Most women with obesity are fertile, although obesity increases the risk of infertility. This review describes the influence of obesity on reproductive health before and during pregnancy and postpartum. It also discusses the multidisciplinary management of obesity during a woman’s reproductive period based on the scientific literature on the subject published from January 2015 to March 2022. Obesity is a risk factor for endometrial hyperplasia and cancer. Women with obesity have a lower response to ovarian stimulation. In ovulation induction treatments, there is less likelihood of ovulation using clomiphene citrate, higher doses of gonadotropins are required and a smaller number of follicles develop. Women with polycystic ovary syndrome (PCOS) have a higher likelihood of obesity (prevalence ranging from 14 to 75 % depending on the population studied), longitudinal weight gain and abdominal obesity compared to women without PCOS. Obesity and PCOS are two conditions with complex pathophysiologies and it is not clear which one of them acts as a cause or as a consequence of the other. The pregnancies of women with obesity are at increased risk of different complications, including gestational diabetes, hypertensive disease of pregnancy (gestational hypertension or preeclampsia), foetal malformations, prematurity, both spontaneous and induced by other complications, Caesarean delivery, postpartum haemorrhage and thromboembolism. Primary care practice includes health promotion and prevention actions, and it is often the first point of contact between a woman and her partner and the healthcare service before they conceive. Primary care is therefore responsible for providing this new family with quality prenatal care with preventive activities prior to pregnancy. In relation to obesity, this situation provides the opportunity for effective communication with women and their families about weight goals at this stage of life, the importance of weight loss prior to pregnancy, maximum weight gain during pregnancy and postpartum weight loss to reduce the risk of adverse outcomes in current and future pregnancies.
Results show vitamin D supplementation during pregnancy improves maternal and infant 25(OH)D concentrations and may play a role in maternal insulin resistance and fetal growth. Literature search was performed using PubMed Database of the National Library of Medicine, with date limits from January 2015 to November 2020. We used the keywords: Vitamin D, pregnancy, vitamin D supplementation, hypovitaminosis D, preeclampsia, gestational diabetes, preterm birth, and other related terms. The studies of interest included original papers and review articles on the influence of vitamin D deficiency in pregnancy and the impact of vitamin D supplementation on the maternal outcomes. The published Cochrane review on vitamin D supplementation studies reported that women who receive vitamin D supplementation had lower risk of preeclampsia but with only borderline significance (RR 0.52, CI 0.25–1.05), whereas combined vitamin D and calcium supplementation significantly reduces the risk of preeclampsia. The overall level of evidence is high for vitamin D supplementation playing no role in the prevention of gestational diabetes. Although analysis of the recent observational studies suggests that vitamin D deficiency can increase the risk of C section, there is a need for investigators to conduct RCT to study the impact of vitamin D supplementation on C-section rates. Maternal vitamin D status closest to the delivery was most significantly associated with preterm birth, thereby proposing that later intervention could be used as a rescue treatment to decrease the risk of preterm deliveries. Though the level of evidence is moderate, our analysis shows no significant association between vitamin D and preterm deliveries. Many studies have been designed to investigate an association between postpartum depression and vitamin D. To determine the benefits of vitamin D supplementation in pregnancy would require further evaluation through large, multicenter double-blind randomized controlled clinical trials, with a focus on specific adverse pregnancy outcomes.
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