Plus-sized pregnancies abound, say federal researchers; nearly half of all pregnant women are clinically overweight or obese.

Extra pounds can impair your fertility and increase your risks in pregnancy, particularly for gestational diabetes, and your lifetime risks for type 2 diabetes and heart disease, say experts at the National Institutes of Health.

So we’re busting the myths and reporting the facts about pregnancy risks when you’re overweight or obese.

“I treat obese patients all the time, and while everything may not go exactly as planned, they can have healthy pregnancies,” says maternal fetal medicine expert and researcher Loralei Thornburg, MD, at the University of Rochester Medical Center, who specializes in high-risk pregnancies.

“While you can have a successful pregnancy at any size, women need to understand the challenges that their weight will create and be a partner in their own care. They need to talk with their healthcare providers about the best way to optimize their health and the health of their baby,” says Thornburg.

1. Obese women don’t need extra nutrition.

MYTH: Ironically, even with the extra calories, many obese women still lack the vitamins vital to a healthy pregnancy. Nearly half (40%) don’t get enough iron, 1 in 4 (24%) need folic acid and 4% are deficient in vitamin B12.

It’s important to have certain vitamins, like folic acid, circulating in your system before you conceive a baby because this powerhouse B vitamin can lower your risks for heart problems in pregnancy as well as protect your baby from certain spinal cord related birth defects. Calcium and iron are also critical for helping babies grow well.

Thornburg advises quality over quantity: Skip the processed foods that are typically high in calories but low on nutrition and opt instead for healthier, nutrient-rich fortified cereals, fruits and vegetables.

“Just like everybody else, you should get a healthy mix of fruits and vegetables, lean proteins and good quality carbohydrates. Unfortunately, these are not the foods people lean towards when they overeat,” noted Thornburg.

“Women should also take vitamins containing folic acid before and during pregnancy.”

2. Regardless of your weight, gain at least 15 pounds in pregnancy.

MYTH: In 2009, the Institute of Medicine revised its recommendations about weight gain during pregnancy to no more than “11 to 20 pounds” for obese women.

Fact is, excessive weight gain during pregnancy when you’re already obese puts you at very high risk for pregnancy complications including preterm birth, cesarean delivery, failed labor induction, large babies (which can lead to birthing complications), and having your baby born with low blood sugar.

If you’re overweight or obese, not gaining a lot of weight can actually improve your chances of having a healthy pregnancy, Thornburg points out.

Determine the appropriate weight gain for your pregnancy with your healthcare provider.

3. Obesity makes you more likely to go into labor unexpectedly.

MYTH: This is a little tricky to understand. Being obese increases your chances of preterm birth for reasons related to gestational diabetes or high blood pressure in pregnancy (preeclampsia). But fewer obese women experience spontaneous preterm labor and birth—or going into labor for an unknown reason. Experts don’t know why this is true, although Thornburg says current thinking shows it could be related to hormonal changes in obesity that may decrease spontaneous preterm birth risks.

4. Breathing issues increase your pregnancy risks when you’re overweight.

FACT: 1 in 3 obese women with breathing issues such as asthma and sleep apnea say their conditions get worse in pregnancy, which is far greater than what normal weight women with these same health issues experience in pregnancy.

If you’re overweight, breathing problems in pregnancy are also related to increased risk for preeclampsia and cesarean birth, which is major abdominal surgery.

Get asthma and other breathing problems under control before you get pregnant if possible, says Thornburg.

5. Obese women are better equipped to breastfeed.

MYTH: It’s more challenging for overweight and obese women to breastfeed their babies.

Despite myths to the contrary, breast size has nothing to do with how much milk you can make. In fact, Thornburg says, it often takes longer for milk to come in when a woman is overweight or obese, and such women can actually end up producing less milk than their skinnier counterparts.

Birthing risks associated with obesity, including preterm birth, can delay starting breastfeeding if baby goes to the neonatal intensive care unit. Complications from cesarean surgery, which is far more painful and requires a longer recovery, may impede your ability to hold baby to start and sustain nursing. These complications occur in up to half of all pregnancies in overweight or obese women.

Ironically, breastfeeding actually helps you lose the extra pregnancy weight and is essential for both your and baby’s health.

“Because of these challenges, moms need to be educated, motivated and work with their healthcare providers, nurses and lactation professionals to give breastfeeding their best shot. Even if you can only do partial breastfeeding, that is still better than no breastfeeding at all,” said Thornburg.

Did you know?

Even if you are already pregnant, it’s not too late to start healthy habits for your baby’s health.


The Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) promotes the health of women and newborns.

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