Improving pregnancy outcome in obese women

Abstract

The global pandemic of maternal obesity presents a major challenge for healthcare providers, and has significant short- and long-term implications for both maternal and fetal health. Currently, the evidence-base underpinning many of the interventions either currently in use or recommended to improve pregnancy outcome in obese women is limited. The nature and timing of these interventions vary widely, ranging from simple advice to more intensive dietary and exercise programmes, cognitive behavioural therapy and drug trials. In addition, a growing number of very severely obese women now enter pregnancy having had surgical interventions. Although surgical interventions such as gastric bypass or banding may be associated with improved pregnancy outcomes, these women have particular nutritional requirements, which need to be addressed to optimise pregnancy outcome. Until the outcomes of ongoing current trials are reported and provide a firm evidence base on which to base future intervention strategies and guide evidence based care for obese pregnant women, pregnancy outcome is best optimised by high-risk antenatal care delivered by healthcare providers who are experienced in supporting these high-risk women.

“I'm Just a Woman Having a Baby”: Negotiating and Resisting the Problematization of Pregnancy Fatness

“…The more recent "maternal turn" in obesity science has placed pregnancy, and new mothers and their babies, at the epicenter of this "war" as both consequence and cause (Parker, 2014). A substantial body of literature has pointed to growing rates of fatness amongst reproductive age women, and its association with an increase in almost all pregnancy and birth complications from infertility, congenital abnormalities, miscarriage and stillbirth, growing rates of cesarean section, postpartum hemorrhage and infection, neonatal unit admission, and failure to initiate breastfeeding (see for example Heslehurst et al, 2008;Denison and Chiswick, 2010;Jarvie and Ramsay, 2010). In tandem, through the scientific developments of epigenetics, pregnancy fatness and diet is now also argued to result in an in-utero programming effect on the fetus predisposing the future child to fatness and a greater risk of chronic disease over their lifecourse (see for example Gluckman et al, 2007).…”

The consequences of obesity and excess weight gain in pregnancy

“…In non-pregnant individuals, diet and exercise are advocated to improve health. In pregnancy, there is limited evidence for the efficacy of diet and exercise ( 45 ) although several trials are underway to test these interventions (e.g. UPBEAT ISRCTN: 89971375).…”

Obesity matters: the skills that strengthen midwifery practice when caring for obese pregnant women

“…Miscarriage (Denison et al 2009;Denison & Chiswick 2011;Stirrat & Reynolds 2014;MBBRACE_UK 2014;MBBRACE_UK 2018) Fetal abnormality (Denison et al 2009;Denison & Chiswick 2011;Stirrat & Reynolds 2014;MBRRACE_UK 2014;MBRRACE_UK 2018) Macrosomic fetus leading to complications at delivery such as shoulder dystocia (Denison et al 2009;Denison & Chiswick 2011;MBRRACE_UK 2014;MBRRACE_UK 2018) Preterm birth (Denison et al 2009;Denison & Chiswick 2011;Stirrat & Reynolds 2014;MBRRACE_UK 2014;MBRRACE_UK 2018) Stillbirth ((Denison et al 2009;Denison & Chiswick 2011;Stirrat & Reynolds 2014;MBRRACE_UK 2014;MBBRACE_UK 2018)…”

“…Living with a raised BMI>30kg/m² whilst pregnant carries risks for both women, and their babies that can lead to poor pregnancy outcomes for both and risk the ongoing health of the off spring (Catalano et al, 2009;Denison et al, 2009;Denison & Chiswick 2011;Drake & Reynolds 2014;Keely 2015;Stirrat & Reynolds 2014;MBRRACE 2014;MBRRACE 2018).…”