Helping women lose weight before they conceive is the only way to curb hereditary obesity and the life-threatening complications that come with it, a new study urges.
A child’s risks of obesity are closely tied to their mother’s weights, and following healthy habits can reduce the risks associated with obesity during pregnancy by up to 75 percent.
The type 2 diabetes management drug, metformin, may be enticing to patients and doctors alike, but a new study from the University of Adelaide suggests that while it may help curb pregnancy weight-gain, it does not reduce risks of complications.
And those complications, in turn, continue to raise risks of maternal mortality, as well as a child’s obesity.
The new study reaffirms that the best interventions are to lifestyle and diet and argues that they should really be made before pregnancy – though one expert says that it’s never too late to lose weight.
Once a woman is already pregnant, neither weight-loss drugs nor diet and exercise lower the risks of complications or obese children – changes must precede pregnancy, a study warns
In the US about other high-income countries like the UK and Australia, about half of women are already overweight or even obese by the time they become pregnant.
As a fetus develops, a mother’s weight gain is inevitable and important to supporting its growth and the changes to the woman’s body.
But unhealthy weights dramatically raise risks of complications that can threaten the lives of both mothers and babies.
Among these complications is gestational diabetes, for which the risks are higher for overweight or obese women.
Insulin is the most common treatment for diabetes but can cause weight-gain.
The drug is safe and effective for treating diabetes in non-pregnant people, and has also shown promise for managing cholesterol and general weight loss.
IThe University of Adelaide researchers recruited 500 pregnant women who were obese or overweight for their study of the potential benefits of metformin and diet and exercise.
All of the women were advised on healthy diet and exercise habits and half of them were prescribed metformin.
The metformin worked to limit how much weight the women on it gained during each month of their pregnancies, it did nothing substantial to cut their risks of developing gestational diabetes, needing C-sections or giving birth to babies over 4kg (just under 9lbs).
Despite being offered diet and lifestyle advice during pregnancy, the women involved in the study made few changes, so their risks and outcomes remained largely the same, too.
‘We’ve now seen a lot of studies showing that dietary and lifestyle advice for pregnant women who are overweight or obese to improve the health of women and their children has very limited benefit,’ said lead study author Dr Jodie Dodd.
‘This study supports that outcome. We need to consider dietary and lifestyle interventions prior to women becoming pregnant if we are going to break the cycle of intergenerational obesity.’
Dr Raul Artal, chair emeritus of Saint Louis University’s OBGYN and women’s health department, agrees that making lifestyle changes to lose weight before pregnancy is certainly preferable, it’s not too late if a woman is already expecting.
‘Pregnancy is a unique time and the best time for behavioral modification,’ he says.
‘In what other period during her lifetime does an indiidual see a physician eight to 10 times during the year?’
Dr Artal suggests that these behavioral changes might be more effective if men were more involved.
‘The reality is that physicians spend very little time discussing behavioral modifications with patients and monitoring them,’ he says.
‘Both patients and physicians should really be aware of this opportunity.’
He advises that pregnant women get at least half an hour of physical activity (‘walking and increasing the pace, joining a prenatal exercise class’) a day, and urges expectant mothers to make time for this, even if it means climbing the stairs at work.
And diets, he says, are little different from what’s best for non-pregnant patients: low on carbs and fats, stressing instead ‘balance’ and lots of vegetables.