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Pregnancy & Obesity: A Dangerous Combo

Pregnancy & Obesity: A Dangerous Combo
Pregnant women -- and their doctors as well -- are affected by the growing epidemic of obesity in this country. Doctors discuss how the birth process is made much more difficult and dangerous for both mother and child if the mother is obese.

MAUREEN CAVANAUGH (Host): It's well known that pregnancy can cause a woman to gain some weight, and sometimes that baby weight doesn't all come off. But what happens when a women starts her pregnancy already overweight or even obese? Doctors are telling us that can be a bad situation for both mother and baby. And it's a risk factor that many primary care doctors and other healthcare workers don't emphasize in preparing women for pregnancy. We'll be speaking for the rest of this hour about how obesity can affect a woman's chances of both getting pregnant and delivering a healthy baby. I’d like to welcome my guests. KPBS health reporter, Kenny Goldberg. Kenny, good morning.

KENNY GOLDBERG (KPBS Health Reporter): Good morning. Hi, Maureen.

CAVANAUGH: Dr. Yvette Lacoursiere is from the UCSD Medical School. Dr. Lacoursiere, welcome.

DR. YVETTE LACOURSIERE (Physician, University of California San Diego Medical School): Good morning and thank you for having me.

CAVANAUGH: And Dr. John Missanelli is OB-GYN at Sharp Hospital. I’ll get this right. Dr. Missanelli, thank you so much.

DR. JOHN MISSANELLI (Obstetrics and Gynecology Physician, Sharp Hospital): That’s okay. You’re welcome.

CAVANAUGH: We’d like to invite our listeners to join the conversation. What kind of advice has your doctor given you about overweight and pregnancy? Do you know anyone who has had a problem pregnancy because of being overweight? Give us a call with your questions and your comments. Our number here is 1-888-895-5727. Kenny, let’s start out with you. You had a feature report on Morning Edition about this subject today. Can you give us some statistics on obesity and pregnancy? Do we know, for instance, what percentage of women of childbearing age are considered obese.

GOLDBERG: Well, the estimates are about two out of three women of childbearing age are either overweight or obese.


GOLDBERG: And over the last 20 years, I understand there’s been a 40% increase in women who start their pregnancy overweight.

CAVANAUGH: I see. So and what about the trend? Is it, on the overall, trending up?

GOLDBERG: Yeah, definitely. I mean, it just – it reflects the trends in American society. And I’m sure the doctors can amplify that but they’re not seeing anything different among women of childbearing age than people in general.

CAVANAUGH: Now in your report, you documented some medical problems that are associated with pregnancy and obesity including gestational diabetes. What is that and what problems does it cause?

GOLDBERG: Well, you’ll have to talk to the doctors about that but it can cause problems to the mother. It can also cause problems for the infant. I understand a woman with gestational diabetes tends to deliver a baby that’s larger. It’s larger at even the early stages, which can lead to premature birth and that can lead to a host of problems. And then also when the baby’s born, if the mother’s diabetic, the baby can come out of the womb hypoglycemic, with low blood sugar, so they have to be hooked up to an IV when they’re born and taken to the neonatal intensive care unit. So it can cause a whole host of problems in the infant as well as the mother.

CAVANAUGH: And, Kenny, is there speculation that maybe more health problems can be transferred from mother to the child in terms of obesity? Are doctors also looking at that?

GOLDBERG: Yeah, they definitely are and I think research shows recently that women who are overweight or obese in pregnancy, they can not only cause immediate problems to the baby but also maybe some lifelong issues with weight and some other health problems, too.

CAVANAUGH: Let me bring in, as you say, the doctors to the conversation. Dr. Lacoursiere, when we’re talking about overweight and obese, how do doctors measure that? Is that purely what someone weighs or is there another way that you actually determine that?

DR. LACOURSIERE: Probably the most common way to measure that is looking at a maternal body mass index which factors in your weight and your height into a formula that gives a range somewhere between 15 and 50. It’s easy to calculate or it can even be found on the internet by body mass index calculators to find out what your actual body weight is.

