Trying to conceive: Do you need to lose weight before conceiving?

I have been trying to conceive for the past year but my menses are very irregular, and I cannot take medications to regulate my cycle because of a recent pulmonary embolism. My doctor told me I must lose weight first and refused to refer me to a fertility specialist. Can I increase my chances of becoming pregnant? Do I really have to be thin before I can conceive? What are the risks of being overweight during pregnancy?

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Peg Plumbo CNM

Peg Plumbo has been a certified nurse-midwife (CNM) since 1976. She has assisted at over 1,000 births and currently teaches in the... Read more

It's not very helpful for any care provider just to tell a woman to lose weight. We wouldn't do this with any other medical condition. No one would say, "Just go home and return when your asthma is resolved." Yet, obesity is a condition with hazards and risks, as well as one that can respond to treatment and concern.

I would go to the nearest specialty clinic with expertise in treating obesity. Such clinics have access to counselors, physicians and nutritionists who can help.

You don't need to weigh 120 pounds to become pregnant, but it would be much better for your own health (especially in view of your pulmonary problems) and that of your baby, if you could take a year and shed some weight. However, this cannot be done without expert help.

Marked obesity is a hazard to both the pregnant woman and her baby. Researchers use various definitions of obesity, but if a woman is heavier than the 95th percentile for her height, she may have a tenfold increase in risk of chronic hypertension and a significantly increased risk of gestational diabetes. Heavy women tend to have heavy babies, who may be more at risk for birth trauma.

Post-term pregnancy (going past the due date) may also be most common in obese women. In this case, the baby is at risk for stillbirth and difficulties in labor, perhaps requiring a cesarean birth. Most complications occur with increasing severity at weights of 50 percent and more above ideal weight.

I believe that dieticians and nutritionists are much under-used in obstetrics. They can be very helpful in planning a healthful diet and avoiding complications.

I hope this helps answer your question and I also hope you manage to find more-sensitive, comprehensive medical care.

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