Article 20: Obesity Issues During Pregnancy, Postpartum, and After Abortion

Pregnancy is a joyous occasion for both the mother and her family. Therefore, as long as conditions permit, everyone will do their best to ensure her nutrition. Pregnant women often eat a lot, and their intake of meat, fish, eggs, and dairy products increases. Even women who are usually very careful about their appearance are willing to make sacrifices for the sake of their children, preferring to gain weight rather than harm their fetus.

At the same time, a series of changes occur in endocrine and metabolism during pregnancy, with increased absorption, reduced excretion, and significantly enhanced metabolism and utilization of nutrients, especially increased synthesis of fat to store nutrients needed by the fetus and after delivery.

With reduced physical activity and less energy expenditure, the body experiences a severe imbalance between calorie intake and expenditure, leading to the rapid conversion of excess calories into fat for storage. By the time of delivery, the pregnant woman is already quite obese.

Obesity during pregnancy poses many risks: ① It can lead to preeclampsia. ② It increases the miscarriage rate. According to relevant data, obese pregnant women have a miscarriage rate approximately three times higher than normal pregnant women. ③ It increases the difficulty of childbirth. Obese pregnant women have a much higher rate of dystocia during delivery than normal pregnant women, often posing life-threatening risks to both mother and fetus due to hypertension and anemia. ④ It increases the fetal mortality rate. Reports indicate that obese mothers have a stillbirth rate 2-3 times higher than normal pregnant women. ⑤ It significantly increases the incidence of complications during pregnancy, childbirth, and the postpartum period.

Some women who gain weight during pregnancy often fail to return to normal weight after childbirth, ultimately becoming obese. Therefore, it is crucial to keep weight gain during pregnancy within a reasonable range.

During pregnancy, a woman's weight increases according to a certain pattern. This proportional increase in weight throughout pregnancy is crucial for both the mother and the fetus.

Both excessively slow and excessively rapid weight gain in pregnant women are detrimental to the health of both mother and child. Weight gain in pregnant women includes three aspects: the mother's own weight gain, the fetal weight gain, and the weight gain of the fetal appendages.

The fetus grows slowly in the early stages of pregnancy, gaining about 1 gram of weight per day. From the second trimester onwards, the rate of weight gain increases.

During the second trimester (weeks 13 to 27), the total weight gain and weekly weight gain are basically the same as in the third trimester. The weight gain is gradual and without significant fluctuations, with an increase of about 350 to 400 grams per week.

Of the non-essential weight gain, interstitial fluid gains 1200 grams, protein reserves 500-1800 grams, and tissue enlargement and water retention amount to approximately 3200 grams.

For the fetus, rapid growth can easily lead to macrosomia, increasing the chances of dystocia, and raising the incidence of complications such as intrauterine asphyxia and surgical injury, thus affecting the fetus's health.

Obese pregnant women have a higher rate of macrosomia (large babies) than non-obese pregnant women, which can lead to future obesity in the fetus. Furthermore, obese pregnant women have an increased neonatal mortality rate after delivery, and their mothers are also more likely to experience poor lactation after childbirth compared to non-obese mothers.

A study on ovulation rates in menstrual cycles one year postpartum found that the ovulation rate was 35% for obese women and 65% for women of normal weight.

In addition, pregnant women who are obese are more likely to have impaired glucose tolerance or diabetes than those of normal weight.

For pregnant and postpartum women, obesity during pregnancy increases the incidence of pregnancy complications such as diabetes and hypertension; it also easily leads to persistent obesity after childbirth, making it difficult to regain a slim figure, and obesity is also a danger signal for the occurrence of various diseases, which is detrimental to physical and mental health.

The direct harms of obesity during pregnancy are related to the degree of obesity and the occurrence of pregnancy complications. Approximately 75% of obese pregnant women experience various complications during delivery, including abnormal fetal position, premature rupture of membranes, delayed labor, dystocia, an increased rate of cesarean section, excessive postpartum hemorrhage, and anemia.

