The Womb: An Epidemic's Incubator?
If a group of obstetricians from the 1950s could travel through a time portal to the examining room of a 21st century obstetrical office, how would they react to the number of super-sized medical accessories now widely used with obese patients — blood pressure cuffs designed for thighs but used on wrists and scales calibrated to accommodate expectant mothers weighing in excess of 250, even 300 pounds?
Perhaps with shock, followed by the stark realization that obesity has become an all-too-common reality in 21st century America. They also would soon learn that obesity not only is increasingly commonplace within the general population but also exacting a heavy toll on expectant mothers and, as obstetricians and nutritionists increasingly suspect, on their newborns.
One thing is certain: Among obese expectant mothers, a routine visit to the obstetrician often proves to be a frustrating, if not humiliating, experience. Practices once considered routine and essential facets of prenatal care have become highly problematic when obese expectant mothers are involved. Extra body fat often impedes accurate ultrasound and blood pressure readings, for example, though obstetricians consider thorough monitoring of these women especially important because of the greater threat of giving birth to babies with neural tube defects and other malformations.
And this is only a few of the many threats obesity poses to newborns.
“Obesity affects the mother’s health, but it also affects the fetus in several ways,” says Dr. Robert Keith, an Alabama Cooperative Extension System nutrition and health specialist and Auburn University professor of nutrition and food science.
Babies born to obese mothers tend to be larger and also more lethargic at birth — larger because so much of their prenatal nutrition is derived from sugar.
“The obese mother’s blood sugar level may be high because she often tends to border on diabetes,” Keith says. “And the baby takes that sugar and just continues to grow.”
And because the babies tend to be larger, obese mothers face a much greater likelihood of undergoing caesarian procedures.
“So they end up having caesarians, which, in turn, poses yet another threat to the prospective mother’s health,” he says.
Could it be that obesity plays an even more insidious role during pregnancy, possibly even condemning the newborn to a life of obesity?
Within the last few decades, obstetricians and nutritionists believe they have discovered a series of positive behaviors expectant mothers can perform, nutritionally speaking, to enhance the health of their babies even while they are in the womb — a practice known as fetal programming. On the other hand, there appear to be factors that can contribute adversely to this programming. Obesity may be one of those factors.
“This isn’t a genetic thing, as many people mistakenly believe, but something in the environment of the womb that programs that fetus in a way that carries on for the rest of that baby’s life,” Keith says.
“It alters the way they grow up and actually how their bodies work.”
Obesity appears to be one of the highly adverse factors associated with fetal programming, providing a prenatal environment that increases the newborn’s likelihood of dealing with a lifetime of obesity.
“That environment, with all of the energy provided by the mother’s higher glucose levels and obesity-related hormones, is programming that fetus with a greater likelihood of becoming obese later in life,” Keith says.
Granted, this is still only a theory, though a compelling one, Keith says.
And if it is borne out in future research, the medical and nutritional communities may come to view obese pregnancies as the incubator of one of this nation’s most serious health epidemics.
Posted by Jim Langcuster at July 31, 2008 09:30 AM