Mireia Pelaez.

First draft
CONSEQUENCES OF EXCESSIVE WEIGHT GAIN DURING PREGNANCY

During pregnancy, all body systems are modified in order to allow an optimum
enviroment for the developing embryo. One of these adaptations is the weight gain. A
gain within 9 and 14 kg are considered as a normal gain rate, however, higher rates are
founded in developed countries. Studies have shown that when women exceed the
recommendations given by The Institute of Medicine (recommendations that take into
acount pre-pregnancy body mass index) are at higher risk of suffering problems such us
gestational diabetes, gestate macrosomic fetus and having cesarean delivery (Asbee et
al., 2009; Polley, Wing and Sims 2002).
Gestational diabetes could be defined as every type of diabetes diagnosed for the first
time during pregnancy (Stafne, Salvensen, Romundstad, Stuge and Morkved2012). The
prevalence of this condition is about 5%, of pregnancies although differences could be
found between countries (Dempsey et al., 2004). The consequences of gestational
diabetes for mother and baby are very similar to those derivated of excessive weight
gain. This risks could be gathered into three groups: (i) risks during pregnancy and
delivery, such us excessive weight gain, preeclamspsia and cesarean delivery, (ii)
mother long-term risks, like obesity, diabetes type II or cardiovascular disease and (iii)
baby short-term and child long-term risks, for example, increased perinatal morbility,
obesity and glucose intolerance, 45% higher probability of developing diabetes type II,
macrosomia and brachial plexus damage and to a lesser extent, jaundice, respiratory
stress, hypocalcemia, higher rate of fetal malformation and perinatal mortality (Marshall
y Carpenter, 2007). Therefore, it could be sugested that gestacional diabetes is a
transitory condition that might lead metabolic disfunctions in long-term.
Mireia Pelaez. First draft
The second consequence of excessive weight gain during pregnancy is macrosomia.
The considered normal range of newborn weight is between 2 500 g and 4 000 g. Babies
with weight equal or above 4 000 g are considered as macrosomic babies. This situation
places the newborn at a high risk of suffering obesity and diabetes type II in the
adulthood (Mottola et al., 2010). Besides, macrosomia could produce complications in
the courso of labor, such us pelvic floor lacerations, the need of episiotomy or the need
of an instrumental delivery. Altough macrosomia is conditioned by diferent factors like
parents genetics, women with excesive weight gain during pregnancy and/or gestacional
diabetes are more likely to gestate macrosomic babies.
Referring the thrid consequence, an excessive weight gain during pregancy could also
increase the rate of cesarean delivery. It consists on the extraction of the baby, placenta
and membranes through the abdominal wall by surgery. This intervention has several
associated risks. Enumerating some short-term risks for the mother, could be
highlighted more pain after delivery and longer hospitalization and recovery periods. In
the long-term risks, authors find more pain, scar adhesion and perinatal complications in
subsequented pregnancies. Women who had several cesarean sections, are at higher risk
of hemorrhage because of the development of placenta accreta (deep attachment of the
placenta throug the uterine walls). There are also other risks of cesarean delivery related
with the newborn: higer incidence of respiratory disease and a reduction on the suction
reflex (O'Shea, Klebanoff y Signore, 2010; Silver, 2010).
In conclusion, women with excessive weight gain during pregnancy are at higher risk of
suffering gestational diabetes, gestate macrosomic babies and having cesarea delivery.
Studies have shown that the aforementioned conditions are linked with short and long-
term consequences for both, the mother and the child, so the development of programs
to prevent the excessive weight gain during pregnancy are warranted.