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Learn More. The increasing rate of maternal obesity provides a major challenge to obstetric practice. Maternal obesity can result in negative outcomes for both women and fetuses.
The maternal risks during pregnancy include gestational diabetes and preeclampsia. The fetus is at risk for stillbirth and congenital anomalies. Obesity in pregnancy can also affect health later in life for both mother and.
For women, these risks include heart disease and hypertension. Children have a risk of future obesity and heart disease. Women and their offspring are at increased risk for diabetes. Obstetrician-gynecologists are well positioned to prevent and treat this epidemic.
The worldwide prevalence of obesity has increased substantially over the past few decades. Economic, technologic, and lifestyle changes have created an abundance of cheap, high-calorie food coupled with decreased required physical activity. We are eating more and moving less. There is evidence for metabolic dysregulation among obese individuals that has been linked with a of possible environmental factors, including contaminants from modern industry. Obesity is a ificant public health concern and is likely to remain so for the foreseeable future.
Maternal obesity increases the risk of a of pregnancy complications, including preeclampsia, gestational diabetes mellitus GDMand cesarean delivery Table 1. According to the in utero fetal programming hypothesis Barker hypothesissize at birth is related to the risk of developing disease later in life. A link between maternal obesity in the first trimester and obesity in children has been demonstrated. Whitaker 5 found that the relative risk of childhood obesity associated with maternal obesity in the first trimester Fat single ladies in Berkey pregnancy was 2.
Birth weight has also been shown to be directly correlated with body mass index BMI later in life. One mechanism thought to underlie these relationships is in utero fetal programming by nutritional stimuli. Fetuses have to adapt to the supply of nutrients crossing the placenta whether a deficit or an overabundance, and these adaptations may permanently change their physiology and metabolism. Moreover, because of fetal programming, obesity may become a self-perpetuating problem.
Daughters of obese women may themselves be vulnerable to becoming obese and more likely to have offspring who share this vulnerability. It is important to note, however, that BMI can be misleading. Fat single ladies in Berkey example, weight lifters and professional athletes tend to have high BMI because they have a high muscle mass, not excess fat. Despite this limitation, BMI continues to be used today because it is easily calculated and is the best tool available from a broad-based health policy perspective. Fat lipid is an essential tissue and performs multiple and diverse functions, including providing nutritional, hormonal, and even structural support.
The main fat depots in the body are in adipose tissue. Adipocytes are cells specifically adapted for fat storage, serve as a future energy source, and help to avoid the negative metabolic consequences of excess cellular lipid deposits in organs such as muscle, liver, and heart.
However, adipose tissue is not a passive organ. It actively regulates metabolism through multiple distinct but overlapping pathways. Adipose tissue also contains a large of nonfat cells, including fibroblasts and immune cells such as mast cells, macrophages, and leukocytes. Adipose tissue functions as an endocrine organ in a of ways. It stores and releases preformed steroid hormones, converts precursors to biologically active hormones, and converts active hormones to inactive metabolites. To this end, adipocytes express a of enzymes critical to steroid hormone biosynthesis and metabolism Table 2.
For example, estrone is converted to estradiol in peripheral adipose tissue. Indeed, most if not all circulating estradiol in postmenopausal women comes directly from adipose tissue. Thus, adipose tissue regulates the local concentration of glucocorticoids and contributes to their metabolic clearance.
Finally, adipose tissue secretes a large of bioactive peptides and cytokines, collectively known as adipokines Table 2. Fat in our diet and on our bodies is beneficial as long as it exists in moderation. Too much fat becomes maladaptive, and normal physiology pushed beyond adaptive function becomes pathology, a concept referred to as allostatic overload. In the setting of obesity, pathology develops because of an increase in adipose tissue beyond the tolerable functional range.
In this way, the metabolic consequences of obesity are analogous to the endocrine dysfunction seen in hyperplasia of any endocrine organ. Another source of obesity data is the Pregnancy Risk Assessment Monitoring System PRAMSan ongoing population-based surveillance system that examines trends in prepregnancy obesity by maternal demographic and behavioral characteristics.
Unfortunately, all of these data sources have their limitations. Similarly, national birth certificate data collected by the NVSS includes maternal weight but Fat single ladies in Berkey height, and so BMI cannot be calculated.
According to Brawarsky and colleagues, 12 African American women are more likely to be overweight prior to pregnancy and were most likely to gain weight in excess of the IOM guidelines, white females were most likely to report target weight gain, Hispanic women were least likely to report target gains, and Asian women were more likely to gain less than the recommend weight. The postpartum period may be a critical time for long-term weight gain and the development of maternal obesity. Excess weight gain during pregnancy and persistent weight retention 1 year postpartum are strong predictors of overweight a decade or more later.
For multiparous women, weight retention from pregnancies and the quality of health care received between pregnancies appear to be important determinants of subsequent prepregnancy weight. Maternal obesity increases the risk of a of pregnancy complications Table 1 and, as such, requires adjustment to routine prenatal care summarized in Table 4. Maternal obesity is a risk factor for spontaneous abortion for both spontaneous conceptions and conceptions achieved through assisted reproductive technologyas well as for unexplained stillbirth intrauterine fetal demise.
A recent meta-analysis of 9 studies revealed that obese pregnant women have an estimated risk of stillbirth that is twice that of normal weight pregnant women. Maternal obesity is associated with an increased risk of hypertensive disorders of pregnancy, including preeclampsia gestational proteinuric hypertensionwith an odds ratio OR of between 2 and 3.
