causes of obesity in pregnancy

Exercise has been found to be helpful in improving glycaemic control in women with GDM and may play a role in its prevention.68 In 2006, the Royal College of Obstetricians and Gynaecologists (RCOG) produced a statement on exercise in pregnancy which stated that, in most cases, aerobic exercise is safe for both mother and fetus during pregnancy, and women should therefore be encouraged to initiate or continue exercise to derive the health benefits associated with such activities.49 Recently, a Cochrane Review assessed aerobic exercise during pregnancy.69 Regular aerobic exercise during pregnancy appeared to improve maternal fitness. All authors contributed to the conception and design of this paper, the acquisition and interpretation of the data presented and drafting and revising it critically for important intellectual content and for final approval. Such patients pose particular management problems relating both to increased risks of specific complications, and to medical, surgical and technical challenges in providing safe maternity care. The increased prevalence of obesity in women of child-bearing age is of particular concern as obesity in pregnancy carries additional risks for the mother and baby.5. Despite our failure to contain the high prevalence of obesity, we now have a better understanding of its pathophysiology, and how excess adiposity leads to type 2 diabetes, hypertension, and cardiovascular disease. Combined, about one third of all women of reproductive age are overweight (BMI = 25 to <30 kg/m2, prevalence between 30 and 38%) or obese (1). An online calculator is available at https://mfmu.bsc.gwu.edu/PublicBSC/MFMU/VGBirthCalc/vagbirth.html. Koivusalo SB, Rono K, Klemetti MM, et al. The number of women undergoing bariatric surgery for the treatment of morbid obesity has increased over recent years. FOIA Athukorala C, Rumbold AR, Willson KJ, Crowther CA. Female reproductive issues following bariatric surgery, Regular exercise therapy in disorders of carbohydrate metabolism in pregnancy results of a prospective, randomized longitudinal study, Aerobic Exercise for Women During Pregnancy (Review). National consensus standards of care are now being developed and will soon be available to guide clinical management. Similarly, maternal obesity is associated with an elevated postnatal mortality risk (first year of life) which increases with increasing BMI (Table 3) (19). This highlights the important role of the placenta as a nutritive sensor, actively influencing the metabolic regulation of maternofetal interactions (e24, e25). AOR of severe types of cardiovascular defects for obese 1.23 (1.051.44), morbidly obese 1.69 (1.272.26), OR of neural tube defect-affected pregnancy for overweight 1.22 (0.991.49), obese 1.70 (1.342.15) and severely obese 3.11 (1.755.46), OR of spina bifida for obese 3.5 (1.210.3), omphalocele 3.3 (1.010.3), heart defects 2.0 (1.23.4), AOR of GDM for overweight 1.78 (1.252.52), obese 2.95 (2.054.25), morbidly obese 7.44 (4.4212.54), AOR of GDM for overweight 1.68 (99% CI 1.531.84), obese 3.6 (3.253.98), OR of pregnancy induced hypertension for BMI 35 3.6 (2.74.8), AOR of hypertensive disorders of pregnancy for overweight 1.74 (1.452.15), obese 3.00 (2.403.74)], morbidly obese 4.87 (3.277.24), AOR of pre-eclampsia for BMI 3540 3.90 (3.54, 4.30), morbidly obese 4.82 (4.045.74), Risk of preeclampsia typically doubled with each 57 kg/m, OR of pregnancy-induced hypertension for women with waist circumference 80 cm 1.8 (1.12.9), BMI 25 2.0 (1.23.4), OR of preeclampsia for women with waist circumference 80 cm 2.7 (1.16.8), BMI 25 1.9 (0.74.8), AOR of preeclampsia for overweight 1.44 (99% CI 1.281.62), obese 2.14 (1.852.47), AOR for antenatal VTE: BMI 25 with no immobilization 1.8 (1.32.4), BMI 25 with immobilization 62.3 (11.5337.6), AOR for postpartum VTE: BMI 25 with no antenatal immobilization 2.4 (1.73.3), BMI 25 with immobilization 40.1 (8.0201.5), AOR of VTE during pregnancy for overweight 1.6 (0.64.4), obese 9.7 (3.130.8), Of women with a known BMI, 31.3% who died of causes directly related to their pregnancy had a BMI 30. Newborn body fat: associations with maternal metabolic state and placental size. Kinnunen TI, Pasanen M, Aittasalo M, et al. 11, where the prevalence of pregnancy-induced hypertension/preeclampsia in normal-weight and obese women (see above) was 2.4% and 9.1%, respectively (adjusted OR 3.00, 95% CI 2.403.74). A few observational studies have reported the prevalence rates of obesity in local maternity populations and, at present, these are the best indicators of maternal obesity prevalence in the UK. Bariatric surgery includes purely restrictive procedures (adjustable gastric banding) and malabsorptive procedures that may also restrict the stomach volume (Roux-en-Y bypass and biliopancreatic diversion). Waist circumference has therefore been used as a better measure of visceral adiposity and its associated risk.7 BMI is also unable to distinguish between muscle and fat mass, and two individuals with the same BMI could have very different body compositions. Likewise, in initially normal-weight women a weight gain =2 kg/m2 was associated with an increased risk of IUFD and postnatal mortality (20). Werler MM, Louik C, Shapiro S, Mitchell AA. "Obesity itself is an inflammatory condition. During pregnancy, eat and drink the following in moderation (or cut out completely): fast food. Potential reasons for the lack of evidence in support of the effectiveness of these interventions include the frequently vaguely defined level of dietary and exercise interventions in obesity, poor analyzability of the intervention due to lack of patient adherence, and very late start of intervention. 