Perspectives in obesity and pregnancy

Abstract

Obesity is currently recognized as a health epidemic worldwide. Its prevalence has doubled in the last three decades. Obesity is a complex clinical picture associated with physical, physiologic, hormonal, genetic, cultural, socioeconomic and environmental factors. The rate of obesity is also increasing in the pregnant women population. Maternal obesity is associated with less than optimal obstetrical, fetal and neonatal outcomes. It is also associated with significant adverse long-term effects on both obese parturients and the infants born from obese women. A number of guidelines have been published to educate health care workers and the general population in an attempt to develop effective interventions on a large scale to prevent obesity. These guidelines are multiple, confusing and inconsistent. There are no standard recommendations regarding gestational weight gaining goals, nutrients and additional elements necessary for certain obese women who have been treated with bariatric surgical procedures, screening for metabolic diseases such as diabetes, additional preventive health care services indicated for obese women in the pregnancy planning stages, during prenatal care, in the immediate post-partum period and as a long-term approach for health preservation. In 2013, the American Medical Association supported by several US national medical specialty organizations published Resolution 420 (A-13) recognizing obesity as a disease state with multiple pathophysiological aspects requiring a range of interventions to improve its prevention and treatment. The goal of this decision was to encourage a broader spectrum of health care benefits insurance coverage for the prevention and treatment of obesity. There are a number of myths and misconceptions associated with obesity. These perspectives present our views and clinical experience with a partial review of recent bibliography addressing the associations between obese reproductive age women and their risks during pregnancy.

Effect of Maternal Obesity and Preconceptional Weight Loss on Male and Female Offspring Metabolism and Olfactory Performance in Mice

“…Obesity is also associated with reproductive issues such as infertility, obstetrical complications, birth defects and stillbirth [21]. When limited weight gain during pregnancy was advised to obese mothers to improve these outcomes, there were only small effects on foetal growth and metabolic outcomes [22,23].…”

Obesity in Pregnancy – Implications on Pregnancy Events

“…Obesity during pregnancy is a disease that affects both the mother and the fetus. Many authors report a wide range of effects on the fetus, the newborn, and the child [10], [11], [12]. Short-term effects affect the prenatal and neonatal periods.…”

“…Short-term effects affect the prenatal and neonatal periods. Obesity increases the risk of fetal malformations, spontaneous, extremely preterm delivery, and stillbirth [10]. Comorbidities such as preeclampsia, gestational hypertension also affect fetal development and growth.…”

Validation of a comorbidity index for use in obstetric patients: A nationwide cohort study

“…The Obstetric Comorbidity Index has, until now, only been validated within highly selected cohorts derived from Medicaid, a health insurance program for low‐income individuals in the USA (https://www.medicaid.gov/basic-health-program/index.html) and from one small geographic area of Canada . Validation of the index in an unselected population as well as in other health registers is, however, of high importance to determine external validity, should the Obstetric Comorbidity Index be used to inform the care of pregnant women . The Danish health registers, with complete data on all obstetric patients, due to free access to health services, are unique sources for such an assessment in a complete and unselected study population.…”

“…3,4 Validation of the index in an unselected population as well as in other health registers is, however, of high importance to determine external validity, should the Obstetric Comorbidity Index be used to inform the care of pregnant women. [5][6][7] The Danish health registers, with complete data on all obstetric patients, due to free access to health services, are unique sources for such an assessment in a complete and unselected study population.…”