CAVANAUGH: And what is an acceptable body mass index?

DR. LACOURSIERE: So, in general, most people agree that a body mass index between 18.5 and 25 is a normal weight for – or a normal BMI for women. What does that mean? Well, a woman who is 5-foot-four, it’s somewhere between 110 and 135 pounds.

CAVANAUGH: Right. And so what are you seeing in terms of people who are coming into your office. As Kenny reported, are there a lot more women coming in pregnant and overweight?

DR. LACOURSIERE: Clearly, there are. And like he mentioned, it’s following the trends that are happening in our regular population of individuals. We had done some studies in one of the leaner states in the country and showed that over a decade, a 40% increase in the number of women who are overweight or obese staring pregnancy.

CAVANAUGH: And when did this start? When did the doctors start to notice that perhaps their – the women coming into their practice who were pregnant were, you know, getting – were heavier?

DR. LACOURSIERE: I think when you start to see more attention to it in the literature was probably in the late nineties, early 2000s, where people were actually starting to publish on this topic.

CAVANAUGH: And does that correspond to when the overall obesity, as people have been calling it, ‘epidemic’ sort of started to hit the United States?

DR. LACOURSIERE: Probably about the same, about the same, past 20 years or so.

CAVANAUGH: I’m wondering, what kind of – Did you get any education in medical school as to advising women to watch their weight before they become pregnant? That that, indeed, was one of the risk factors?

DR. LACOURSIERE: Not in particular but I’m a little bit older, so it wasn’t an issue.

CAVANAUGH: Oh, well, that would…

DR. LACOURSIERE: But I think the residents now are receiving a lot more education about these risks.

CAVANAUGH: I see. That – You are not a little bit older but, indeed, that was my point, in that this is something new that doctors are now being attuned to.

DR. LACOURSIERE: Yes, right.

CAVANAUGH: Dr. Missanelli, as a specialist in OB-GYN, how many obese women do you see in your practice?

DR. MISSANELLI: I’ve been practicing for over 30 years now and I never thought at the end of my practice time that the most important thing that I would do every single day when I see pregnant women is talk about weight. It didn’t used to be that way. We never learned it well, never were concerned about it because it was something that didn’t happen. It’s an epidemic now. It’s something that we have to address. I think it’s the most important thing that we could look at in pregnancy now.

CAVANAUGH: Is it because at least one of the factors, do you think, that women are a little bit older now when they become pregnant?

DR. MISSANELLI: Possibly. I just think it’s a reflection of our American society. We have a society of abundance. We eat too much. We eat the wrong things. We eat at the wrong time. We eat for the wrong reasons. And that happens in the childbearing age women as well as it happens with everyone else.

CAVANAUGH: We’re taking your calls at 1-888-895-5727 if you’d like to join the conversation about what you’ve been told by your doctor about the effects of overweight and pregnancy or if anyone you know has had a problem pregnancy because of being overweight, that’s 1-888-895-5727. Dr. Missanelli, what are the problems in treating and caring for women who are overweight and pregnant?

DR. MISSANELLI: Well, that’s a very simple answer, and the answer is everything. There’s – From the moment they walk in until the time they deliver, every single thing that we need to do, that we need to make sure is safe for both the baby and the mother, is more difficult. It’s more difficult to listen to a fetal heartbeat because of the obesity factor. If they go into labor, we worry about their blood pressures, the size of the baby, the difficulty of the labor, every aspect of what normally would happen is made worse in pregnancy.

CAVANAUGH: And Dr. Lacoursiere, when women come into your office and you’re counseling them about their pregnancy, are they surprised that overweight might be an issue?

DR. LACOURSIERE: I think they are surprised. I think it’s something that doesn’t – hasn’t received enough attention. There are specific weight gain recommendations that differ by someone’s pre-pregnancy body mass and I have found most patients are quite surprised that their recommendation of what they should gain during pregnancy is different because they’re starting their pregnancy a little bit heavier.