8600 Rockville Pike Association between maternal body mass index in early pregnancy and Incidence of cerebral palsy. Author disclosure: No relevant financial affiliations. Gaillard R, Steegers EA, Duijts L, et al. The NICE Antenatal Care Guideline recommends that repeated weight measurements during pregnancy should occur only in circumstances where clinical management is likely to be influenced.53 Maternal obesity is an example of one such circumstance as maternal weight throughout pregnancy determines the need for specific additional interventions and specialist equipment. Callaway LK, Prins JB, Chang AM, McIntyre HD. Bethesda, MD 20894, Web Policies Chu SY, Kim SY, Schmid CH, et al. Early administration of epidural anesthesia can be advantageous as, in case an emergency cesarean section is indicated at a later stage of labor, it avoids the risks associated with general anesthesia (e34). Tieu J, Shepherd E, Middleton P, Crowther CA. A recent meta-analysis of six cohort studies and three case-control studies found a doubling in the risk of stillbirth among obese women (unadjusted OR 2.07, 95% CI 1.592.74) compared with women with a healthy BMI.28 There was one retrospective UK-based cohort study included in this meta-analysis, which analysed 287,213 pregnancies from 1989 to 1997.10 Women with a BMI 30 had a stillbirth rate of 6.9/1000 total births compared with 4/1000 total births in women with a BMI of 2025 (adjusted OR 1.40, 99% CI 1.141.71, OR adjusted for ethnicity, parity, maternal age, history of hypertension, gestational diabetes, preeclampsia, emergency caesarean section and smoking). Mothers after gestational diabetes in Australia (MAGDA): a randomised controlled trial of a postnatal diabetes prevention program. The probability of conception declines linearly, starting from a BMI of 29 kg/m2, by 4% for each additional 1 kg/m2 of BMI (hazard ratio 0.96, 95% confidence interval: [0.91; 0.99]). Genes also may contribute to a person's susceptibility to weight gain. On the one hand, macrosomia appears to be the consequence of increased maternal blood glucose levels, resulting from obesity-related insulin resistance which can already be detected below the diagnostic threshold for gestational diabetes (26, 27, e22). OReilly SL, Dunbar JA, Versace V, et al. There are also a number of studies that have shown an association between pregnancy weight gain and specific outcomes. Nutritional deficiencies during pregnancy following laparoscopic adjustable gastric banding or gastric bypass procedures appear uncommon when adequate supplementation is maintained.60,61 Severe nutritional deficiencies requiring parenteral nutrition have been reported in approximately 20% of pregnancies following biliopancreatic diversion.60 Although most studies have attributed deficiencies to non-adherence with supplementation, parenteral nutrition has also been reported for women taking supplements and for those in whom adherence was unclear.6264 These findings emphasize the importance of careful nutritional monitoring during pregnancy. Dr. Kahan says that obesity during pregnancy is particularly concerning because it can transfer many health risks to the baby. What's considered obese? Careers, Unable to load your collection due to an error. The decrease in fetal chromosomal fraction associated with obesity results in reduced detection rates for chromosomal aberrations, regardless of gestational age, in non-invasive prenatal testing (NIPT) too (e7). Translated from the original German by Ralf Thoene, MD. Dietary advice interventions in pregnancy for preventing gestational diabetes mellitus. High pregnancy weight gain was strongly associated with the birth of an LGA infant, with this being more pronounced in the lower BMI categories. Lindam A, Johansson S, Stephansson O, Wikstrom AK, Cnattingius S. High maternal body mass index in early pregnancy and risks of stillbirth and Infant mortalitya population-based sibling study in Sweden. Maternal obesity increases the risk of fetal macrosomia, as demonstrated by the results of a meta-analysis including 21 studies: 13.4% with obesity (n = 31 756) versus 7.8% with normal weight (n = 57 392, pooled OR: 2.11 [1.97; 2.27]) (25). Copyright 2023 American Academy of Family Physicians. Because of the increased difficulty of administering regional and general anesthesia in pregnant patients who are obese, physicians should consider anesthesia consultation before admission for labor if the patient has obstructive sleep apnea or poorly controlled diabetes mellitus or hypertension, or if a difficult airway is anticipated. A 10% increase of pregravid BMI increases the relative risk of gestational diabetes and that of preeclampsia by approximately 10% each. Likewise, recurrent miscarriage was more common in obese women (0.4% versus 0.1%, OR: 3.51 [1.03; 12.01]). Carmichael SL, Blumenfeld YJ, Mayo J, et al. Chiswick C, Reynolds RM, Denison F, et al. Dresner M, Brocklesby J, Bamber J. The majority of observational studies since 1996 have shown a direct correlation between maternal BMI and risk of preeclampsia.13 A Swedish cohort study of 805,275 pregnancies to women delivering between 1992 and 2001 found that 2.8% of women with a BMI of 29.135.0 had preeclampsia compared to 1.4% of women with a BMI of 19.826.0 (adjusted OR 2.62, 95% CI 2.492.76).14 This difference was more marked in the Australian study reported by Callaway et al. In the triennium 20032005, 28% of all women who died in the UK were classified as obese.25 These deaths in obese women are associated with many causes of direct and indirect death, including preeclampsia and pulmonary embolism. Livergood MC, LeChien KA, Trudell AS. ACOG Practice Bulletin No 156. Other projects include a retrospective observational study investigating the prevalence of maternal obesity and associated demographic factors in a sample of NHS Trusts in England,8 and a cost analysis of the additional care and complications associated with obesity in pregnancy. Maternal prepregnancy overweight and obesity and the pattern of labour progression in term nulliparous women, Maternal obesity and risk of caesarean delivery: a meta-analysis, Audit of the influence of body mass index on the performance of epidural analgesia in labour and the subsequent mode of delivery, The challenges of obesity and obstetric anaesthesia, Confidential Enquiry into Maternal and Child Health.
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