Overweight, obesity and excessive weight gain in pregnancy as risk factors for adverse pregnancy outcomes: A narrative review

Abstract

The global prevalence of overweight and obesity in pregnancy is rising and this represents a significant challenge for the management of pregnancy and delivery. Women who have a pre‐pregnancy body mass index greater than 25 kg m–2 are more likely than those with a body mass index in the ideal range (20–24.99 kg m–2) to have problems conceiving a child and are at greater risk of miscarriage and stillbirth. All pregnancy complications are more likely with overweight, obesity and excessive gestational weight gain, including those that pose a significant threat to the lives of mothers and babies. Labour complications arise more often when pregnancies are complicated by overweight and obesity. Pregnancy is a stage of life when women have greater openness to messages about their lifestyle and health. It is also a time when they come into greater contact with health professionals. Currently management of pregnancy weight gain and the impact of overweight tends to be poor, although a number of research studies have demonstrated that appropriate interventions based around dietary change can be effective in controlling weight gain and reducing the risk of pregnancy complications. The development of individualised and flexible plans for avoiding adverse outcomes of obesity in pregnancy will require investment in training of health professionals and better integration into normal antenatal care.

Early life programming of health and disease: The long‐term consequences of obesity in pregnancy

“…125,126 The most effective approaches to managing weight gain in pregnancy appear to rely on more personalised interventions that are supported by eHealth packages and health professionals who have received appropriate training. 8,127,128 Midwives, in particular, can find it difficult to engage with women about excess weight gain 129,130 but may find it useful to have an understanding of the transgenerational consequences of antenatal obesity as they frame their conversations with women.…”

“…The risks associated with obesity in pregnancy manifest during the pregnancy itself, although this review focuses on the later impacts on the health of individuals who experienced maternal obesity during foetal development. Maternal weight status is an important determinant of pregnancy outcomes for both mothers and babies, and also of obstetric complications 8 . Overweight, obesity and excessive gestational weight gain are all risk factors for poor outcomes.…”

“…A simple explanation of how GDM and possibly maternal obesity provide the insult that programmes long‐term consequences for the exposed offspring is that an excess of energy substrates reaches the foetal compartment. The conventional wisdom is that this is the cause of macrosomia in GDM pregnancies because the foetus is hyperinsulinaemic and the insulin resistance of the mother drives glucose and lipids across the placenta 8 . However, this is an over‐simplification because, similar to obesity, GDM has a broad impact on the placenta that will bring other factors into play.…”

“…Pregnancy is perceived as a teachable moment when women are more open to public health messages and willing to make lifestyle changes, 8,124 although numerous large‐scale trials show limited efficacy of, and high resistance to pregnancy‐focused interventions 125,126 . The most effective approaches to managing weight gain in pregnancy appear to rely on more personalised interventions that are supported by eHealth packages and health professionals who have received appropriate training 8,127,128 . Midwives, in particular, can find it difficult to engage with women about excess weight gain 129,130 but may find it useful to have an understanding of the transgenerational consequences of antenatal obesity as they frame their conversations with women.…”

“…Limiting gestational weight gain and promoting a return to prepregnancy weight in the postpartum period will have many benefits. Pregnancy is perceived as a teachable moment when women are more open to public health messages and willing to make lifestyle changes, 8,124 although numerous large‐scale trials show limited efficacy of, and high resistance to pregnancy‐focused interventions 125,126 . The most effective approaches to managing weight gain in pregnancy appear to rely on more personalised interventions that are supported by eHealth packages and health professionals who have received appropriate training 8,127,128 .…”