Nurses Tackle the Obesity Epidemic in Pregnant Women

With more than one-third of Americans now considered obese, it seems like everyone from first lady Michelle Obama on down is looking for a way to reverse this deadly trend in our culture.

Unfortunately, obesity — which is defined by a body mass index above 30 — is the new normal in America. (BMI is a measurement of body fat using weight in relation to height.) One in five deaths in America can now be traced to obesity, according to the Centers for Disease Control and Prevention.

Obesity during pregnancy is even more dangerous because it carries severe risks for both mother and baby.“There are two types of weight concerns with pregnancy: prepregnancy obesity and excessive weight gain during pregnancy,” says Andrea Domas, MS, RD, CDE, LDN, advanced-level dietitian and instructor in the Department of Clinical Nutrition at Rush University.

An obese non-diabetic woman can develop gestational diabetes during pregnancy. That can lead to large babies and cesarean sections; a greater risk of both mother and baby developing Type 2 diabetes later in life. Obesity increases a woman’s risk for high blood pressure, pre-eclampsia, preterm birth and miscarriage. Babies born to obese mothers often have their own health complications, too, according to the National Institutes of Health.

When Megan Polson, a recent graduate of Rush’s Doctor of Nursing Practice (DNP) program, worked at Rush Gynecological Care Group (GCG), she saw all of these problems daily with her patients. She quickly realized that the clinic had a majority population of obese patients who already had the odds stacked against them even before they became pregnant. They lacked affordable nutritional education resources.

“What Medicaid offers these moms is nothing,” Polson says. “They can’t afford to spend $80 to meet with a dietitian and pay out of pocket.”

Polson was also seeing complications with obese moms who had already delivered.

“I’m passionate about having healthy, happy babies. I wanted to do something about it,” Polson says.

For her DNP project, Polson worked with an attending physician at the GCG clinic and reached out to the Department of Clinical Nutrition at Rush. Her project outlined a free program using resources Rush already had: students studying nutrition who needed real-world counseling experience, and their instructor, Domas, who was willing to supervise students working in the clinic one day a week.

Polson and Domas agree the nutritional counseling program made available last year is an all-around success: Patients receive free care, students obtain great experience counseling a diverse patient population, and the nurses in the clinic have another set of eyes and ears on their patients’ progress.

Domas says good nutrition counseling is individualized and targeted. It starts with setting weight gain goals for pregnancy, helping patients identify potential areas for diet adjustments through, for example, reading labels and journaling or using an app, and educating about other tools to assist with lifestyle changes. Substituting water for juices and sugary sodas is one example of a small dietary change that can make a big difference, Domas says. Or debunking the myth that only expensive fresh produce is good for you, when, in fact, healthy canned or frozen options are acceptable.

Domas admits it can be a struggle for busy moms who lack resources or transportation to make it to appointments and keep track of what they are eating. But when they do, it’s worthwhile because they’re taking the first step toward breaking the obesity cycle for themselves and their family. “Our intent is not to overhaul their diet but to guide our moms with simple yet significant changes, “Domas says. “Once they feel up to it after the baby is born, they can follow up with us for more lifestyle changes.”

Polson graduated in August 2016, and has moved on to another city and a new job. However, her brainchild continues to improve the lives of more and more women in the GCG clinic. “We started out with three patients and now the students are kept busy,” Polson says. Recently, the clinic opened to those who are thinking about getting pregnant as well.

The nurses are teaching those prospective moms what they can do to prevent these problems in the first place, she adds proudly.

Originally published in the Chicago Tribune special section Nursing In Action on September 23, 2016.