Dr. Connie Graves

As medical director of both the perinatal program at Baptist Hospital and of Tennessee Maternal Fetal Medicine, Graves has seen countless deliveries, high-risk pregnancies and infants in need of immediate medical attention during her almost two decades of practice. After all, Baptist Hospital delivers more than 7,000 babies each year. Still, the triple board certified physician, who is a nationally recognized expert in maternal disease states, is bothered by a trend among pregnant women that has become all too commonplace … obesity.

“One of the most troubling things is our obesity rate, and it doesn’t exempt our young women,” she said. From 30-50 percent of women, depending on the specific population segment, are now clinically defined as obese. No one is immune, she noted.

“It crosses all racial and socioeconomic lines. These women then come to us with chronic diseases that manifest much earlier than you’d think.” Graves said it is no longer shocking to see a pregnant teen or woman in her early 20s present with type 2 diabetes, high blood pressure and underlying cardiovascular disease.

 “I used to say, ‘Oh my gosh, she’s 250 pounds!’ Now I say, ‘Oh thank goodness, she’s only 250,” Graves continued.

Obese expectant mothers present a host of issues for the perinatologist that impact both the mother and child. In addition to trying to manage chronic conditions, Graves said, “The obesity often hampers our prenatal diagnosis.”

She explained that it is difficult for equipment to penetrate through excess adipose tissue to get an optimal look at the fetus. “Often we have to take much greater caution than we normally would,” she continued, noting that physicians have to plan for any number of contingencies when prenatal testing is compromised. Not only does it increase cost to have equipment and staff on standby ‘just in case,’ but it might also require a woman be delivered by a specialist rather than her own OB/GYN.

On multiple occasions, Graves has seen women who weigh more than 400 pounds by the time they are ready to give birth. Special tables that are designed to hold up to 600 pounds have to be used in the delivery. Anesthesia is impacted by the mother’s weight, and surgery becomes much more difficult.

“I can do an emergency C-section on someone who is normal weight, and I can be in, in 30 seconds. With these patients, it might take 10 minutes; and for the baby, every second is counting,” she said.

OB/GYNs at hospitals across the state are making a concerted effort not to induce before 39 weeks to help combat the state’s alarmingly high infant mortality and low birth weight rates. However, that conventional wisdom must be quickly abandoned when hypertension, which is a commonly associated with obesity, comes into play.

Graves was recently forced to deliver a baby at 24-1/2 weeks because of the mother’s severe preeclampsia. While both mother and child survived, Graves noted the infant was still in the neonatal intensive care unit two months after birth.

Unfortunately, Graves said once a woman becomes pregnant, their obstetrician must go into management mode. “Often, I think we’ve approached this as the mother’s an entity and the baby is an entity. The are not separate entities,” Graves stressed. “How the mother begins the pregnancy is reflected in how the baby fares.”

She added, “If a woman conceives, and she has pre-existing diabetes — whether known or unknown — and a blood sugar of great than 180, she increases her risk of having a baby with a birth defect by 25 percent.”

Rather than managing weight and chronic conditions, Graves would like to see early intervention efforts to combat obesity. Just as information on the effects of tobacco and alcohol on an unborn child have impacted behaviors, she thinks it is possible to educate women about the dangers of carrying excess weight when pregnant.

“I think anyone who takes care of women of childbearing age should talk to them about healthy childbearing and chronic illness.” Graves continued, “There should be education at the schools for boys, as well as girls, on being healthy before having a baby.” She added these types of conversations should begin long before a woman conceives.

Graves said the bottom line to achieve the best outcomes for newborns and their moms is to recognize “the mother’s health does matter.”

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