Overweight women need better pre-pregnancy counseling
GALVESTON – Better care and counseling is needed to teach overweight women hoping to become pregnant about the health dangers of their excess weight and the importance of maintaining a healthy diet, a new US study concludes.
“Overweight women trying to conceive largely misperceive their weight, which is concerning because they may not try to adopt healthier behaviors,” said study author Mahbubur Rahman of the University of Texas Medical Branch (UTMB) in Galveston.
Those excess pounds can lead to diabetes and high blood pressure, which increase the chances of pregnancies complicated by gestational diabetes, pre-eclampsia (dangerously high blood pressure and high protein in the urine), cesarean section, stillbirth or congenital abnormalities, lead author Dr. Abbey Berenson and her team write in the Journal of the Academy of Nutrition and Dietetics.
Recent research indicates that half of U.S. women of childbearing age are overweight, the researchers note. The Centers for Disease Control and Prevention in 2006 recommended improved pre-conception care, including screening for obesity and education about its risks, they add.
In 2010 and 2011, to see whether women intending to become pregnant were better informed about the risks of overweight and obesity than women not planning a pregnancy, the researchers administered questionnaires to 1,726 women aged 16 to 40 years old from reproductive health clinics in southeast Texas.
The women were asked what they knew about the risks of obesity, their perception of their own weight and their attitudes about healthy diets.
About half of the group was overweight or obese, and 126 women (about 8 percent) said they were hoping to become pregnant.
Among those planning a pregnancy, 31 percent mistakenly thought their weight was “about right” and 47 percent thought their diet was healthy and saw no reason to adjust what they were eating.
More than half of the women planning pregnancy showed low knowledge of obesity risks in their survey answers. And more than three-quarters said they felt confused about what constitutes a healthy diet.
The level of knowledge about obesity risks and healthy eating was about the same among women not hoping to become pregnant.
The overweight women were much more likely to misjudge their own weight than were obese women or women of healthy weight. Some 71 percent of overweight women didn’t think they were too heavy, compared to 10 percent of obese women.
Dr. Lisa Neff, an endocrinologist at Northwestern University Feinberg School of Medicine who studies excess weight gain in pregnancy, said this study “highlighted the gaps in knowledge about risks of obesity and pregnancy and particularly . . . about weight misperception among overweight women.”
But, Neff said, many women simply struggle with slimming down. “I think one important thing is that many women often come in to a weight management center with expectations that they have to lose a lot of weight to have a good health benefit,” said Neff, who was not involved in the new study.
“Doctors often will tell people, ‘you need to lose 50 or 100 pounds,’ and that leads to this sort of sense of hopelessness because it feels like this insurmountable challenge. But in fact, the research shows that modest weight loss of 5 or 10 percent of starting weight can have a really profound effect on health.”
Neff said more dietary counseling is needed to explore what patients eat daily and to help them set small goals for improving their nutrition.
“The trouble is a lot of doctors don’t have the time we have in our clinic and also don’t have the expertise in diet and nutrition,” Neff said. “It goes beyond just handing someone a pamphlet.”
One easy way to advise patients on a healthy diet, Neff said, is to show them the Harvard Healthy Eating Plate picture, which breaks down how much of each nutritious food and beverage should be included in a meal.
“Unfortunately many women do not seek pre-conception care where they would be able to receive information regarding healthy weight and a nutritious diet,” said Ali Pohlmeier, a UTMB postdoctoral fellow and another of the new study’s authors. – Reuters