The Impact Of Weight In Pregnancy

We finish our conversation on how obesity and metabolic dysfunction shape pregnancy outcomes and why a mom’s metabolic health can influence a baby’s health for life. We break down healthy pregnancy weight gain ranges, explain why pregnancy increases insulin resistance, and share practical steps for safer prenatal and postpartum health. 

• obesity rates before pregnancy and why it raises risk for mom and baby 
• recommended pregnancy weight gain by pre-pregnancy BMI and when most gain should happen 
• risks tied to excessive gestational weight gain including gestational diabetes, hypertension, preeclampsia, clots, and C-section 
• normal pregnancy changes in blood volume, heart rate, blood pressure, and clotting 
• why pregnancy increases insulin resistance and how the pancreas compensates 
• how high blood sugar affects mom’s future type 2 diabetes risk 
• how gestational diabetes can affect baby size, delivery risk, newborn low blood sugar, and lifelong diabetes risk 
• why family planning and effective birth control support healthier pregnancies 
• treatment paths before pregnancy including obesity medicine, medications before conception, and bariatric surgery timing 
• pregnancy strategies including nutrition, low-impact activity, prenatal screenings, and dietitian support 

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Transcript

Welcome And Medical Disclaimer

Dr. Lindsay Ogle 0:00

Welcome to the Modern Metabolic Health Podcast with your host, Dr. Lindsay Ogle, Board Certified Family Medicine and Obesity Medicine Physician. Here we learn how we can treat and prevent modern metabolic conditions such as diabetes, PCOS, fatty liver disease, metabolic syndrome, sleep apnea, and more. We focus on optimizing lifestyle while utilizing safe and effective medical treatments. Please remember that while I am a physician, I am not your physician. Everything discussed here is provided as general medical knowledge and not direct medical advice. Please talk to your doctor about what is best for you.

Why Weight Matters In Pregnancy

Dr. Lindsay Ogle 0:45

I wanted to take this opportunity to finish up the previous conversation about the link between weight, obesity, and metabolic dysfunction with pregnancy and how that impacts the woman and baby. Last week I talked about preconception, how weight and metabolic health can impact fertility. And today I'm going to talk about what happens during pregnancy and after pregnancy. My name is Dr. Lindsay Ogle, and I'm a board-certified family medicine and obesity medicine physician. This topic is so important because women's health before they get pregnant and during their pregnancy have huge implications for our health as a population because mom's health impacts babies' health throughout the rest of their lives. And we're gonna explore that today. First of all, how common of an issue is this? In the US, it is estimated that approximately 30% of women are classified as having obesity prior to becoming pregnant. And the reason this is important is because having that excess weight prior to conception can increase the woman for being at risk of complications during and after their pregnancy. And as I mentioned before, can also put baby then at risk for complications during gestation or in their early life or later on

Pregnancy Weight Gain Targets By BMI

Dr. Lindsay Ogle 2:29

in life. Now, weight gain in pregnancy is something that is not always talked about. So obviously, we know you're going to gain weight in pregnancy. You want to gain weight in pregnancy that is healthy. Everybody should gain weight while they're pregnant. The amount of weight varies depending on your pre-pregnancy BMI. The lower your BMI is, the higher relative amount of weight you should be gaining. So if you are considered underweight before pregnancy, which is a BMI of 18.5 or less, it is recommended to gain a total of 28 to 40 pounds during your entire pregnancy. So that is one pound or less per week. Most of the weight gain during pregnancy really should be in the second and third trimester. That's when baby is actually growing in size. Early on in pregnancy, baby is super, super little, and we shouldn't be seeing necessarily a significant amount of weight gain. And again, so most of that weight gain occurs, most of that healthy weight gain occurs in the second and third trimester. If you fall within the normal weight category, so that's a BMI of 18.5 to 24.9, then the recommended weight gain is anywhere from 25 to 35 pounds during pregnancy. If you are in the overweight category, which is 25 to 29.9 for your BMI, then the recommended weight gain during pregnancy is 15 to 25 pounds. And then if you fall within the obese category that's 30 of that's a BMI of 30 or greater, then the recommendation is to gain between 11 and 20 pounds during pregnancy. And so that is just half a pound a week in the second and third trimester. So we know many women gain more weight than recommended. And if that is you, I don't want you to stress about it, especially if this has already happened in the past. There's nothing we can do about it. But excessive weight gain during pregnancy can put you at higher risk for conditions such as gestational diabetes, gestational hypertension, pre-eclampsia, eclampsia, blood clots, complicated deliveries that may require a C-section or an assist device like a vacuum or other instruments to help deliver baby. Plus, it can be harder to lose the weight than after pregnancy to get you back to your healthy best