CAVANAUGH: Now, Kenny, in your report this morning, you profiled a woman who, indeed, was struggling with her weight while she was pregnant but you also made the point that this was sort of a battle that this woman had been fighting for quite some time.

GOLDBERG: That’s right. She sort of has had a lifelong up and down relationship with her weight and right before she got pregnant, ironically, she’d lost about 30 pounds. She really took care of business. But then when she got pregnant, she’s gained it all back and then some, and so it’s just a very difficult thing. And I would imagine it must be extremely difficult for the doctors to encounter a patient who starts the pregnancy overweight or obese. I mean, what do they tell them at that point?

CAVANAUGH: Right. What do you tell them at that point, Dr. Lacoursiere?

DR. LACOURSIERE: Well, then you start from the very beginning of pregnancy, kind of setting up the expectation that the weight gain in the first trimester should be around four pounds. And that the weight that they should gain on a weekly basis is less than a half a pound a week. So you do your best to try to help that patient walk through the steps it takes to optimize their weight gain in pregnancy. Not – they’re not eating for two, that they should increase their physical activity or at least keep it at a steady state and not decrease their activity. And then it’s our job as the doctor to explain to the patient that there are additional risks and it’s our job to be – have a heightened surveillance for those risks and act early and screen early.

CAVANAUGH: You’re sort of going against what is sort of accepted wisdom in pregnancy in the sense that people think they are eating for two. People think, you know, well, this is the one time in my life that I don’t have to worry about my weight.

DR. LACOURSIERE: Well, that’s true. You are eating for two but the size of that second person is quite small and so – and I tend to remind my patients of that. I think that the Institute of Medicine has helped support us doctors recently. In 1990, they came out with recommendations that were really targeted to a different population. They were targeted to decrease the amount of very low birth weight babies. And so those recommendations liberalized how much weight women should gain during pregnancy. So as of last year, they have reassessed the current knowledge base and have come out with new recommendations that limit the weight gain in the obese population.

CAVANAUGH: Dr. Missanelli, how difficult do your patients tell you it is to actually restrict their weight while they are pregnant?

DR. MISSANELLI: Well, they tell us that it’s difficult but I think the real bottom line is that they don’t want to restrict what they eat. They want to eat. You know, San Diego area has many ethnicities that are here established and are moving here. And we fight that battle every day, to tell them that what they’re aunt told them, what their grandmother told them about eating and pregnancy is not correct. That I’ve had many patients that have gained absolutely no weight during their pregnancy and have had normal size babies. That is possible. You’re not eating for two. You don’t have to eat all of the things that you’re told to eat to make the pregnancy healthy. In fact, what you’re doing is making it unhealthy.

CAVANAUGH: But is it – Let’s say a woman is prone to being overweight, to obesity, isn’t it more likely that with all the hormones that are going on during pregnancy that it’s going to be even more difficult for her not to gain a large amount of weight when she is pregnant?

DR. MISSANELLI: No, I don’t think that’s true. I think it’s – it comes down to eating. I think it comes down to what you eat, how much you eat, when you eat, and you really have to decide that you’re going to do something for yourself and your baby and follow the strict guidelines that Yvette has been talking about.

CAVANAUGH: And I’m also wondering what kind of exercise do you – is exercise a good thing for someone who is overweight and pregnant?

DR. LACOURSIERE: Yeah, physical activity’s important for all pregnant women and, in fact, the American College of OB-GYN recommends that women get at least five days of moderate physical activity for 30 minutes at a time. There are women who are not good candidates for physical activity but they’re very rare. They’re very uncommon.

CAVANAUGH: Okay, so that’s basically across the board. You – and what…

DR. LACOURSIERE: What should they be doing?



CAVANAUGH: What should they be doing?

DR. LACOURSIERE: So one of the things, if they have not been physically active before pregnancy, pregnancy’s not exactly the time to start training for a marathon but getting women out and walking, exercising by way of playing with the – with their children, getting the TV off and just getting moving. Swimming is another thing that works really nicely for patients as pregnancy progresses because it’s actually easier on the body.

CAVANAUGH: Dr. Missanelli, you seem a little bit harsh about your patients.