In severe cases, obesity increases peripheral vascular resistance, affecting tissue fluid return and causing hypertension and edema. In severe cases, it can damage heart and kidney function, leading to symptoms of heart and kidney failure such as proteinuria, shortness of breath, and difficulty lying flat. This is called pregnancy-induced hypertension syndrome. If not treated in time, it can lead to preeclampsia, such as convulsions and altered consciousness, which can endanger life.

Obese women are more likely to develop gestational diabetes before pregnancy, require a cesarean section during delivery, and experience other problems during pregnancy.

This finding comes from a survey of 100,000 first-time mothers conducted between 1992 and 1996. The survey concluded that obesity is a significant risk factor for pregnancy-related complications.

More than one-third of American women of childbearing age are obese or overweight, 20% of mothers are thin, 52% of mothers are of average weight, 18% of mothers are overweight, and 10% of mothers are obese.

The risk of gestational diabetes, preeclampsia, or seizures increases with increasing obesity.

Obesity has a significant impact on fertility; it can be said to be a major cause of female infertility.

Studies have shown that women with a body mass index (BMI) greater than 25 kg/m² are twice as likely to experience infertility due to anovulation compared to women of average weight. Furthermore, abdominal obesity further increases the likelihood of infertility in women.

Some calculations have shown that for every 0.1 increase in the waist-to-hip ratio, the chance of conception decreases by 30%.

The main reason for infertility in obese women is that obesity affects the endocrine hormones related to ovulation and conception.

As mentioned earlier, obese individuals often have insulin resistance and hyperinsulinemia, meaning that tissues such as the liver and muscles are not sensitive to insulin. Therefore, the pancreas has to produce excessive insulin to compensate. However, the ovaries are much more sensitive to insulin than the liver and muscles. As a result, the effect of hyperinsulinemia on the ovaries is excessively strong, which can stimulate the ovaries to secrete excessive androgens, thereby affecting ovulation and leading to infertility.

There is a drug called troglitazone, which can improve insulin resistance and reduce hyperinsulinemia. Obese women who take troglitazone can restore normal menstruation and fertility even if their weight does not change, indicating that insulin resistance and hyperinsulinemia are the main factors affecting fertility.

In addition, recent studies suggest that leptin, the expression product of obesity genes, may also be related to infertility.

Scientists disrupted the obesity gene in mice, preventing the production of leptin, which caused the mice to become obese and infertile. By artificially introducing leptin into these mice, their fertility was restored.

Studies on women with anovulatory infertility have found that their leptin levels are higher than normal, but they do not respond well to leptin, possibly indicating leptin resistance. This suggests that anovulatory infertility in humans is related to leptin.

The ideal amount of weight gain during pregnancy remains a subject of debate in the medical community.

One viewpoint suggests that pregnant women are eating for two and should be allowed to eat more. However, this dietary arrangement can lead to many adverse consequences, such as excessive fetal weight gain and preeclampsia.

Later, another extreme view emerged, advocating for strictly limiting weight gain to 4.5–5.5 kg. This dietary arrangement also had adverse consequences. If a mother does not gain weight after the third month of pregnancy, she is likely to give birth prematurely, endangering the health of the fetus, and the mother may also develop gestational hypertension syndrome.

Mothers prone to seizures are often pregnant women who gain less than 7 kg or more than 13 kg after conception.

The stages of weight gain are just as important as the total weight gain, meaning that weight gain at each stage of pregnancy follows a certain pattern.

It's important to note that restricting weight gain during pregnancy for fear of postpartum weight gain can be very risky. Studies have shown that women who consume less than 7,531 kilojoules of energy per day cannot maintain a positive nitrogen balance. This means that if the fetus continues to grow, it will be at the expense of the mother's tissues.

Furthermore, data shows that a woman gains 4 kilograms of weight during pregnancy, loses 2 kilograms in 6 months after delivery, and the remaining 2 kilograms usually disappear after 6 to 8 months.

It is generally believed that a weight gain of 9-11 kg is the safest amount during pregnancy and is most beneficial to the health of both the mother and the fetus. In the second half of pregnancy, an additional 1255 kJ of energy per day is sufficient to meet the energy needs of pregnancy and will not cause obesity in the fetus or the pregnant woman.

