Maternal obesity

Obesity is the most common health problem in women of reproductive age.

Obesity affects almost 40% of reproductive aged females with a body mass index of 30 or greater in the US, with a rising prevalence over the past two decades.

Obesity in pregnancy poses health risks during pregnancy and after delivery, and has long-term health implications that require recognition and treatment.

Maternal obesity adversely affects fetal, neonatal, and infant outcomes along with lifelong consequences for offspring.

There has been a 33% relative increase in the prevalence of obesity among women 20 to 39 years of age in recent decades.

In 2020 among women with a live birth, only two in five entered pregnancy with a normal range BMI, where as 26. 7% were overweight and 29.5% were obese.

Obesity prior to pregnancy is disproportionately prevalent among American Indian and Alaskan natives (40%), Blacks (39%), Hispanics (32%) as compared with whites at 26% or Asians at 10%.

The proportion of women with normal range pre-pregnancy BMI decreases with age.

Associated with neural tube defects and anencephaly.

The chronic positive energy balance associated with obesity increases triglyceride and adipocyte hypertrophy, followed by hyperplasia from adipogenesis.

The adipose tissue secretes diverse cytokines, proteins, and influences metabolic and physiological function of other organs.

Obesity is associated with chronic low grade inflammation which is important in the development of insulin resistance.

Before and during pregnancy, women with obesity have greater insulin resistant than  women of normal weight, and this increased insulin resistance in pregnant women with obesity affects all glucose, lipid, and protein metabolism.

Altered resistance to insulin in pregnancy may be related to human placenta lactogen, placental growth hormone, and micro RNA of placental origin, decreased adiponectin, and increases in pro inflammatory cytokines, especially tumor necrosis factor alpha.

Obesity is associated with small absolute risk of maternal death.

Women with obesity, have a higher odds of postpartum hemorrhage and normal weight women.

With obesity alterations in the hypothalamus pituitary ovarian axis may lead to menstrual dysfunction with the prevalence of oligoovulation or anovulation that is up to three times as high as the prevalence among women of normal weight.

There is a lower likelihood of conception with obesity and sub fertility or even fertility may occur.

Obesity can affect endometrial implantation, and increase miscarriage rate, and poor outcomes of assisted reproductive technology treatments.

Obese women are more likely than normal white women to miscarry, regardless of where the conception is spontaneous or assisted.

Obesity is associated with higher doses of gonadotropins, increased cycle cancellation rate, and fewer and lower quality oocytes retrieved.

These are reported lower rates of embryo transfer, pregnancy, and live birth and higher miscarriage rates.

Women with obesity or 3 to 4 times as likely to have gestational diabetes than normal weight women.

The prevalence of gestational diabetes is higher among women who are Hispanic, Black, Native American, Asian or Pacific Islander than among white women.

Women with gestational diabetes have an increased risk of gestational hypertension, preeclampsia, cesarean delivery, and diabetes is estimated to develop in up to 70% of such women 22 to 28 years after pregnancy.

Gestational hypertension and preeclampsia more prevalent among women with obesity than among women of normal weight.

The estimated risk of preeclampsia doubling for every increase of 5 to 7 in the BMI.

Preeclampsia develops in only about 10% of women with obesity.

There is a small positive association between obesity and maternal depressive symptoms and anxietyboth before and after childbirth.

Underlying association of depression may be due to hypothalamic pituitary adrenal axis and immunologic dysregulation, dissatifaction with body image, stigmatization, and binge eating.

Maternal obesity is associated with increased risk of congenital heart defects, and neural tube defects with evidence of a dose response relationship with BMI.

Obesity has health implications for offspring related to changes in developmental programming in utero.: increased rates of childhood obesity, and related comorbidities later in life.

Meta-analysis show positive dose response associations between maternal BMI and both macrosomia and large for gestational age.

The risk of stillbirth is 1.3 to 2.1 times is high among obese women as among normal weight women.

The association of a higher stillbirth rate may be related to coexisting conditions of obesity in pregnancy such as hypertension, and a limited ability for women of high BMI to notice and seek care for decreases in fetal movements.

There is significant, but small, increases in the overall role risk of severe maternal morbidity during hospitalization for delivery among women with obesity as compared with women of normal weight.

Women with a BMI of 50 or higher have the highest risk.

Parturient women who are obese and undergo cesarean delivery of the surgery, or a significantly higher risk for surgical site infections than normal white women.

The risk of thromboembolism is four times as high  among parturient it women with a BMI of 40 or more as among those with normal weight.

along with routine ultrasound assessments, it is recommended that weekly antenatal surveillance for fetal well-being start by 34 weeks of gestation for women with a pre-pregnancy BMI of 40 or  higher and by 37 weeks for women with a pre-pregnancy BMI of 35 to 39.

The association between maternal obesity and preterm birth remains controversial.

There are higher rates of labor induction, oxytocin augmentation, failure of labor to progress, and instrumental delivery among obese women as compared with normal weight women.

Shoulder dystocia is also more prevalent among women with obesity than normal weight women by a factor of 2 to 2.5 among women with a BMI of 35 or higher.

Women with obesity, or less likely than normal weight women to initiate breast-feeding.

There is a documented higher risk of post-term birth with increasing BMI.

While obesity alone is not an indication for cesarean delivery the risk of cesarean delivery for women with obesity is double the risk for normal weight women.

The increased rate of cesarean section among women with obesity may be related to decreased cervical dilatation rate, in the presence of coexisting conditions, and concern about shoulder dystocia.

Women with obesity have increased risk for complications associated with cesarean delivery such as anesthesia related complications, wound complications, excessive blood loss, venous thrombosis, postpartum endometritis, and failure of vaginal birth after cesarean delivery.



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