What to Know About Obesity If You’re Pregnant—Or Want to Be
Yes, that all sounds pretty scary. The good news is that making healthy changes to start addressing obesity now—whether you’re already pregnant or want to be—can make a measurable difference, and fast. “First, women with obesity need to know that there is hope,” Dr. Younglove says. “Actively gaining weight worsens these things considerably, while losing weight improves them—almost immediately.”
What You Can Do Pre-Pregnancy
If you’re obese and hoping to become pregnant, the most powerful thing you can do is move toward achieving a healthy BMI, even if you’ve never had success before. “The goal isn’t about perfection—it’s about making small, positive changes that support your fertility and a healthy pregnancy. Even losing 5 to 10 percent of your body weight can improve ovulation, boost fertility, and lower pregnancy risks,” Dr. Jenna Turocy, MD, OBGYN and fertility expert at Columbia University Fertility Center. Focus on consistency and losing weight in a way that’s sustainable, not following a crash diet or other extreme approach. Ideally, get advice from a trained obesity-medicine provider, especially if you’re considering weight-loss injections. “Although we are seeing a lot of people use anti-obesity medications leading right up to pregnancy, then stopping them as soon as they are pregnant, this isn’t ideal,” Dr. Younglove notes. “We don’t want a phase of rapid weight re-gain to occur during pregnancy, as it cranks up inflammation and insulin.” If you do use weight-loss medication, your doctor will guide you on when to stop and how long to wait until trying to get pregnant. “Some of our anti-obesity medications are absolutely contraindicated during early pregnancy, the risks of others are completely unknown, and nobody wants to experiment on their developing fetus,” Dr. Younglove adds. If you want to lose weight without medication, a registered dietician is another great resource who can guide you on how to balance your diet so you shed fat without feeling depleted or ravenous, and how to adjust your meals to include enough protein, calcium, and iron once you’re eating for two—without overdoing it and rapidly re-gaining weight.
In addition to healthy eating, when you have obesity and are planning to get pregnant, “you should be tested for diabetes and monitor your blood pressure to assess your personal baseline,” says Dr. Donna Adams-Pickett, PhD, MD, a board-certified OB/GYN and women’s health advocate in Augusta, GA. Early screening can allow you to better manage any issues through lifestyle modifications before and during pregnancy.
Finally, if you’re having trouble conceiving, see a fertility specialist right away; they can monitor key health factors and give you personalized advice on what to do next. Note that fertility problems can often resolve as you begin to lose weight. Bariatric surgery may be an option if you have a BMI of 40 or greater or a BMI between 35 and 39 with major health problems caused by obesity, according to ACOG. It’s recommended that after weight-loss surgery, you delay getting pregnant for 12 to 24 months.
What You Can Do During Pregnancy
If you’re pregnant and have obesity, your healthcare provider will likely recommend early testing for gestational diabetes, at your first prenatal visit (this is usually done between weeks 24 and 28 of pregnancy). If your blood glucose levels test high, you’ll need additional testing, and your healthcare provider can discuss how to monitor and control your blood sugar. Also at this first visit, your healthcare provider should screen for obstructive sleep apnea, which is common among obese pregnant women and can lead to serious pregnancy risks like preeclampsia. If needed, you can then see a sleep specialist for a treatment plan.
