Pregnancy: Obesity's next target?

Philip J. Goscienski, M.D.

November 2007

Obesity has been in the news so regularly in the past decade that it has acquired a large yawn factor — the average person isn't too concerned about it. Physicians are concerned however, and alarm bells are going off in pediatric and pregnancy clinics. Two segments of our population, children and expectant mothers, foretell the seriousness of the obesity epidemic about which the average American has become complacent.

Obesity in pregnancy is nothing new. As a medical student I once helped to deliver a 320-pound woman of a 13-pound infant. That was so rare during my practice years that it became a memorable moment; it is now disturbingly common.

Being overweight or obese matters at every stage of life but it affects at least two individuals in a pregnancy. Besides having a longer labor than a normal-weight person the obese woman is more likely to require Caesarean section, to have high blood pressure and to suffer more complications during and after delivery. Her infant is more likely to have breathing problems and to suffer from birth defects of the heart, brain and spinal cord. The more a pregnant woman weighs, the more likely that her infant will not survive.

Gestational diabetes is the temporary elevation of blood sugar that occurs during pregnancy and it increases as the mother's weight increases. Not surprisingly, as our population becomes fatter, gestational diabetes is increasing at the rate of about 12 percent a year. Since the 1970s it has roughly doubled every ten years. One in 8 pregnant women had gestational diabetes in 2000.

This is a bigger deal than most people recognize. The woman who develops an elevated blood sugar during pregnancy is at greater risk of pre-eclampsia, a serious and sometimes life-threatening complication. She has a 50-50 chance of eventually developing frank type 2 diabetes. Her children are more likely to have high blood pressure early in life and to develop type 2 diabetes .

The Pima Indians of the American Southwest have become a natural laboratory for the study of obesity, type 2 diabetes and gestational diabetes. Their ancestors were neither obese nor diabetic but today's Pimas have become the poster children for a medical disaster. They are the most obese population group on the planet and their rates of diabetes are astronomical. Among Pima women over the age of 55, fully 80 percent have type 2 diabetes.

These Native Americans carry a set of genes that protected them centuries ago when food scarcity was common. They now indulge in food that is perpetually abundant but of poor nutritional quality, mostly refined grains and high in sugar. Their subsidized lifestyle makes few physical demands upon them. Type 2 diabetes is the second leading cause of death among Native Americans in general. It is destined to take the lead within another generation.

A study at Kaiser Permanente of Colorado concludes that "the vicious cycle of diabetes in pregnancy initially described among Pima Indians may also be occurring among other U.S. ethnic groups."

Let's not waste the lessons that pregnant Pimas are teaching us.

Philip J. Goscienski, M.D. is the author of Health Secrets of the Stone Age, Better Life Publishers 2005. Contact him at drphil@stoneagedoc.com.