Pregnancy: Docs won't say, 'You're fat'

You're overweight.

They're words that some doctors have a hard time saying to their pregnant patients -- the ones, in fact, who need to hear it most.

Women already overweight tend to gain too many pounds during pregnancy, increasing their risk of complications. But data from 2000 to 2006 in Utah shows that overweight and obese women were significantly less likely than normal-weight women to be counseled by their physician about weight gain during pregnancy.

About 76 percent of normal-weight women received counseling, compared with about 68 percent of overweight women and 69 percent of obese women, according to data from the Utah Pregnancy Risk Assessment Monitoring System (PRAMS).

"It doesn't make a lot of sense to us," said Lois Bloebaum, manager of the state's reproductive-health program, noting other research suggests women are open to talking about weight gain.

"The only thing we can attribute it to is perhaps health-care providers are ... uncomfortable talking to women who have a weight problem," she said.

And that, she said, "is the opposite of what should be happening."

Weight is an issue not many doctors want to approach, but it's a necessary subject for women concerned with pregnancy.

"It's a challenge by all means," said Dr. Dianne Woolard of Cape Care for Women. "Doctors are human. You don't want to terribly upset your patient."

Woolard said an obese patient with a weight gain of 50 pounds or more has an increased risk of miscarriage, stillbirth, hypertension, diabetes or dystocia -- complications in the birthing process.

The stress that comes with knowing those possible complications can be more detrimental than a few extra pounds, Woolard said.

Utah women who had excessive weight gain during pregnancy, according to the PRAMS data, were 60 percent more likely to have a Caesarean section and almost twice as likely to experience problems during labor.

That's because some overweight women have children who are large for gestational age, making their labors especially slow and difficult, said Susan Rose, an obstetrician and gynecologist at University Hospital in Salt Lake City. And women who aren't in good shape have a tougher time pushing out their baby.

In 1990, when the obesity epidemic was in its early stages, the Institute of Medicine released guidelines that stressed gaining enough weight during pregnancy. Now it's emphasizing that women not put on too much.

Its recommendation for a woman with normal weight is 25 to 35 pounds; for obese women, however, it's still working to define a healthy range, Bloebaum said.

The Utah PRAMS data shows that inadequate weight gain dropped 20 percent between 2000 and 2006, while excessive weight gain spiked 11 percent.

"I don't think the message is not to gain weight [during pregnancy]," Bloebaum said. "I think the message is to gain the appropriate amount of weight."

Southeast Missourian features editor Chris Harris contributed to this report.