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

When Baby Comes Early

Premature Labor—Are You at Risk?

Each year 8 to 12 percent of pregnant women in the United States go into premature labor. The cause is usually unknown (as it was for Yvette Vanesko), but some of the risk factors are:

• a previous preterm delivery (this raises your risk by up to one-third)
• smoking
• drug/alcohol use
• age younger than 18 or older than 40
• history of sexually transmitted diseases

Uterine contractions sometimes can be stopped by drinking a lot of water and getting off your feet. When that doesn't work, doctors may give terbutaline, magnesium sulfate or other medications.

Today when a baby comes a few weeks early, the biggest problems for the parents are likely to be rushing to finish the nursery, get grandma there and find clothes to fit their tiny infant. Thanks to modern medical care, "preemies" who wouldn’t have made it 30 years ago not only survive but thrive.

"Some newborns as early as 22 weeks gestation may survive today," says Kara Coassolo, M.D., maternal/fetal medicine specialist at Lehigh Valley Hospital and Health Network. "The vast majority born between 28 and 37 weeks do. These later preemies have only a slightly higher chance of serious health problems than full-term (40-week) infants."

Yvette Vanesko didn’t know that when 33 weeks into her pregnancy, she began leaking amniotic fluid and her doctor sent her from her Pocono area home to Lehigh Valley Hospital. "I didn't know what it meant to be leaking fluid," she says. "I was afraid, not knowing what the outcome would be. But the nurses and doctors answered all my questions and reassured me everything would be OK."

Seven days later, little Stephen Vanesko came into the world. He was just over five weeks early and weighed a mere 5 1/2 pounds, but had no significant health problems. "He was a little jaundiced, which improved after a day or two," Vanesko says. "But his lungs were developed, he had no trouble breathing, and he went to the regular nursery. He was fantastic."

Respiratory distress is a big concern with premature infants because they don't always produce enough lung surfactant—a substance that keeps their lungs from collapsing when they breathe—until 34 weeks or beyond. If it looks as if a woman is going to deliver early, doctors can give her steroid shots that help the baby's lungs mature faster. If they're still not fully matured at birth, the lungs are treated with replacement surfactant to allow them to function properly.

It's thanks to surfactants, Coassolo says, that so many more preemies survive today. "Since the advent of this therapy, the survival rate has increased remarkably. In specialty hospitals like Lehigh Valley Hospital, the rate is up to 50 percent in infants born as early as 24 weeks," she says. "Very early babies do have a significant risk for problems with brain development compared to those born at 28 weeks or later."

The Vaneskos were fortunate to have their nursery set up and everything ready to go before Stephen was born. They had to make a last-minute search for extra-small baby clothes. But the toughest part of having a preemie for them was worrying about his future development and coping with his feeding schedule.

"Stephen ate every two-and-a-half to three hours around the clock for almost two months," Vanesko says. "By his 4-month checkup, he weighed 14 1/2 pounds and our doctor was very pleased with his development. He said only a pediatrician would know he was born five weeks early."

Is This Affecting My Baby?

The baby arrives— And the pregnancy worries are over for Tricia Singh of Jim Thorpe (photo above) with baby James and Tiffany Lopez of Catasauqua (below) with baby Reece.

Another happy outcome —Lexie Gallagher is a healthy 2-day-old. (See her and her mother below.)

Worry—it’s pregnancy’s middle name. How much caffeine is too much? Can I use cleaning products? Is it safe to exercise?

“Worrying about the health of your unborn baby is completely natural,” says obstetrician Amanda Flicker, M.D., of Lehigh Valley Health Network. “You are responsible for a new life.”

If you’re unsure about how a decision will impact your baby, talk to your doctor, says Kara Coassolo, M.D., a maternal-fetal medicine specialist at the hospital. Meanwhile, Flicker and Coassolo ease your fears with these guidelines:

Caffeine—Although no studies show clearly that caffeine causes miscarriage or preterm labor, it’s probably wise to limit yourself to one or two coffees a day.

Artificial sweeteners— Aspartame (Equal or NutraSweet) and sucralose (Splenda) are safe in moderation. If in doubt, stick to old-fashioned sugar.

Fish—One to two servings weekly provide healthy omega-3 acids for you and your baby, but avoid fish containing high levels of mercury (shark, swordfish, mackerel, tilefish, some types of tuna). It can harm the baby’s developing nervous system. Also avoid raw shellfish (oysters, clams).

Weight gain—If you’re average-weight, expect to gain 25- 35 pounds by the end of your pregnancy. Avoid gaining more by consuming a healthy diet and exercising 30 minutes a day. Excess weight raises your risk for diabetes, pre-eclampsia and health problems in the baby.

Exercise—It’s safe as long as there is no risk for falls or injuries (avoid in-line skating, skiing or powerlifting). Try walking, running, yoga, Pilates or swimming.

Massage—Find a therapist with experience in prenatal massage who will avoid trigger points that can stimulate preterm labor.

Hair coloring—Because so little dye is apparently absorbed through the skin, hair coloring is generally considered safe for pregnant women.

Household cleaning products—They’re generally safe, but consider wearing gloves and make sure there’s good ventilation (or go natural with baking soda and vinegar).

Ultrasounds and X-rays—There’s been no demonstrated risk from ultrasounds, and you’ll probably have one or more to check the baby’s growth and development. X-ray tests also may be done during pregnancy; your doctor can determine what level of radiation is safe.

Amniocentesis—Some women choose to have this test to reveal conditions such as Down syndrome. A needle is inserted into the uterus to withdraw amniotic fluid. There is a small risk for miscarriage afterward; discuss it with your doctor or genetic counselor.

Pain medications—It’s fine to use acetaminophen (Tylenol) in standard doses. High doses can damage your liver. Avoid ibuprofen (Advil, Motrin) and naproxen (Aleve), which can decrease amniotic fluid and affect an important blood vessel in the baby’s heart.

Air travel—Flying is generally safe, but talk to your doctor and check the airline’s policy—most allow pregnant women to travel until about a month before their due date. The airport security metal detector won’t harm you or your baby. On the plane, choose an aisle seat so you can easily get up to go to the bathroom or stretch your legs.

Worrying—If you’re extremely anxious or have a specific concern about your baby’s health, talk to your doctor. Part of taking care of your baby is keeping yourself as relaxed and stress-free as possible.

Published from Healthy You Magazine, September-October 2008