DR. MISSANELLI: You noticed.

CAVANAUGH: Is this tough…

DR. MISSANELLI: My patients notice, too. No, I…

CAVANAUGH: Is this tough love?

DR. MISSANELLI: It is tough love. That’s exactly what it is. They have to be reminded of what is best for themselves and their babies. That baby has only the mother to rely on and the mother needs to take that responsibility seriously and do what is correct for the baby, number one, and then for them in the long run, too. There’s nothing good about being obese, nothing.

CAVANAUGH: We are taking your calls at 1-888-895-5727. Do you – If you have had a pregnancy and been overweight, please do give us a call. Tell us what the experience was like if you encountered any problems that perhaps you wouldn’t have otherwise. What kind of advice has your doctor given you about overweight and pregnancy? As I say, you can give us a call at 1-888-895-5727. Dr. Missanelli, what do your patients come in and tell you about why they can’t do what you want them to do?

DR. MISSANELLI: Because of pressure, because of time off. I notice that Americans, when Americans have leisure time, they fill that leisure time by eating. And so it’s a whole behavioral change. We have to get them to understand that although pregnancy is not a disease, it’s a condition that you have to be serious about when it comes to eating. And they say, many times, if they gain too much weight during – from one visit to the next that there’s a reason for it with a party or they had to eat out or there was a shower or there’s many excuses and that’s what it turns out to be in the end, excuses.

CAVANAUGH: We’re taking your calls, as I say, at 1-888-895-5727. Right now Yvonne is on the line from Imperial Valley. Good morning, Yvonne. Welcome to These Days.

YVONNE (Caller, Imperial Valley): Hi. Good morning. Thank you for taking my call.

CAVANAUGH: You’re welcome.

YVONNE: Well, one of the things that I noticed in my pregnancy which was kind of unusual, I was at my actually healthy weight at that point. I’m five-seven and I was 135 pounds when I got pregnant. And I started experiencing a lot of problems throughout my pregnancy and I got preeclampsia, the whole works. I mean, my chances of getting that was very slim but then I went through that. And through that moment of my pregnancy, I did start overeating because of the reason of eating for two.


YVONNE: I gained a lot of weight, almost like 40 pounds.


YVONNE: And during that time I did have a premature child. She was barely three pounds at 32 weeks. And throughout, you know, after I had her, I did gain – I kept the weight…


YVONNE: …and it took me a lot of problems – I started having high blood pressure and the only way to resolve that was to, obviously, lose the weight, watch my diet, and starting a workout program.

CAVANAUGH: Right, right. Well, I appreciate the call. Is it your point, Yvonne, that women of normal weight can also have problems during pregnancy?

YVONNE: Well, that was one of the unusual things but I did notice that I had no energy after – when I had all that weight. I had no energy to take care of my child. I was – I felt very unhealthy, and so I really encourage all the women to watch their diets while they’re pregnant because they don’t have to overeat. They don’t have, like you said and throughout the program, eating for two is not going to help the child. If anything, it’s going to hurt it, and yourself, too, because you need the energy to take care of the child after this point.

CAVANAUGH: Yvonne, thank you so much. And Dr. Lacoursiere.

DR. LACOURSIERE: Yeah, so, Yvonne, you point up something that’s very important, is that it’s not just what someone’s pre-pregnancy weight is that puts them at risk for diabetes, preeclampsia and caesarian delivery but also excess weight gain during the pregnancy puts people at risk for those outcomes as well.

CAVANAUGH: Oh, I see. And for those of us who don’t know, what is preeclampsia?

DR. LACOURSIERE: Oh, preeclampsia is a disease of pregnancy that has elevated blood pressures and protein in the urine. Unfortunately, it can have a lot of complications for the mother that require early delivery for the fetus.

CAVANAUGH: I see. We have to take a short break. When we return, we will continue our discussion about obesity and pregnancy, and take your calls at 1-888-895-5727.

