Perils of Pregnancy: Obesity and Advanced Age


Pregnancy's Biggest Complications

Obesity also can affect ovulation, and many women who would do better by losing weight instead turn to in vitro fertilization to get pregnant, Wenstrom said. Some go on to have twins, putting themselves at even greater risk.

Obstetrical teams are now paying more attention to obese women. Before having a C-section, patients are given the blood-thinner heparin to prevent blood clots, special devices are used to keep their airways open, and special protocols and surgical equipment is in place.

"We are working to develop special protocols and have more pre-delivery requirements," she said. "It's a huge problem for us and stressful for patients."

Hypertension and Preeclampsia

Hypertension, or high blood pressure, can be managed well, but becomes a problem if in pregnancy if it advances to preeclampsia.

Preeclampsia, with high blood pressure and protein in the urine, develops late in the second or third trimester. Possible causes include autoimmune disorders, blood vessel problems, diet or heredity. Women who are over 35, pregnant with twins or who are obese are at greater risk.

It can be particularly dangerous because a woman usually doesn't feel sick, and if the condition worsens and goes untreated, it can cause death. The only way to cure preeclampsia is to deliver the baby.

"If you have hypertension and get pregnant, the chances of preeclampsia are much higher," said Druzin. "Management is still problematic, but the biggest problem is appropriate detection and diagnosis. Once it's diagnosed, management is pretty good and we know how to deal with the severe side effects."

Pre-Gestational and Gestational Diabetes

Though there is a higher incidence of diabetes in mothers, it is almost never life-threatening and management of the disease is excellent. Gestational diabetes is high blood sugar that starts or is first diagnosed during pregnancy. In pregnancy, hormones can block insulin from doing its job. When this happens, glucose levels may increase in a pregnant woman's blood.

After birth, the condition resolves. Older women with high blood pressure and those who have a history of diabetes are at greater risk.

"Old-style pre-gestational diabetes that develops in childhood is still there and we are pretty good at getting that under control before women get pregnant," said Druzin. "What is emerging now is a wrinkle in the picture with these obese young people who develop type 2 diabetes is on the absolute climb. But there are those patients who are not very healthy and come into us already pregnant with diabetes."

Doctors treat diabetes with blood sugar control in the diet, insulin and oral medication.

Peripartum Cardiomyopathy on the Rise

A less-common form of cardiac disease seems to be on the rise among pregnant women, and doctors don't seem to know why.

"It's not the classic coronary artery disease, but more of an increase in cardiomyopathy -- not the congenital, but more of the acquired type," said Druzin.

Peripartum cardiomyopathy strikes as many as 3,000 new mothers in the U.S. each year and is characterized by fatigue and shortness of breath -- symptoms that resemble those common to new mothers and, therefore, often are missed. It may be related to obesity, hypertension and diabetes, according to Druzin.

Fetal Health

The health of a baby is directly connected to maternal health.

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