In her studies, Hilde Bruch found that obesity that develops during or after pregnancy often develops in response to stress (see reactive obesity). Some women gain weight after each pregnancy, some only after one. Bruch’s studies determined that the most frequent causes of stress underlying obesity following pregnancy are disappointment with the marriage, unfulfilled, unrealistic expectations about what the child might do for the mother or frank envy of the care the child receives and resentment about the demands it makes.
Though noting that much has been written about obesity indicating a desire for pregnancy, Bruch argued against this theory. While agreeing that some fat women have pregnancy fantasies, she cautioned that those who are not fat do also.
Occasionally, Bruch added, a father may become fat after the birth of a child; this occurs in extremely dependent men who, even before the baby is born, feel that they never received quite enough attention . They will resort to overeating to combat their anger and jealousy and to compensate themselves for what they feel they are missing.
The more children a person has, the greater the risk he or she will become obese, according to a study from Duke University Medical Center. From an analysis of a large database of middle-aged Americans, researchers found women faced an average 7 percent increased risk of obesity per child and men an average 4 percent increased risk per child. Researchers attribute the weight gain to a busier lifestyle that may include a diet of more fast food and leave less time for exercise. Increased risk of obesity in both men and women suggests a substantial portion of the effect of obesity related to parenthood has to be social, cultural or psychological, said Lori Bastian, M.D., a study coauthor. It’s difficult to imagine a physiological mechanism through which men could gain weight during pregnancy or after childbirth. Further studies are needed to isolate cause and effect so we can more accurately suggest target groups for obesity prevention and research.
Pre-pregnancy maternal obesity more than doubled the risk of stillbirth and neonatal death in a Danish study of 24,505 pregnancies. No statistically significant increased risk of stillbirth or neonatal death was found among underweight or overweight (but not obese) women. Countering that was a recent American study of 2,910 women that found obesity before pregnancy to be associated with a lower rate of spontaneous preterm birth.
European research to determine whether morbidly obese women have an increased risk of pregnancy complications and adverse perinatal outcome compared 2,472 women with morbid obesity (body mass index greater than 40) with normal-weight women. There was an increased risk of the following outcomes: gravidic hypertension, preeclampsia, gestational diabetes, cesarean delivery and macrosomia. However, the authors noted a lower rate of prematurity in the obese group (0 vs 11%). Even when morbidly obese women with preexisting diabetes and chronic hypertension were excluded from the analysis, significant differences in the perinatal outcomes still persisted.
Diets to control weight during pregnancy must account for the increased need for protein, iron, folic acid and most other minerals and vitamins. For this reason, during pregnancy weight is best controlled through small decreases in calorie intake, with increased energy expenditure through exercise. VERY LOW-CALORIE DIETS are to be avoided during pregnancy unless specifically prescribed by a physician.
Until recently, few studies had been done on pregnancy weight gain and its effect on maternal health. Physiological psychologist Jennifer Lovejoy has been researching the disparity between women’s chance of gaining weight and men’s (women’s is about double) and believes pregnancy may be a factor. Studies show that the average woman retains two to five pounds after nine months of carrying a baby, far above the normal pace related to aging. Many women end up 20 or more pounds heavier long after childbirth.
Siega-Riz et al. call for more studies on the effect of pregnancy weight gain. Past research on maternal weight gain during pregnancy has focused on determinants and consequences of inadequate weight gain with concerns for the health of the infant. However, with the rising prevalence of obesity among women of child-bearing ages and the high proportion of women who are gaining in excess of recommendations, a shift in research focus must occur to include consideration of the mother’s long-term health status. The few studies that have examined determinants of excessive weight gain and post-partum weight retention in this country were not comprehensive in assessing diet, physical activity and psychosocial factors and suffer from small
