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St. Clair Hospital's Fit for Two Program Means Healthier Mothers, Healthier Babies
By Nancy Kennedy

Debra Lenart, M.D., chief of obstetric services at St. Clair HospitalObstetricians and expectant mothers have the same goal: the best possible pregnancy outcome for mother and baby. Every prospective mother hopes for a healthy, problem-free pregnancy, a safe, supported childbearing experience and a healthy full term baby.  This can be a challenge when the prospective mother is obese, however, and with national rates of obesity continuing to climb, it is an increasingly common problem. "We see a lot of overweight, pregnant young women," says Debra Lenart, M.D., chief of obstetric services at St. Clair Hospital. "We also see many women who are hoping to become pregnant and are worried about excessive weight gain. Weight management and obesity are important issues for obstetricians and their patients. At St. Clair, we've created a lifestyle management program called Fit for Two to help women who are overweight and pregnant, or overweight and planning to become pregnant."

Obesity and pregnancy are a high-risk combination, putting both mother and baby at increased risk for medical complications. Mothers face a higher risk of developing gestational diabetes and hypertension, conditions that can complicate pregnancy and even become chronic diseases. Obese women are more likely to have longer, more difficult labors and to need a Cesarean section delivery, which can result in excess blood loss and is associated with a higher risk of infection. There is even a greater risk of miscarriage and stillbirth.
Babies born to obese mothers may be big babies, with a greater risk of birth trauma, including fractures or dislocations of the shoulders. Bigger babies may also have unstable blood sugars and more difficulty establishing feedings.

Obese mothers require closer and more frequent monitoring of their health and the health of the fetus. The Fit for Two program emphasizes good self-care, nutrition, rest, exercise and stress management, all of which go a long way towards helping the baby grow and develop well, along with regular prenatal checkups and monitoring of fetal well-being.  The program, which is free of charge, features more frequent non-stress tests and a second ultrasound, as well as earlier screening for diabetes, because of the increased risks. The Fit for Two program includes nutrition counseling and healthy recipes from a registered dietician, health education with a registered nurse and an individualized exercise program from a fitness instructor.

Ideally, management of obesity and weight loss begins pre-pregnancy, as part of conception planning, says Dr. Lenart. Getting into shape and becoming as healthy as possible before becoming pregnant gives the woman a head start, enabling her to be at her very best from the first moment of her pregnancy. Dr. Lenart believes that pregnancy can be the healthiest time of a woman's life and an opportunity to make lasting, healthy lifestyle changes that will serve her throughout her lifespan. "Pregnancy is an opportunity to create a foundation for the long term health of her child, but also for herself," she says.

Still, talking about obesity with patients is not a simple matter. "It can be complicated, because obesity is a complex condition and it is an uncomfortable topic for some women. They may be offended, and many of them are afraid of gaining more weight. There is already plenty to be scared about: pregnancy is associated with a lot of anxiety, normally. The stress alone can make a woman gain weight. Obesity and its complications are one more thing she has to worry about. Women should not be afraid to talk about weight and eating issues with the physician; we can help."

Michelle Iddings, 33, of Washington PA, is an enthusiastic participant in Fit for Two. She is having her first baby and was introduced to the program at 30 weeks. "Dr. Lenart encouraged me to join; she said the doctors in her group are seeing less weight gain in the women who joined the program. They gave me a packet filled with good information and tips. I've learned to drink tons of water, eat a lot of vegetables and stop drinking soda. It's a focused program that requires planning but it's worth the effort."

Michelle says that Dr. Lenart approached the subject with sensitivity and compassion. "Dr. Lenart handled it well. She has never made me feel bad about my weight. She was so positive – she said, 'We think you can do this.' And I did do it. My baby is due in two weeks, and I've only gained 18 pounds, thanks to Dr. Lenart and Fit for Two."

To learn more, visit www.wpsbc.org. To contact Beth Ramella, call (412) 621-0100 Ext. 379 or email her at ramellab@wpsbc.org.

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