Obesity is a topical issue, not only because of the great advertising bombardment of the slender and sporty body, the endless list of dietary regimens, miraculous medicines and how much machinery and gadget difficult to slim they happen to invent, but by the contradictory element of the presentation of fast food chains, fabulous restaurants and Babylonian banquets, all presented as a reward or an indulgence to the efforts of daily life. How can one stay sane before this contradictory information? On the one hand, you have to spend a fortune to gobble up “the gastronomic pleasures” that are offered to the senses, and on the other hand, you are advised to spend an even greater fortune on systems and products to lose weight and eliminate the ravages of first offer. A whole caloric odyssey!

During pregnancy it is of the utmost importance to take care of nutrition in order to obtain a suitable modification of body weight

I Weight and pregnancy

There are two conditions of weight and pregnancy: (1) Initial weight and (2) Weight gain.

The Initial Weight is the weight prior to pregnancy or very close to its beginning and the Weight Gain refers to the extra kilos that are expected to increase throughout the pregnancy.

Weight gain in pregnancy

It is expected that there will be weight gain in pregnancy, the figure loses importance in this period of life! At the first visit or prenatal check the calculation of the BMI (Body Mass Index) will be made based on the preconceptional weight (Initial Weight) in order to classify the patient in one of the weight categories. Once the classification is done, the weight gain range allowed for the current pregnancy is suggested (Weight Gain):

BMI of Low Weight (<19.8): it is allowed to gain from 12.5 to 18 Kg.

BMI of Normal Weight (19.8 – 26.0): allowed gain of 11 to 16 Kg.

BMI of Overweight (30 -34.9): allowed gain of 6 to 11 Kg.

BMI of Obesity (> 30): allowed gain of 5 to 9 Kg.

(weight loss is currently suggested in the morbidly obese patient, BMI> 40))

The first thing that comes to mind is that overweight patients will have narrower limits of increase while thin or low weight will have much wider ranges of increase and therefore higher caloric requirements if they want babies of adequate weight at birth . The extremes in obstetrics are not good for babies. Initially it was thought that the fetus obtained from the mother all the nutrients that were necessary regardless of the nutritional status of the mother; however, over time it was determined that those women who started their pregnancy with malnutrition or those who did not gain enough weight had babies of lower weight. There are some very important points:

• Chronic malnutrition affects the final weight (low birth weight) and the future health of your baby
• Your baby will weigh less if you gain weight only after the first half of pregnancy even when you gain the expected weight gain.
• Adequate nutrition before pregnancy and adequate weight gain before week 24 will guarantee the adequate growth potential of your baby.
• The fetuses of obese mothers tend to have normal or high birth weights regardless of the increase in body weight during pregnancy

II Obesity before pregnancy

The patient who starts her pregnancy with body weight in the range of overweight or obesity faces important challenges and risks in her pregnancy. The fundamental challenge is to control weight gain as expected for the BMI, the idea is that you do not add an excess of kilograms to an organism whose weight is already excessive, this is something complicated because the obese patient is used to ingest Large caloric portions during the day and pregnancy will add an extra appetite. Current evidence suggests that you can lose weight in pregnancy and obtain maternal-fetal benefits

This is a long list of obstetric complications to which the obese patient is exposed, it does not imply that they will always occur but it must be borne in mind that their frequency is increased.

Complications during pregnancy:

• Chronic hypertension
• Hypertension Induced by Pregnancy, Preeclampsia
• Pregestational Diabetes (exists before pregnancy, known or not)
• Gestational diabetes (appears during pregnancy)
• Breathing difficulty during sleep (obstructive sleep apnea)
• Urinary infection

Complications of Childbirth:

• Increased risk of Cesarean section
• Bulky fetus: fetopelvic disproportion, prolonged labor, pelvic injury
• Shoulder dystocia (fetus trapped by the shoulders in the maternal vagina)
• Difficulties with anesthesia: techniques and dosage

Postpartum Complications:

• Deep venous thrombosis
• Uterine infection
• Infection and dehiscence (opening) of the operative wound
• Pulmonary embolism
• Post-partum haemorrhage
• Prolonged hospitalization

Fetal and Newborn C omplications:

• Fetal macrosomia
• Fetal injuries during delivery or cesarean
• Metabolic disorders of the newborn: hypoglycemia, hypocalcemia, etc.
• Newborn’s respiratory distress
• Spina bifida, cleft lip or palate, anorectal atresia, hydrocephalus, limb disorders.

III Excess weight gain

A patient with normal body weight (BMI Normal) who incurs an excessive intake can exceed the limits and recommendations made by your doctor if you are careless or if you are too indulgent in your daily intake, especially if the diet includes many calories from trinkets and of junk food with little nutritional value. These patients will present fewer complications than a chronically obese patient can suffer but after childbirth a great battle against “fatness” will begin. Some of the complications that could occur are Gestational Diabetes, Fetal Macrosomia, Preeclampsia, higher risk of Caesarean section and postpartum depression.

