Lisa Anderson started putting on weight in high school.
She would lose a little with diet and drugs but gain it right back. She eventually decided she didn't care and stopped worrying about her weight.
But then she wanted to get pregnant.
Her extra weight meant she didn't ovulate anymore. Her doctor told her she needed to lose 100 pounds not only to to become pregnant naturally but also to make it a healthy nine months pregnancy.
"I was so devastated," the 33-year-old said recently. "The way my husband looked at it, that would be his legacy. For me, I always wanted the 2 Â½ kids, the picket fence. All of it."
Many women are preoccupied with their weight during pregnancy watching it steadily climb for nine months. But it's the weight gain before pregnancy they should worry about.
About 17 percent of new Utah mothers in 2010 were obese before they gave birth a 70 percent hike since 1993. Obesity is defined as having a body mass index (BMI) of 30 or above, or a 5-foot-6 woman weighing 186 pounds.
State public health officials have recently tracked an even sharper increase in the number of morbidly obese pregnant women, or a BMI of 40-plus or 245 pounds on a 5-foot-6 woman. In 2010, 2.8 percent of Utah women who gave birth were morbidly obese, a 55 percent leap since 2003, compared to an 18 percent jump in all obese mothers.
Because obesity can lower fertility, Utah doctors report seeing more obese women seeking help to lose weight in order to get pregnant, including through bariatric surgery, the option Anderson chose.
When obese women do get pregnant, the risks to the mother and developing babies for everything from needing cesarean sections to depression and death rise along with the women's weight.
Dangers: diabetes, depression • Janice Houston, director of the state Office of Vital Statistics, recently reviewed birth records for Utah mothers who weighed more than 300 pounds before pregnancy. Skeptical of Utah's increase, the National Center for Health Statistics kept asking the state to confirm the weights.
"I wanted to prove a point to NCHS this does happen and it's becoming more frequent," Houston said.
Houston found such mothers have much higher rates of cesarean sections, large babies and diabetes.
Jeanette Chin, an OB-GYN at the University of Utah hospital and a fellow in high-risk obstetrics, said she tests obese women for diabetes earlier than the typical second trimester because they may have undiagnosed Type 2 diabetes.
They are also more likely to develop diabetes during pregnancy, called gestational diabetes. That can lead to larger babies: The extra blood glucose causes the baby to produce more insulin, and both lead to excessive growth.
Last year, 210 women who weighed more than 300 pounds before pregnancy gave birth in Utah. Their weight averaged 328 pounds.
• About 13 percent had gestational diabetes, compared to just 4 percent of pregnant Utah women.
• And 15 percent, or 32, had babies weighing more than 8 pounds, 13 ounces.
On average, 6 percent of Utah mothers have what are called "large for gestational age" babies, who can make labor and delivery more difficult.
Houston's research also found that 19 percent of the mothers had a mental disorder, most commonly depression.
Past research has shown that obese Utah women have higher rates of postpartum depression, which can cause problems with mother-child bonding.
Struggles in labor • Obese women labor longer and often require more drugs to induce or augment labor. And it's not only because they are more likely to deliver bigger babies, Chin said.
With funding from the Deseret Foundation, Chin will study 160 women a third each are obese, overweight and normal weight to better understand why obese women have longer labors and more C-sections.
She will test their cholesterol during pregnancy, believing there is a connection between high levels and reduced contractions. Such testing isn't normally part of prenatal care because there's no "normal" level established for pregnancy and statins aren't thought to be safe.
Eventually, such studies could lead to medicine to target the problem.
"Ideally, you would want them to lose weight," Chin said. "I think we all know they're not all going to lose weight."
It's also harder to monitor a baby's heartbeat with external monitors during an obese mother's labor.
Many obese women "fail to progress" and need a C-section. Utah data show 36 percent of obese women have the surgery, compared to 18.5 percent of women of normal weight. For the women weighing over 300 pounds, half needed a C-section.
The complications Chin sees include wound infections and excessive blood loss.
Since the obese mothers often have other health problems that can lead to complications from surgery, Chin said, doctors are "doing C-sections on the exact women we don't want to do C-sections on."
'How severe the issues can be' • Miscarriage and stillbirths are higher among obese women.
In reviewing Utah infant deaths from 2004-2006, the Utah Department of Health found the rates of infant mortality were two times higher for obese women, compared with overweight or normal weight women. The death rate also increases with increased obesity.
Infants of diabetic mothers are also at higher risk of birth defects and of having respiratory problems 12 percent of the babies born to the morbidly obese women needed help breathing.
Chin cautions obese patients that ultrasounds aren't as accurate at detecting fetal anomalies for them because it's difficult for the ultrasound waves to penetrate fat tissue.
Children of obese mothers are also at risk of being overweight and developing the diseases associated with obesity, continuing the cycle.
"I don't think they realize how severe the issues can be," said Spencer Barney, an OB/GYN at St. Mark's Hospital. "They say, 'Yeah, I know I'm overweight and I shouldn't be.' "
While physicians have been hesitant to bring up patients' weight, Barney said they must. "We need to make sure we're having a conversation with patients ... during annual exams and wellness visits."
When that doesn't happen, obstetricians are left to manage the risks during pregnancy.
They now advise obese patients to gain little to no weight to reduce the potential for problems. Institute of Medicine guidelines suggest obese women gain 11 to 20 pounds, instead of the 35 recommended for women of normal weight.
Pregnancy tends to be a big motivator for women, noted Fred "Rocky" Seale, an OB/GYN at the Ogden Women's Clinic, who has seen obese women lose weight.
"This may be a period of time where the woman is really paying attention to her diet," he said, "and wanting to do the best for her baby."
'Second thoughts' • Anderson says she wishes she had known her weight would affect her fertility. After she learned she had polycystic ovary syndrome, she again tried diet and exercise. When that failed, she used the fertility-enhancing drug Clomid for four months. Then she decided to have the weight-loss surgery gastric bypass.
Anderson's bariatric surgeon, Rodrick McKinlay, who works at St. Mark's Hospital Center for the Surgical Treatment of Obesity, said about 5 percent of his patients are women seeking help with fertility.
"We can tell them after significant weight loss, whether through natural means or through surgery ... that they're likely to have better health as well as their babies," said McKinlay.
After her 2011 surgery, Anderson lost 113 pounds. Her asthma is better, she is no longer borderline diabetic and she now ovulates.
But further tests showed her husband has fertility problems. He, too, is overweight.
"Neither of us understood the weight could cause problems," she said, pointing to their family members who were also overweight but became pregnant.
If she had known, "I'm sure I would of had second thoughts about what I ate."
Inside • A new approach to obesity-related infertility
The University of Utah and Brigham Young University are teaming up on a study aimed at helping couples lose weight and boost their fertility by working on their marriage. > A4