competing. In fact, she recently completed the Boston Marathon for the first time. Diligent about health screenings, she has this message for other women: “Listen to your body. Cancer doesn’t yell; it whispers. See your doctor if you have any concerns.”

Want to Know More about ovarian cancer and Team Survivor? Call 610-402-CARE.

Published from Healthy You Magazine , January February 2009

Obesity and Pregnancy

Starting your pregnancy at the perfect weight and gaining just the right amount is ideal. But with rising obesity rates, many women fall short of both marks—putting themselves and their babies at risk for life-threatening complications.

“Women with a body-mass index, or BMI, over 30—which defines obesity—are at higher risk for gestational, or pregnancy-related, diabetes and preeclampsia (pregnancy-related high blood pressure),” says Kara Coassolo, M.D., a maternal-fetal specialist with Lehigh Valley Health Network. “They’re also at greater risk for stillbirth, early delivery and C-section.” And babies born to obese mothers are more prone to neural tube defects like spina bifida, congenital heart problems, and cleft lip and palate.

“There are probably many mechanisms at work here,” says health network obstetrician Joseph Patruno, M.D. “Preeclampsia and gestational diabetes may result from the fact that heavier people already have a higher risk for vascular and metabolic problems. And the birth defects could be because these women metabolize certain vitamins, like folic acid, differently.”

“If you’re obese, it’s best to lose weight before getting pregnant,” says Peter Rovito, M.D., a bariatric (weight-loss) surgeon with the health network. Preconception counseling with your obstetrician or family physician can help you achieve the best weight for you and your future baby. Be sure to discuss diet, exercise and even the possibility of weight-loss surgery with your doctor.

If you become pregnant before losing weight, it’s wise to have a maternal-fetal (highrisk childbirth) specialist monitor your health, particularly if you have existing conditions. He or she can advise you on appropriate weight gain to minimize complications.

The Institute of Medicine recently revised its pregnancy weight-gain guidelines to include obese women (see box). They’re advised to add fewer pounds than normal-weight women. “The goal should be to gain around 15 pounds,” Coassolo says, “but less is OK as long as you don’t lose weight and you and the baby continue to do well.”

Published from Healthy You Magazine, November December 2009