Normal Body Changes And Insulin Resistance

Dr. Lindsay Ogle 5:20

weight. Normal changes that happen during pregnancy include increased blood volume, increased heart rate, lower blood pressure, and increased ability to form clots. And so the reason that this happens is that we want to improve blood flow to baby through the placenta. And so that is why we have more blood circulating, our heart is beating more often, and our blood pressure decreases so it can flow easier. And then the increased ability to form clots is to prepare our body to stop bleeding after we deliver baby. Another major change that occurs during pregnancy is that women's bodies become more insulin resistant. And what that means is that the cells themselves are not responding to insulin as well as they used to. And this is purposeful. The reason this happens is so that blood sugar goes up a little bit, so that baby gets that blood sugar, gets those nutrients, that energy into their circulation so that they can grow. In a normal pregnancy, the woman's pancreas overcomes this insulin resistance by increasing more insulin production to make sure that blood sugar doesn't go too high, just keeps it a little bit high. And blood sugar remains in a normal range, but on that slightly higher end. For women who prior to pregnancy have struggled with some level of insulin resistance, their pancreas is a little bit tired, we call it.

Gestational Diabetes Risks For Mom

Dr. Lindsay Ogle 7:36

So high blood sugar can negatively impact mom and can cause increased inflammation and can further put that stress and demand on the pancreas, which will put her at higher risk for developing type 2 diabetes after the pregnancy and later on in life. It also increases the amount of that sugar and energy to the baby, so baby now has a lot of excess energy and sugar, and that promotes growth. And so baby grows larger than we would expect. And that sounds great, but in reality it can cause complications. So if baby is bigger than what would be expected for the mama that size, then it will be harder for mom to deliver that baby vaginally, and we may need to schedule a C-section, or baby will be at higher risk for getting stuck during delivery. We call that shoulder dystocia. Also, those

Baby’s Risks And The Generational Cycle

Dr. Lindsay Ogle 8:44

higher blood sugars in baby circulation puts strain on baby's pancreas. It has to produce more insulin itself to overcome that high blood sugar and control it so it's in a safe level for baby. And so even before baby is born, its pancreas is stressed, and this will lead it to have a higher predisposition or a higher chance of developing diabetes in its life, typically at an early age. And so this is where we really see that vicious cycle of generational, of generations after generation, of families having diabetes and often at earlier ages. Baby is also at risk of having low blood sugar after delivery because the pancreas is used to secreting higher levels of insulin because it's having to overcome the blood sugar and that mom, the higher blood sugar that mom has. But once baby is delivered, it loses access to mom's blood sugar and it's still secreting a similar amount of insulin that it's used to, and then blood sugar can drop into a dangerous level. And so we have to closely monitor blood sugars for babies that are born to moms who have gestational diabetes.

Family Planning And Prevention Strategies

Dr. Lindsay Ogle 10:03

The truth is pregnancy is a natural stress test on the body, and so we want women to be extremely healthy prior to becoming pregnant, which is why having effective birth control and planning for pregnancies is so important because we want to optimize your health prior to pregnancy so you can have the safest pregnancy and you can be healthy postpartum and baby can be healthy throughout their life. So family planning is so important. I will include a video with all of the birth control options and you can review that and choose something that is most effective or fits best into your life at this moment. But using a birth control until you're ready to become pregnant is so important. Now, what can we do about this? It's one thing to talk about a problem, but we need to have solutions. And so if you or someone you love is wanting to become pregnant and is carrying excess weight, talk to obesity medicine physician and see what your choices are for treatment prior to becoming pregnant. If you are able to utilize our medications, great, and we can use those up until pregnancy. For some patients, bariatric and metabolic surgery may be the answer. And we can do that, but we just want to plan at least a year, maybe two, before you become pregnant so your body can cover can recover fully from that surgery. If you become pregnant and you continue the pregnancy and you are carrying excess weight, or maybe you're at a normal BMI, but you have a family history of gestational diabetes or diabetes in general, it is really important to focus on healthful nutrition, continue physical activity, or start low-impact activities like walking, and schedule your appointments with your OBGYN or family medicine doctor, whoever is providing your prenatal care, and get all the recommended screenings so that you can ensure the safest and most healthy pregnancy possible. Try to stick within those guidelines for weight gain during pregnancy and follow up with your doctor. It may be worth talking with a dietitian. They are super helpful and can really guide you. If you do have gestational diabetes, it is absolutely recommended to work with a registered dietitian.

Key Takeaways And How To Help

Dr. Lindsay Ogle 12:32

I hope this was helpful. I hope it wasn't too overwhelming. The point really is that women's health is so important for the women themselves, their babies, their families, and the population at home. We need to put more emphasis on healthy moms, healthy women to improve our population's health. This is a huge opportunity that we have, and I hope this brought more light to this important topic. Thank you for listening and loving how you can improve your metabolic health in this modern world. If you found this information helpful, please share with a friend, family member, or colleague. We need to do all we can to combat the dangerous misinformation that is out there. Please subscribe and write a review. This will help others find the podcast and they may also improve their metabolic health. I look forward to our conversation next week.