CAVANAUGH: I'm Maureen Cavanaugh. You're listening to These Days on KPBS. We’re talking about obesity and pregnancy and how they really don’t miss (sic) for the optimum health – they really don’t mix, that is, for the optimum health of both mother and child. My guests are KPBS health reporter Kenny Goldberg, Dr. Yvette Lacoursiere, and Dr. John Missanelli. We’re taking your calls at 1-888 and 895-5727, that’s 1-888-895-KPBS. Dr. Lacoursiere, I want to make a very important point here because I think I kind of glossed over it, and that is it’s not just that there are more overweight women who are showing up in doctors’ offices who are pregnant, before their pregnancy really gets underway they start out overweight, but they’re more overweight than they used to be.

DR. LACOURSIERE: Exactly. And, in fact, if you look at the statistics that we’ve recently run at UC San Diego, about 18% of our women who come to Labor & Delivery to deliver are over 250 pounds and about – a little over 1% of those are over 300 pounds at delivery. And even for a normal weight woman, that’s clearly someone who’s in the Class III or severe obesity range.

CAVANAUGH: So nearly one out of five women who come in to deliver at UCSD is over – is about 250 pounds?

DR. LACOURSIERE: Umm-hmm. Exactly.

CAVANAUGH: Wow. Okay. Dr. Missanelli, could you tell us what problems are encountered with – what problems do overweight women encounter during the birth process? What makes it more difficult for them?

DR. MISSANELLI: Well, the birth process is difficult to begin with.


DR. MISSANELLI: And so when you are overweight, the – just the logistics of everything that you need to know during a safe delivery become more difficult. You can’t monitor the baby’s heart rate as readily and as accurately as you need to. The progress of the labor is more difficult and longer. The ability to know whether or not the mother’s going to maintain her blood pressure in acceptable ranges for the entire labor is put in jeopardy. The failure of that pregnancy – of that labor to progress to the point where you could safely have a vaginal delivery is much less likely. There’s more of a chance of bleeding both before and after the delivery if it happens vaginally. Should I go on? There’s…

CAVANAUGH: Yes. Yes, yes.

DR. MISSANELLI: The incidence of caesarian section, of course, goes up in direct proportion to the body mass index. And so for a normal pregnancy with a normal body mass index and appropriate weight gain, it’s about 21%. And then as soon as you get up over 30 body mass index, it goes to 34, 35% and then when you’re up over 35 body mass index, there’s about 50% caesarian section rate. Now those statistics vary according to, you know, what research you’re looking at but the idea is that we only do caesarian sections for reasons of safety. We don’t do caesarian sections because we like to or because it’s convenient. It’s because it’s a last resort. And there’s more situations during an obese woman’s labor that give us the opinion that we have to do a caesarian section for the safety and the health of the mother and the baby.

CAVANAUGH: And apparently in reading, Dr. Lacoursiere, there’s also some problems that women encounter after birth, obese women encounter more than normal weight new mothers, and that has to do with breast feeding and depression.

DR. LACOURSIERE: Exactly, and that’s some of the newer research that’s coming out of UCSD right now, is that if you look at a woman’s pre-pregnancy body mass index it’s directly related to her risk of developing post-partum depression. That, along with difficulties in breast feeding put that woman at a increased risk for having support. So especially with respect to breast feeding…


DR. LACOURSIERE: …there are lower rates of initiation of breast feeding and then once a woman who is overweight starts to breast feed, her chance of success is diminished as well. So I think it’s important for providers to know that information partly because it’s our job as providers to support a woman. There’s resources in the community to support women who want to breast feed, it’s our job to recognize those women who are at greatest risk for failing and support them with that process.

CAVANAUGH: We’re taking your calls at 1-888-895-5727. Dawn is calling us from Del Mar. Good morning, Dawn. Welcome to These Days.

DAWN (Caller, Del Mar): Hi. Thank you for taking my call.

CAVANAUGH: You’re welcome.

