Obesity

Abstract

KEY POINTS lThe preconception visit may be the single most important health care visit when viewed in the context of its effect on pregnancy. Height in meters and weight in kilograms should be recorded for all women at each doctor visit to allow for calculation of BMI. The BMI category should be reviewed with the patient, making sure she understands that her category is not normal. l Obesity is a risk factor for cardiovascular disease; diabetes; hypertension; stroke; osteoarthritis; gall stones; increased incidence of endometrial, breast, or colon cancer; cardiomyopathy; fatty liver; obstructive sleep apnea; urinary tract infections; other complications; and, most importantly, mortality. Prepregnancy obesity and excessive gestational weight gain are associated with increased risk of childhood obesity. l Preconception weight loss with diet, exercise, behavior change, and, if necessary, pharmacotherapy is recommended. Weight loss of at least 5% to 10% will help reduce the incidence of obesity-related comorbidities. l Preconception (and at first prenatal visit), check BP with a large cuff, fasting lipid profile and blood sugar, thyroid function tests, and overnight polysomnogram. In obese patients with chronic hypertension or type 2 diabetes, it is advisable to obtain an EKG and an echocardiogram. l Women with BMI !40 or !35 with comorbidities are candidates for bariatric surgery in the preconception or interconception period. Incidences of gestational diabetes and hypertension are reduced after gastric bypass surgery, especially if BMI is back to less than obese levels. Pregnant patients with bariatric surgery can be started on vitamin B12, folate, iron, and calcium if deficient. l