Women are prone to weight gain after childbirth, and some develop persistent obesity afterward. This is mainly because some people only emphasize strengthening nutrition while neglecting a balanced diet.

It is common knowledge that women should increase their nutrition appropriately during the postpartum period, because at this time they need to replenish the energy consumed by the fetus during its development, compensate for the physical exertion and blood loss during childbirth, and also breastfeed their babies.

Therefore, people are keenly aware of the harm that nutritional deficiencies can cause to mothers and infants, but often overlook the dangers of excessive postpartum nutrition. A new mother's blind pursuit of "nutrition" and excessive intake of certain nutrients can lead to obesity, which is detrimental to her health.

Some women believe that breastfeeding will affect their figure, or for various other reasons they do not breastfeed or have a very short breastfeeding period. In fact, this situation is more likely to lead to postpartum obesity.

During pregnancy, a mother stores approximately 3000 grams of fat, which needs to be used up during breastfeeding. If breastfeeding is not performed, fat consumption will inevitably decrease, leading to obesity.

A postpartum woman's diet should be well-balanced, with an increased variety of foods, including a mix of whole grains and refined grains, as well as a mix of meat and vegetables, to meet her nutritional needs and address any deficiencies.

A reasonable dietary plan should be established, distributing food throughout the day in a fixed quality, quantity, and time. The types and quantities of food should be selected to meet the postpartum woman's required energy and nutrient intake.

A daily diet should include grains, animal products and soy products, vegetables and fruits, dairy products, etc., and different foods in the same category should be selected in rotation to achieve a diversified diet. This can not only avoid the deficiency or excess of certain nutrients, but also allow various foods to complement each other in terms of nutritional components.

It is also important to pay attention to proper cooking methods, which should not only facilitate the digestion and absorption of nutrients, but also minimize nutrient loss and the formation of harmful substances.

If postpartum obesity cannot be reversed through diet control and exercise, it is often because of the presence of an obesity gene called "825T gene" in the body.

People with this obesity gene in their bodies will have this gene activated under the stimulation of postpartum endocrine changes, which directly affects the metabolism of body fat. This not only makes people gain weight quickly, some people describe it as "blowing up a balloon", but also makes it very difficult to lose weight. Even if they use a variety of weight loss methods, their weight is still difficult to return to normal.

Experts believe that regardless of whether a new mother has the "825T gene," in order to prevent and reduce obesity, she should have proper nutrition after childbirth, avoid overnutrition, participate in appropriate exercise as early as possible, and avoid overeating and being too idle.

In the mid-1980s, Western countries conducted follow-up surveys on women who had undergone induced abortions and found that women who had one induced abortion gained an average of 500 to 700 grams in weight, while women who had two induced abortions gained 800 to 900 grams in weight.

There are two main reasons: First, after a woman becomes pregnant, the function and metabolism of hormones in her body will change significantly, one of which is to accelerate the synthesis of fat; second, after an abortion, the endocrine system will change rapidly, causing hyperactive stomach function. In addition, overeating high-fat and high-sugar foods will make it easier to develop obesity.

After an abortion, unlike breastfeeding mothers who need to produce milk to provide energy for their babies, there is no need to supplement with excessive calories. Instead, one should eat more lean meat, seafood, soy products, and fresh vegetables and fruits.

A study from Yale University in the United States shows that women with higher levels of life stress are more likely to accumulate fat in their abdomen, especially slim women, where this is more pronounced.

The study involved 59 white women and found that women with a high waist-to-hip ratio (i.e., a waist circumference larger than hip circumference) were more prone to stress, which caused them to produce a hormone called hydrocortisone, leading to fat accumulation in the waist and abdomen.

Among the women with high waist-to-hip ratios, it was found that overweight women were more adaptable to stress; conversely, slender women were less adaptable to stress and therefore more prone to developing hydrocortisone. These women may have overreacted to stress due to psychological factors.

Of course, in addition to stress hormones, there are other factors that lead to the accumulation of abdominal fat, such as genetic factors, lifestyle, and lack of exercise, so further research is needed.