DAWN: I have a body mass index of 30 and I have a healthy child already and, you know, of course, most families consider having multiple children so I’ve been hesitant because, you know, my body mass index is in an unhealthy range and I have no high blood pressure, I constantly get checked for heart disease, my cholesterol, my glucose. Everything is actually in great range because I’m pretty physically active and eat well. I just am, you know, have a larger body mass index. I’m wondering, with pregnant – like if I happen to get pregnant would my chances of – just be higher just because my body mass index is high?

CAVANAUGH: Thank you for the call, Dawn. Who would like to take that?

DR. LACOURSIERE: I can. It actually – Some of the studies that are out have controlled for preexisting health conditions, so they control for diabetes, they control for hypertension, and still show this association that being overweight or obese can actually increase your risks.


DR. MISSANELLI: Yeah, so there’s more of a risk of not being able to get pregnant and then there’s more of a risk of, once they are pregnant, having a miscarriage. And the only factor that would be necessary to blame for that would be a body mass index over 30. In fact, what we do every day in the office is preconception counseling. We want women to be normal body mass index or we’re not going to talk about weight anymore because it doesn’t matter. It’s body mass index, a normal body mass index before they attempt to become pregnant. If they do that, then all of what we just said – well, not all but most and overwhelmingly go away, those factors go away.


DR. LACOURSIERE: You know, part of it is no one is asking someone to go from a body mass index of 30 down to a body mass index of 20. It takes weight changes of 5% to see an appreciable difference in outcomes. So just bringing your weight down some, increasing your physical activity, are good things to do prior to conceiving.

CAVANAUGH: Now when you say bring your weight down some, do you have an idea of how much…



DR. LACOURSIERE: You know, a reasonable, attainable weight loss is somewhere around 5%. Some women can get up to 8 to 10%. Men are lucky. They can get to those targets a little bit better. But a 5% overall body mass decrease could improve the outcome of the pregnancy.

CAVANAUGH: Let’s take another call. Meredith is calling us from Kensington. Good morning, Meredith. Welcome to These Days. Okay. Carly – I’m sorry. Meredith is no longer with us on the line and Carly is on the line now from San Diego. Good morning, Carly.

CARLY (Caller, San Diego): Good morning. Thank you for taking my call. I wanted to share my story. I have had two pregnancies. I have a 4-year-old and an 8-month-old. And I actually started both pregnancies at about the same weight. I was about 40 BMI. I’m pretty short, and I was about 220 pounds when I started both my pregnancies. My first pregnancy, I ended up gaining a total of about 40 pounds and had a very difficult pregnancy. I ended up going into short term disability because I had high blood pressure and was getting panic attacks, very difficult long labor, ended up needing vacuum assistance in order to deliver my first daughter. My second pregnancy, I started the same weight and was about 220 pounds when I got pregnant with my second daughter but instead of gaining weight, I actually ended up losing about ten pounds my first trimester just because I was very ill. But then I just maintained that weight the rest of my pregnancy and it wasn’t a conversation that I had with my doctor, it was just kind of something that I had done research with and a lot of the new research that I saw said that if you are severely overweight that staying the same weight throughout your pregnancy can actually lend itself to a healthier pregnancy and delivery. And my second pregnancy was a hundred times easier, both the pregnancy itself, the delivery and the recovery afterwards.

CAVANAUGH: Carly, thanks so much for sharing that story with us. I really appreciate it. And when a woman finds herself pregnant at 220 pounds, is Carly’s story just about the best you can hope for? I mean, she had a reduction in ten pounds and she didn’t gain any weight during her pregnancy.

DR. MISSANELLI: And that proves what I think I said earlier, it’s possible to lose weight during your pregnancy. The mother loses weight, the mother makes her body mass index better but the baby gains an appropriate amount of weight and that we could tell that that’s happening throughout the pregnancy by ultrasound determinations of estimated fetal weight and so forth. And it’s easier, once they become thinner and so it’s possible. What – Her story is something I think a lot of listeners should take to heart.

CAVANAUGH: Now, Kenny, in your report you spoke to these doctors and you looked into this subject in depth. Are doctors having much luck in actually urging their patients to do, as Dr. Missanelli says, lose weight while they’re pregnant and at least not gain a lot?