Obese women are at increased risk of complications at the time of labor and delivery. The rate of successful vaginal delivery decreases progressively as maternal BMI increases.
A meta-analysis of 33 studies showed that the ORs of cesarean delivery were 1. Maternal obesity also influences the success rate of attempted vaginal birth after cesarean VBAC. Carroll and colleagues 21 found that women weighing less than lb had a VBAC success rate of A similar relationship was observed in a subsequent study using BMI rather than absolute maternal weight, with VBAC success rates ranging from In addition to an increased rate of operative delivery, obese women are also at increased risk of intraoperative complications, including increased infectious morbidity and thromboembolic events Table 1.
There is also an increased risk of anesthetic complications, such as failed intubation at the time of general endotracheal anesthesia. The reason obese pregnant women are more likely to end up with a cesarean delivery is not known, but a theory is that obese women are more likely to experience dysfunctional labor. For example, Vahratian and colleagues 24 found that the rate of cervical dilation in nulliparous women in spontaneous labor decreased as maternal BMI increased.
In this study, normal weight women BMI This appears to be true also in women undergoing induction of labor at term. Nuthalapaty and colleagues 25 demonstrated that, although multiparous women progressed faster Fat single ladies in Berkey induced labor than nulliparous women, in both groups an increase in maternal weight quartile was associated with a decreased rate of cervical dilation and an increase in the duration of labor.
Denison and colleagues 26 showed that a higher maternal BMI in the first trimester and a greater increase in BMI throughout pregnancy were associated with a reduced likelihood of spontaneous labor at term, an increased risk of post-term pregnancy, and an increased rate of intrapartum complications.
Maternal obesity is associated with abnormal fetal growth. The major concern in obese pregnant women is fetal macrosomia defined as an estimated fetal weight of greater than or equal to gwhich appears to be increased 2- to 3-fold in obese parturients. In a recent meta-analysis, the prevalence rates of fetal macrosomia were Fat single ladies in Berkey macrosomia in obese women is associated not only with an increase in the absolute size of the fetus, but also in a change in body composition.
Of note, the majority of this effect appears to be a result of weight gain during pregnancy. Indeed, prepregnancy BMI appears to for only 6. Maternal obesity is associated also with an increased risk of neural tube defect NTD in the offspring, even after controlling for ethnicity, maternal age, education, and socioeconomic status.
The mechanism underlying the increased risk of NTD in pregnancies complicated by maternal obesity is unknown. However, a of theories have been proposed, including a reduction in the amount of folic acid reaching the developing embryo due to insufficient absorption and greater maternal metabolic demands, chronic hypoxia, and increased circulating levels of triglycerides, uric acid, estrogen, and insulin due, in part, to increased insulin resistance. Maternal obesity is associated with an increased risk of diabetes, both pregestational diabetes and GDM.
Hedderson and colleagues 37 found that GDM was more likely in women who were older than 35 years of age and who were of Hispanic or Asian ethnicity. In this cohort, GDM was also more common in women with 12 years or less of schooling and with 2 or more live births.
The reason obese women are at higher risk of developing GDM has yet to be fully delineated, but is likely related to an increase in insulin resistance. As a result of the continued production of counterregulatory anti-insulin hormones by the growing placenta, insulin resistance increases progressively throughout pregnancy. At any single point in pregnancy, however, obese women have higher insulin resistance lower insulin sensitivity than women of normal weight, which in increased availability of lipids for fetal growth and development.
The development of GDM has a of adverse maternal and fetal implications. Pregnancies complicated by GDM have a 4-fold increased risk of perinatal mortality and a 3-fold increased risk of macrosomia. In addition to being larger, infants born of pregnancies complicated by GDM also have ificantly larger skin folds at all areas of measurement triceps, subscapular, flank, thigh, abdomen and, as such, are at increased risk of shoulder dystocia and resultant birth injury.
With the known adverse consequences of maternal obesity, it is important that physicians address this issue with their patients. Disconcertingly, Honda 43 found that, over a period of 1 year, only The incidence of maternal obesity and its attendant comorbid conditions diabetes, cardiovascular disease continues to increase at an alarming rate, with major public health implications.
Not only does maternal obesity affect the woman, but it also impacts the health of the child, leading to increased childhood obesity and diabetes.
Despite improvements in our understanding of this endocrinopathy, there are still many barriers to the clinical care for such women. Obstetrician-gynecologists are in a key position to prevent and treat this epidemic.
National Center for Biotechnology InformationU. Journal List Rev Obstet Gynecol v. Rev Obstet Gynecol. Author information Copyright and information Disclaimer. This article has been cited by other articles in PMC. Abstract The increasing rate of maternal obesity provides a major challenge to obstetric practice. Open in a separate window.
Figure 1. Biology of Adipose Tissue Fat lipid is an essential tissue and performs multiple and diverse functions, including providing nutritional, hormonal, and even structural support. Table 3 Recommendations for Weight Gain in Pregnancy. Effect of Obesity on Maternal Complications in Pregnancy Maternal obesity increases the risk of a of pregnancy complications Table 1 and, as such, requires adjustment to routine prenatal care summarized in Table 4.
This should include a baseline electrocardiogram and, if abnormal, an echocardiogram and cardiology consultation. Effect of Maternal Obesity on Perinatal Outcome Maternal obesity is associated with abnormal fetal growth. Maternal Obesity and Diabetes Maternal obesity is associated with an increased risk of diabetes, both pregestational diabetes and GDM.Fat single ladies in Berkey
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