One question that I hear a lot from women either looking to conceive or at first pregnancy visits is “how will my weight affect my pregnancy?”  As weight can very often be a sensitive topic, it can be a tough topic for your provider to discuss with a patient.  That being said, weight has been proven to play a role not only in a women’s ability to become pregnant, but also her ability to have a healthy pregnancy and carry it to term.  Below are some of the most significant ways that BMI (and yes, I understand that for a select few BMI may not be perfectly accurate, but it’s what we’ve got) can affect pregnancy.
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Starting with getting pregnant, obesity (a BMI over 30) is often related to increased adipose (fat) tissue, and this adipose tissue actually makes its own hormones that can disrupt ovulation.  If no egg is released, then pregnancy can’t happen.  Even with successful ovulation and pregnancy, the risk of miscarriage increases by 3%, and there is also an increased chance of birth defects such as neural tube defects (problems with the spine) as well as heart defects.  This can be associated with either a problem with chromosomes (genetic material) in the egg or during the development and growth of the pregnancy.

Unfortunately, there are also increased chances of maternal health issues during pregnancy with higher BMI.  For preeclampsia (blood pressure issues in pregnancy that may cause seizure/stroke, kidney/liver damage, or even death), the single greatest risk factor is obesity, which is present in about 1/3 of cases.  In fact, women with a BMI >30 are 3 times more likely to develop preeclampsia than those women who begin pregnancy with a BMI in the normal range.  Why do we care?  Blood pressure issues in pregnancy are the most common cause of maternal death in most developed countries, like the U.S.

Blood sugar issues are another problem that is more common in obese women during pregnancy.  Gestational (pregnancy-related) diabetes risk increases as maternal BMI increases.  While only about 2.5% of women with a normal BMI develop gestational diabetes, this increases to about 5% with a pre-pregnancy BMI of 30 and to more than 10% for a BMI >35.  While it’s certainly not enjoyable to watch one’s diet before pregnancy, having to prick a finger to check blood sugar and taking or injecting medicine during pregnancy would definitely be less fun.

Even delivering the baby can be tougher for obese moms.  Labor tends to last longer, the chances of needing a cesarean section are higher, and babies tend to be bigger.  For moms with a starting BMI >30, the chances of delivering an 8 lb 13 oz baby is as high as 15%, and the chances of having a baby weigh nearly 10 lbs or more is about 4%.  In comparison, mothers with a normal BMI have less than a 10% chance and about a 1% chance, respectively.  The issues with larger babies are that they often have to stay in the hospital longer as they can have trouble with their blood sugar or they can potentially get hurt if they get stuck during the delivery.  In fact, baby size alone increases the odds of needing a cesarean section to deliver the baby.

Of course, not all obese mothers have poor pregnancy outcomes, and not all normal weight mothers have good pregnancy outcomes.  Also, we’d definitely not advise intentional weight loss during pregnancy.  Still, working to attain a healthy weight prior to conceiving and monitoring weight gain during pregnancy do decrease the risk of pregnancy complications, and that happy, health pregnancy is what it’s all about 😊

Dr. Nick

CBD Oil seems to be the hot new product that cures all sorts of ailments: anxiety, depression, nausea, seizures, inflammation, and insomnia just to name just a few.  CBD oil is available in sorts of different products: gums, candies, lotions, hair products, capsules, vape oil.   At prenatal visits, I get asked all the time- Is it safe to use CBD oil products for my nausea while I’m pregnant?

1. So, let’s start with what is CBD oil?  CBD oil is made by extracting cannabidiol from the flowers and buds from Marijuana or hemp plants and then diluting it with a neutral edible oil.  It does not have an intoxicating effect because it does not contain THC which is what causes the “high” when you smoke marijuana. 
2. Is there any medicinal use for Cannabidiol?  The FDA has only approved the medication Epidiolex to treat a rare form of childhood epilepsy.   Of the research done with cannabidiol, this is the only indication where the evidence suggests there may be some efficacy for treatment with cannabidiol.  For all its other purported benefits, there is not enough evidence for the FDA to recommend it as a treatment modality.  Also, whenever any product seems to be the panacea for so many different symptoms, there is always a concern about it being the new snake oil. 
3. Is CBD oil safe to use during pregnancy?  So unfortunately like most things, there are not enough studies for us to be able to say with certainty that CBD oil is safe in pregnancy.  However, several studies have found that there is an increased risk of preterm birth, small for gestational age babies, placental abruption, and increased admission to the Neonatal Intensive care unit for moms who used marijuana while pregnant.  Long term neurologic studies in children whose mothers used marijuana while pregnant do show increased risk of attention and behavioral problems, impaired visual acuity, verbal reasoning and comprehension and short-term memory issues.  For these reasons the American Academy of Pediatrics, the American College of Obstetrics and Gynecology and the US Surgeon General all warn pregnant women not to smoke marijuana or use any of its byproducts.

So, at this point, the FDA hasn’t found CBD oil to be an effective treatment for pregnancy-related nausea, and the medical community is concerned about the safety of cannabinoid-based products as they may be related to negative pregnancy outcomes.  Also, while we are aware that the THC in marijuana is responsible for the “high,” there haven’t been any studies to determine which part of cannabis plants is dangerous in pregnancy.  Given the lack of proven efficacy and also the potential danger of these products, the safest course of action would be to avoid them in pregnancy until the FDA and the medical community suggest doing otherwise.

​Dr. Pam

Every year, over 90% of people make New Year’s resolutions, but typically, less than 10% of them achieve their goals.  Some of the most common resolutions often involve improving diet and exercising more.  While everyone knows that these lifestyle changes improve health, what they may not know is that exercise can also boost the quality of their sex life.

For women, a short, vigorous workout in the gym (as little as 20 minutes), can lead to a vigorous workout in the bedroom, too.  The hormonal boost from intense exercise can increase arousal by over 150%!  Not only are women more aroused after exercise, but they also experience increased genital bloodflow, which, in turn, can improve the quality of the intercourse that they have.  Just don’t wait too long to “workout” with your partner as these boosts are generally short-lived.

For men, exercise can increase testosterone by up to 15%.  Weightlifting is particularly beneficial for increasing testosterone production, especially with heavier weights.  In addition to improved sexual drive associated with testosterone production, testosterone can increase muscle mass and decrease adipose (fat) tissue.  When fat loss is from the abdomen, penile bloodflow increases as can erection length (less covered by adipose).  Men shouldn’t fully neglect cardio, though, as atherosclerosis and hypertension can result in erectile dysfunction if not prevented.

For both men and women, improved self-image from weight loss and increased muscle tone often results in desire to share their new, sexy look with their partner (how about lights on in 2020?).  By being more comfortable with oneself, stress from being intimate is often lessened, thus allowing for more enjoyment of (and desire for) sex.  Lastly, as fitness increases, insulin resistance decreases, and the suppression of sex hormones by high insulin levels also ends.  With normal sexual hormone function, arousal and excitement happen more readily, and now that strength and stamina are increased from regular exercise, a person often has more energy to act on those urges.

So, here’s to a healthier 2020.  Keep making those resolutions for a fitter you, but when your exercise routine gets a little stale or your life gets busy, a healthy heart or lower cholesterol isn’t your only reason to stay active.  Remember that getting sweaty in the gym can lead to getting sweaty with your significant other, too!
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Dr. Nick