GOLDBERG: That’s a very interesting question. I think another way to look at it is are primary care doctors doing enough to address the issue. And what I understand is that it’s a very uncomfortable subject to bring up with their patients and it’s almost a turn off if a doctor brings up weight with a patient. I mean, it’s irritating, it’s embarrassing, and I think that’s really the issue, do primary care doctors do enough to talk about it.

CAVANAUGH: Primary care doctors even before a woman is pregnant.


CAVANAUGH: A woman who wants to become pregnant…


CAVANAUGH: …to bring up the issue, you know, if you do want to have a healthy pregnancy, you might consider losing some weight. That’s not done a lot.

GOLDBERG: I don’t know. You’d have to ask our experts here.

DR. LACOURSIERE: Well, I know even in the obstetric community, when you talk to obstetricians about this, they will tell you that it’s a very hard subject. Why should I bring it up? My patients won’t come back. And I said, well, there are many things we talk about in obstetrics that are very hard for doctors to say and this is a very important thing that doctors should be bringing up. I don’t think it’s done routinely. In a survey of patients that we evaluated of over 1000 women, only 70% of them said that their physician even discussed weight throughout their pregnancy, and 25% of them said it was addressed at the post-partum visit. So it’s not – It’s a difficult subject. I don’t think it’s getting addressed.

CAVANAUGH: Well, it’s certainly addressed in your offices, I tell you.

DR. MISSANELLI: It’s addressed. And I, as I say, have been practicing for 30 years, so I went from being uncomfortable about bringing up these topics to being dogmatic about it.


DR. MISSANELLI: I have to tell them that this is what they need to do. And once they see my gray hair and maybe the way my demeanor is then they tend to listen. And so I’m accomplishing what needs to be accomplished for the good of the patient and the baby. If – And I think they realize that and they accept that. But I find that I have to be very tough to get them to do what’s necessary. It’s hard in this society.

CAVANAUGH: Yes, Dr. Lacoursiere.

DR. LACOURSIERE: Well, I think one of the things is we don’t consider, we don’t think about enough, is pregnancy’s a teachable moment. If you look at when a woman is most receptive to information, it’s when she’s caring about another individual, when she starts preparing for her baby. And so the message about limiting weight gain during pregnancy and healthy weight is probably most effective when it’s administered during pregnancy. And so, you know, for my practice, I tend to try to set the weight gain goals early and give people doable tasks. Limiting their caloric intake is kind of a global thing. It’s hard for them to put their hands around it but if you can talk to them about portion sizes and starches that are the size of a tennis ball, or pieces of meat that are the size of a deck of cards and smaller, so using that moment to give them small daily things that they can attend to in hopes of decreasing their overall weight and their overall health.

DR. MISSANELLI: In this young society there’s some commonality to what they eat. So I have a little routine that I go through when I see them. I say, as of this moment, you’re not allowed to eat fast food at all. You’re not allowed to go to fast food, have someone bring you fast food, or have to go to fast food during your lunch break at work. You’re not allowed to have potato chips, soda, ice cream or candy. And because that’s what the American young diet consists of. So we have to address those things first. Secondly, I don’t let the man off the hook either. You know, the man has to do what his significant other is doing. He can’t do those things, and I make sure that they bring them to their office visit so I can talk to him, too. And then one other thing I want to bring up about information. The information that that last caller got was not from her doctor, it was from the internet. And so that’s good and bad because most internet information is not accurate. And so I would really recommend to everyone that wants to know about these things that they go to where the science and the medicine is and that’s the American College of OB-GYN. So There are other organizations but the links that they can get to go to those other organizations come from where the research is done. We know about these things, so don’t listen to your Aunt Tillie.

CAVANAUGH: Perfect way to end. Thank you so much. I want to thank my guests, Dr. John Missanelli, Dr. Yvette Lacoursiere, and KPBS health reporter, Kenny Goldberg. Thank you so much.

GOLDBERG: Thank you.

CAVANAUGH: And thanks to everyone who called in. If you’d like to comment online, you can go to You’ve been listening to These Days on KPBS.