What Size Garden Tiller Do I Need

When Sue Thomas, of Rochester, New York, learned she was pregnant, she first worried about finding cute maternity clothes to fit her size 20 curves. Then in her third trimester, she had more serious concerns: Her blood pressure skyrocketed, causing her face and lips to occasionally go numb, and upping her risk for preeclampsia, a condition that is triggered by high blood pressure in pregnancy. It can be life-threatening for both Mom and Baby, and can result in premature birth.

Because of her high blood pressure, Thomas spent a scary evening in the ER at seven months pregnant and nearly required an emergency cesarean section. "I was terrified my baby would pay a price because of my weight," she recalls.

Thomas's experience during her pregnancy isn't uncommon. One out of five women are obese at the time they conceive, according to the Centers for Disease Control and Prevention. And even more are overweight. (A person with a body mass index of 25 to 29 is considered overweight; with a BMI of more than 29.9, obese.) Those extra pounds can increase the risk of pregnancy complications, says Justin Lappen, M.D., an assistant professor of ob-gyn at Case Western Reserve University School of Medicine in Cleveland.

If you were concerned about your weight before you got pregnant, don't panic. "Most women still have healthy pregnancies and deliveries," Dr. Lappen says. "What's crucial is that you and your doctor discuss any potential complications."

Weighty Concern: Gestational Diabetes (GD)

Why it happens

During the second trimester, pregnancy hormones block insulin from helping your body to properly use or store glucose, causing glucose levels to build up in your blood. This condition can occur in healthy-weight pregnant women, too, but overweight women are up to four times more likely to develop GD because they are already more insulin-resistant. And GD leaves its mark long after you deliver: Your lifetime risk of developing diabetes is higher after having the condition, research shows. Plus, "because excess nutrients cross the placenta wall, your baby makes more insulin to compensate, which could predispose her to obesity, heart disease, and diabetes too," says Debra Krummel, Ph.D., R.D., a nutrition researcher at the University of Cincinnati.

What to do

No skipping breakfast! Your glucose levels will remain more stable if you eat a meal or snack every few hours -- and what you eat is as important as when. Stick with

lean protein (chicken, soy products, beans), high-fiber foods (fruits, veggies, whole grains) and healthy fats (avocados, almonds, walnuts). "Keep in mind that excessive weight gain, even if you began pregnancy at a healthy size, will increase your chances of GD," says Diane M. Ashton, M.D., M.P.H., deputy medical director at the March of Dimes.

To better protect yourself if you are overweight at conception (or have a family history of diabetes), ask your ob-gyn whether you can be tested for GD twice: once in your first trimester and again at the midway point, when pregnant women usually are screened. Moderate exercise can also reduce your risk.

Weighty Concern: High Blood Pressure

Why it happens

The higher your BMI at conception, the greater your risk for hypertension in pregnancy. If left unchecked, high blood pressure can result in preeclampsia, putting both you and your baby at risk.

What to do

Begin an exercise routine, even if you weren't physically active before pregnancy. Talk with your doctor first, but you should be able to manage moderate activities, such as brisk walking, swimming, or yoga, about three times a week, says Sean Blackwell, M.D., an ob-gyn at The University of Texas Medical Center in Houston. Reducing stress is also key. Many moms-to-be find meditation and breathing exercises helpful. If your numbers remain high, your doctor may have you take readings with a home blood-pressure monitor, so you can immediately alert her if you notice your blood pressure beginning to spike.

That's what Thomas did, and her doctor prescribed hypertension medication. Thomas also added more salads and fruit to her diet, and tried to get more sleep, which can help lower blood pressure. When she delivered at 41 weeks, her baby was healthy, and in the last year Thomas has shed the baby weight. "I run or work out four times a week and I hope to finish my first 5K soon," she says. Thanks to these efforts, her blood pressure is down and she no longer takes medication.

"I'm making better decisions about my health and diet now because of my daughter," notes Thomas. "I want to be around to watch her grow up."

Pregnant woman eating

Credit: Alexandra Grablewski

Weighty Concern: A Difficult Delivery

Why it happens

Obese women are twice as likely to require an emergency C-section as women who are at a healthy weight. The reason remains unclear, but one theory is that "excess fat deposits can impede a baby's passage through the birth canal," explains Dr. Ashton.

What to do

There's no evidence that a particular delivery technique, such as Lamaze or water birthing, works better for plus-size moms; try them only if they interest you. "What might make for a better birth is to find a doctor who supports you and your plans for delivery," says Dr. Lappen. In a Yale University study, 69 percent of overweight and obese women say they had experienced a physician's bias against them because of their weight. "You deserve a doctor who listens to your concerns and doesn't make you feel uncomfortable about your size," he adds.

Weighty Concern: A Plus-Size Baby

Why it happens

Women who gain too many pounds during pregnancy, even those who aren't overweight to begin with, double their chances of delivering a baby weighing 9 pounds or more, according to a study in The American Journal of Obstetrics & Gynecology. "When an overabundance of nutrients crosses the placenta from the mom, the baby increases in growth," explains Dr. Lappen. Large babies can make labor more difficult. For instance, Baby may not descend into the pelvis, increasing the odds of needing a C-section, and research suggests your baby won't necessarily "grow out" of his big birth weight. He may still outweigh his peers at age 3, setting the stage for extra pounds for life, Dr. Lappen says.

What to do

Remind yourself that your baby is another reason for you to eat healthy. Fill up on nutrient-rich produce, low-fat dairy products, and lean protein instead of sweets and snacks that are full of empty calories. You may pass on a taste preference for healthy foods (like carrots!) to your baby if you load up on good stuff during pregnancy, studies show.

Post-delivery, give nursing a try--it will benefit both of you. Says Dr. Lappen: "Breast milk could reduce your baby's risk of becoming obese, and nursing could also help you shed pregnancy pounds and decrease your risk of heart disease later in life."

Originally published in the October 2013 issue of American Baby magazine.

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