Aiesha Eddins, who is 7 months pregnant, has lost 20 pounds by… (Kim Hairston, Baltimore…)
Before Aiesha Eddins got pregnant, she didn't give much thought to her diet.
"I ate whatever," said the 27-year-old Owings Mills woman. "We ordered take-out."
But when she weighed in at 220 pounds during her initial prenatal visit, she quickly earned a spot at the Johns Hopkins Hospital's Nutrition in Pregnancy Clinic, launched in December to counsel and treat obese women. The clinic has around a dozen patients but already is expanding.
An estimated one in five pregnant women are obese, according to the U.S. Centers for Disease Control and Prevention, an epidemic according to some doctors who have begun to buck conventional ideas about "eating for two." They now recommend healthy diets, little or no weight gain and even bariatric surgery for obese women before they get pregnant.
Obese pregnant women are at increased risk of miscarriage, high blood pressure, diabetes, pre-term delivery, stillbirth, cesarean section and other problems. Their babies, which are harder to see on ultrasounds, are more likely to be obese and diabetic and have other maladies.
Conventional advice for these women since 2009 has been to gain 11 to 20 pounds, reflecting guidance from the Institute of Medicine, the influential federal advisory panel. Normal weight women are told to gain 25 to 35 pounds.
Most doctors generally stick to the guidance and treat obesity complications, said Dr. Janice Henderson, an obstetrician for high-risk pregnancies at Johns Hopkins Bayview Medical Center and Eddins' doctor. But she said some doctors have begun to see that as a "missed opportunity" to teach patients about nutritional and lifestyle changes that can improve their and their babies' health.
Eddins was counseled to eat more fruits, vegetables and whole grains. Now seven months pregnant, she's lost 20 pounds.
"Over the course of a pregnancy they learn a lot that we hope will have a carry-over effect postpartum both for themselves, their child, and perhaps even spill over to other family members," Henderson said about the women in the Hopkins clinic. "Imagine if we don't begin to address this problem what the next generation or the generation after that will look like with respect to obesity rates."
Henderson said some women gain too much weight in pregnancy, but most already are overweight. Federal statistics show that nearly a third of women of reproductive age are obese, and the numbers are higher among minorities.
Obese pregnant women are all considered high risk for complications, doctors say. And they are filling high-risk centers, such as Mercy Medical Center's Center for Advanced Fetal Care.
The center also treats women with diseases or infections, who are carrying twins or who are older than 35, but half of the women are obese, said Dr. Robert Atlas, chair of Mercy's obstetrics and gynecology department and an assistant professor at the University of Maryland School of Medicine.
Many of the women come from impoverished areas of Baltimore and don't have ready access to good food or have developed poor eating habits, he said. If he can impress one thing on them, Atlas said, it's to not drink sugary soda or even juice.
"I don't want obese patients to gain any weight," he said. "I don't use the term dieting, but I tell them to eat healthy."
He's learned about nutrition in part from battling his own weight. But he conceded he's not a nutritionist, and insurance doesn't often pay for women to see one unless the patient is diabetic, which an increasing number of obese patient are.
That lack of nutrition training means many doctors don't give full or even proper advice to patients, said Dr. Yvonne S. Thornton, a professor of clinical obstetrics and gynecology at New York Medical College.
Thornton first learned about nutrition from a commercial weight loss center, where she went after her first baby was born. It was an experience she translated not only into advice for obese patients but also into a study proving that little to no weight gain was safe.
Thornton was using Weight Watchers when she became pregnant again. She intentionally gained no weight during this pregnancy and quickly lost weight afterward. Neither she nor the baby had any complications, so she decided to seek permission from her hospital review board to let her conduct a similar experiment on patients.
"It took years to convince them," she said. "They all thought, as many people did, that dieting would harm or kill the baby."
Once she was allowed to do the study, her patients ate a healthy diet and gained little or no weight. They had significantly lower rates of high blood pressure, diabetes, miscarriage, early delivery and infant death.
She now encourages other doctors to counsel patients on nutrition and wants the Institute of Medicine to change its recommendations on weight gain.