OVERWEIGHT AND PREGNANCY (1):

DEFINITIONS

BEFORE PREGNANCY

Fertility

After Bariatric Surgery

Dr. Claude Allouche, GynecologistSurpoids 1-4 ia engl
Ahuza Clinic, Raanana
058 726 02 64

OVERWEIGHT AND OBESITY: KEY FIGURES

Overweight and obesity in adults are due to an excess of body fat or adipose tissue.

HOW TO EVALUATE OVERWEIGHT?

If you are planning a pregnancy, calculate your body mass index (BMI) and waist circumference to determine if you are overweight.

Body Mass Index (BMI)

Overweight and obesity are defined by calculating BMI using the following formula:
Weight / Height squared
Weight in kg and height in meters

If the BMI is:

  • Between 25.0 and 29.9 kg/m², it indicates overweight;
  • Between 30.0 and 34.9 kg/m², it indicates moderate obesity;
  • Between 35.0 and 39.9 kg/m², it indicates severe obesity;
  • Above 40 kg/m², it is referred to as massive obesity.

Waist circumference, another important indicator of overweight or obesity

It provides a simple picture of excess fat accumulated around your abdomen.Surpoids ia 1

How to measure waist circumference?

Waist circumference is measured under specific conditions:

  • Without clothing, directly on the skin;
  • Standing with feet together, arms relaxed at your sides;
  • At the end of a normal exhalation;
  • By placing a tape measure horizontally around the waist (midway between the lower part of the last rib and the highest point of the pelvis).
  • Waist circumference is considered too high if it is 80 cm or more for a woman.

You are overweight: how severe is it?

  • It is important to assess your overweight and medical issues before becoming pregnant, as pregnancy monitoring will be influenced by your BMI and health status.

Overweight or obesity without associated complications:

  • If you are overweight with a BMI between 25 kg/m² and 29.9 kg/m²;
  • If you have moderate obesity with a BMI between 30 kg/m² and 34.9 kg/m², without complications due to obesity.

Complex obesity:

  • If your obesity is severe with a BMI of 35 kg/m² or more;
  • If you have less severe obesity but with complications or associated diseases, significant discomfort in daily life, eating disorders such as binge eating, material and social difficulties, or failed attempts at previous obesity treatments.

Some statistics in France:

  • The obesity rate in the general population has doubled in 20 years, from 8.5% of adults in 1997 to 17% in 2020.
  • Among young people aged 18 to 24, the obesity rate quadrupled during the same period.

 

 

OVERWEIGHT AND PREGNANCY (2): BEFORE PREGNANCY

OVERWEIGHT OR OBESITY: GYNECOLOGICAL MONITORING BEFORE PLANNING TO HAVE A CHILD

What to do before considering pregnancy?Surpoids ia 2

  • In case of obesity, losing weight before becoming pregnant improves fertility and reduces the risk of pregnancy complications.
  • If you are overweight or obese, do not neglect your regular gynecological follow-up: breast exams and gynecological exams with cervical smears from age 25 to screen for cancers or precancerous lesions of the cervix.
  • With your doctor, gynecologist, or midwife, discuss your physical feelings and the impact of your overweight on your emotional and sexual life.
  • If you are obese, the gynecological exam can be done in a specialized obesity center or on a suitable examination table.
  • As long as you do not wish to have children, your doctor will suggest contraception adapted to your health and your relationship.
  • Indeed, overweight and obesity are cardiovascular risk factors, such as high blood pressure, high cholesterol, smoking, and diabetes.
  • Contraception must consider these factors and be adapted accordingly.
  • Before starting a pregnancy, it's the time to address your overweight or obesity.
  • Promoting weight loss improves fertility and reduces the risk of complications (such as gestational diabetes) related to obesity during pregnancy.

OVERWEIGHT: IMPORTANCE OF THE PRECONCEPTION CONSULTATION

  • Preconception consultation is strongly recommended if you are overweight or suffer from obesity, as it helps anticipate difficulties or risks during pregnancy and the postnatal period.
  • Although most women who are overweight or obese have a straightforward pregnancy and childbirth and healthy babies, it is important to assess your health to detect other cardiovascular risk factors, diabetes, or shortness of breath before pregnancy.
  • In consultation with you, the doctor or midwife calculates your BMI and offers tailored follow-up based on your BMI and health issues.
  • If you are overweight or obese without complications, your follow-up can be managed by your general practitioner, midwife, medical gynecologist, or obstetrician-gynecologist during your pregnancy, depending on your choice.
  • In cases of complex obesity, your follow-up will be managed by an obstetrician-gynecologist and an obesity specialist.
  • If you suffer from eating disorders (binge eating), don't hesitate to mention it so that it can be taken into account during pregnancy monitoring.

 

OVERWEIGHT AND PREGNANCY (3): FERTILITY

  • Overweight and obesity in women are associated with reduced fertility and an increased risk of miscarriage.
  • Obesity causes hormonal imbalances leading to hyperandrogenism (increased male hormones), which results in menstrual cycle disorders (amenorrhea, irregular cycles, and anovulation), mimicking polycystic ovary syndrome.
  • The body also becomes insulin resistant (leading to diabetes), and insulin secretion increases as a result.
  • If the partner also suffers from obesity, difficulties in achieving pregnancy increase, as male obesity is associated with decreased testosterone secretion and altered sperm quality.
  • Weight loss and better control of increased insulin secretion help promote ovulation and increase fertility in these patients.

Overweight or obesity: infertility assessment and assisted reproductive technology (ART)

If you are overweight and unable to conceive:Surpoids ia 3

  • An infertility assessment is necessary, and ART is possible.
  • It is neither delayed nor conditioned on unrealistic weight loss.

OVERWEIGHT AND PREGNANCY (4): AFTER BARIATRIC SURGERY

A SPECIAL CASE: CONSIDERING PREGNANCY AFTER BARIATRIC SURGERY FOR OBESITY

  • Before your obesity surgery, you were informed of certain recommendations:
    • A delay of at least 12 months is recommended between bariatric surgery and pregnancy;
    • Effective contraception adapted to your situation is necessary during this period.
  • Once this period has passed, the pregnancy is planned:
    • The surgeon ensures there are no complications from the surgery;
    • Your nutritional status must be good.
    • All nutritional deficiencies are corrected before starting the pregnancy based on biological results.
    • Your diet is balanced and provides at least 60 grams of protein per day (meat, fish, cereals, legumes) and prioritizes complex carbohydrates (cereals, legumes).
    • It is essential to continue micronutrient supplementation systematically and add folic acid supplementation as soon as you plan to become pregnant.
    • For follow-up, you are referred to a dietitian or nutrition specialist with expertise in bariatric surgery: they evaluate your nutritional status, detect deficiencies, correct them, and anticipate the organization of pregnancy follow-up, your care, and your child's care after birth.

Vigilance in cases of malabsorption surgery

  • If you have had digestive tract bypass surgery, follow-up with a doctor experienced in these surgeries is essential, as higher doses of vitamins and minerals are often necessary.
  • These needs are individualized based on biological results.

Source: Ameli