Optimizing Fertility through Weight Management: ACOG’s Guidelines and Beyond – ARC Summit

The American College of Obstetricians and Gynecologists (ACOG) strongly recommends managing obesity before pregnancy. They advise women with a BMI over 30 to lose weight prior to conception, highlighting that a reduction of at least 4.5 kilograms can significantly decrease the risk of gestational diabetes by 40%. ACOG also stresses the importance of proper vitamin supplementation, including folic acid and vitamin D, to support overall health and pregnancy readiness.

Accurate assessment of a patient’s BMI is crucial, and I find that during telehealth sessions and in-office visits, patients often report incorrect weights and heights. This underscores the need for precise measurements to tailor appropriate health advice and interventions. Nutrition plays a pivotal role, and while many of us believe we are adept at dietary guidance, enlisting a registered dietitian or nutritionist is invaluable for providing specialized nutritional counseling.

ACOG recommends a minimum of 150 minutes of high-intensity exercise per week to aid in weight management. When it comes to pharmacological interventions, new weight loss medications such as GLP-1 receptor agonists (e.g., semaglutide, brand names like Wegovy or Ozempic) show promise. These treatments can lead to an approximate 15-18% reduction in excess body weight, with a relatively mild side effect profile and minimal impact on the cardiovascular system, unlike stimulant-based medications such as phentermine.

It is crucial to note that these weight loss medications are contraindicated during pregnancy. Therefore, they should be accompanied by contraceptive measures to prevent pregnancy while in use. Effective weight management often involves a comprehensive approach that includes medication, dietary counseling, and regular physical activity.

For patients where pharmacotherapy is insufficient or inappropriate, bariatric surgery presents a more definitive solution, particularly for those with severe obesity. This surgical option not only aids in significant weight loss but also helps in ameliorating or resolving obesity-related comorbidities, such as type 2 diabetes and hypertension, thereby improving overall fertility and reducing risks during pregnancy.

In summary, managing obesity effectively requires a multi-faceted approach, especially when addressing fertility and reproductive outcomes. Engaging with healthcare professionals, including dietitians, endocrinologists, and bariatric surgeons, ensures a comprehensive and tailored treatment strategy that enhances the chances of a healthy pregnancy and long-term health benefits.