Nina, (not real name), who weighs 120 kilogrammes has struggled with conception for five years. She has suffered several miscarriages but feels like the pain of loss is worse than the taunting from her in-laws.
“In my first years, I tried so much because I was tired of the stares and comments regarding children,” she shares. However, the pain of loss haunts her so much that she is ready to leave a childless life.
Dr Joshua Sebuliba, a gynaecologist with Seguku Doctor’s Medical Centre, says obesity has associated diseases such as Type 2 diabetes mellitus, hypertension, coronary heart disease, stroke, gallbladder disease, sub-fertility, deep-vein thrombosis and poor wound healing.
“It is the coexistence of the above obesity related diseases that complicates pregnancy,” he explains.
Dr Sebuliba says obesity can affect conception, pregnancy, delivery and after delivery.
Dr Sebuliba says obese women may have delayed conception as obesity and its effects may increase insulin resistance and interfere with ovulation. Dr Robert Busingye, a reproductive health specialist at Mulago Women’s Hospital, says when one is obese or overweight, there is an increased chance of difficulty in conceiving, and gestational diabetes. This, he says, is because when one is obese, there is hormonal imbalance otherwise called Polycystic Ovaries Syndrome.
“Such women ovulate a few times in a year. They, therefore, have irregular periods which shows underlying failure to ovulate. They may also have features of excess androgens (male-like hormones) which lead to increased body hair, say on the face and pimples due to an oily skin. A high body mass is also present in half of the group.
Dr Busingye adds that excessive body weight may also reduce sexual drive and frequency which worsens the infertility problem. This cuts across to males as well.
Presence of hypertension, diabetes and thyroid disease together with the excessive body weight further complicate the problem. He adds that obese men may also have decreased testosterone and sperm count.
Dr Busigye says at this stage obesity is associated with increased risk of first trimester and recurrent miscarriages.
He adds that compared to women with a normal BMI, obese pregnant women have an increased risk of pregnancy complications such as gestational diabetes, preeclampsia (high blood pressure in pregnancy), post term pregnancy (prolonged pregnancy more than 40 weeks) and urinary tract infections, among others.
“Such women are at risk of stillbirths due to untreated high blood sugar, common in obese women,” he says. Delivery by an obese woman is likely to be complicated due to birth injuries since they tend to have bigger babies. Dr Sebuliba adds that they are also likely to deliver by caesarean section due to the size of their babies.
Dr Sebuliba says obese women are more likely to develop complications such as postpartum haemorrhage -excessive bleeding after delivery, pelvic infections, poor wound healing, vaginal tear, and infections after caesarean section.
They are also more likely to develop a blood clot in their legs and lungs compared to non-obese women because they may not start to walk soon after delivery due to the excessive weight and caesarean delivery.
“Babies born to obese women tend to be bigger than normal. That predisposes them to suffering from birth injuries, low blood sugars on the first day of birth and have an increased risk of early neonatal death,” he warns.
Dealing with the weight
Dr Busingye says weight loss from exercise and paying careful attention to diet alone, improves the chances of achieving a spontaneous pregnancy.
Dr Joshua Sebuliba, a gynaecologist with Seguku Doctor’s Medical Centre, says obesity is defined by Body Mass Index (BMI) – which is calculated as weight in kilogrammes divided by height in square metres:
• A normal BMI is 18.5 to 24.9 kg/m2;
• Overweight is a BMI of 25 to 29.9 kg/m2; and
• Obesity is a BMI of 30 kg/m2 or greater.
He confirms that prevalence of obesity has increased worldwide, over the last 30 years, especially in the developed world. The problem is now common in young people, including young women therefore it is common to find an obese pregnant woman.