IV Objectives of the nutritional management of pregnancy

Pregnancy should not be a reason for indulgence to gain weight in an uncontrolled way, the mother must learn to eat in a healthy and restrained way. It should be insisted that pregnant women eat foods of high biological value, in a balanced way and in adequate quantities to maintain a harmonious weight gain throughout their pregnancy and ensure a healthy and healthy weight baby, avoid maternal nutritional wear and guarantee adequate energy deposits for effective breastfeeding.

V Frequently asked questions

What is the effect of obesity on fertility?

Obesity as a cause of infertility is intimately related to ovulation disorders and important alterations in reproductive endocrinology. It is not uncommon to find cases of obese patients who do not ovulate, with menstrual delay or with totally irregular menstruation, therefore it is not unusual to find higher rates of infertility in these patients. If there is infertility associated with obesity, many things must be corrected before attempting a pregnancy.

I’m obese, what should I do?

If you think about a pregnancy in the short term you can not do much about your weight but it would be wonderful for a nutritionist to educate you in your diet so that you choose the best available foods and learn to take smaller portions in a balanced way. In the long term we have more time not only to educate you from the nutritional point of view but to initiate more drastic measures such as hypocaloric diets, medication and even surgery. In any case, just suspect that you are pregnant go to prenatal care early; Of course, the ideal is that you attend control months before your future pregnancy (Preconceptional Carel) to adjust many nutritional details.

I have a gastric bypass, can I get pregnant?

There is no formal contraindication for pregnancy after anti-obesity (Bariatric) surgeries, but it must be borne in mind that during the first months or years you will be in a state of relative malnutrition and pregnancy is not advisable in that period. It is advisable to wait 1 or 2 years for you to have time to achieve a new stable nutritional status, that the operative discomfort, that you have learned to eat and to manage the state of chronic selective malnutrition that these interventions leave (for example, the deficiency of vitamin B12), in addition to losing the weight you wanted to lose, of course. Depending on the type of surgery, appropriate measures will be taken and potential risks and complications will be discussed.

Can I diet and lose weight during pregnancy?

It is not recommended to establish a state of attrition nutrition during pregnancy, the weight reduction diets in pregnancy should be established by nutritionists; Recent studies suggest that losing weight during pregnancy (obese patient) does not affect the neurological development of the fetus, the maternal plasma acidity does not affect the fetus or the maternal capacity to release oxygen to the fetus. It is imperative to lose weight when in massive obesity the patient presents respiratory distress that could be aggravated by the increase in uterine volume and the increase in body fat.

Remember

• Pregnancy is not the excuse or gives you the right to eat and get fat without control.
• Being overweight is not the best ally of human reproduction.
• Healthy eating is an art that requires education, practice and will.
• Calories are like sins: easy to acquire but very difficult to eliminate (their effects)
• Overweight and obesity are not aesthetic problems, they are personal health problems that have become a real public health problem
• If you do not consider yourself able to maintain adequate nutrition during pregnancy, ask for help from a nutritionist
• Indulgence in eating alone causes overweight: do not abuse calories

recommendations

• Set the final weight indicated by your doctor as a goal. Progressively increase weight according to the BMI curve that was assigned to you. If necessary, you should lose weight under specialized vigilance.
• Eat healthy foods with high nutritional value
• Eliminates the “Calories Scrap” with low nutritional density and high caloric density.
• Use low-calorie foods if you want to appease your appetite without getting fat: microwaves without butter, vegetables, legumes, cassava, salads without oily sauces, soups, etc.
• Drink enough water: 6-8 glasses daily keep you hydrated, meet the requirements of pregnancy and decrease appetite; In addition, it improves constipation.
• Do not succumb to all the “cravings”

Nutrition concepts

Nutritional Density: Consider this example, suppose you are given a snack of 300 calories and you are given a choice between 2 options: (1) French fries (25 sticks) or (2) A glass of milk and a cheese sandwich with wholemeal bread. What option would you take and what would you consider the best nutritional option? Although both have the same caloric content (fattening the same) the first option is far from being considered a nutritious option, however, the second would provide a non-negligible amount of protein, essential fatty acids and vitamins. This is Nutritional Density, concentration of useful nutrients per caloric unit.

Caloric Density: This is another interesting concept. In the previous example it is clearly noted that the person who chose the sandwich with milk ate more volume than the person who chose the potato chips. the first one was satiated and the second one just wants to continue eating, he was hungry. This is the caloric density: calories per unit weight of the food.

Glycemic index: The glycemic index (Montignac.com) measures the ability of a food to raise the glycemia after a meal and the insulin response it triggers, with respect to a standard reference that is the response to pure glucose. In general, it is recommended to eat foods of low to medium glycemic index.