Maternal Obesity and Pregnancy

Abstract

Obesity is a global health problem that is increasing in prevalence. The World Health Organization characterizes obesity as a pandemic issue, with a higher prevalence in females than males. Thus, many pregnant patients are seen with high body mass index (BMI). Obesity during pregnancy is considered a high-risk state because it is associated with many complications. Compared with normal-weight patients, obese patients have a higher prevalence of infertility. Once they conceive, they have higher rate of early miscarriage and congenital anomalies, including neural tube defects. Besides the coexistence of preexisting diabetes mellitus and chronic hypertension, obese women are more likely to have pregnancy-induced hypertension, gestational diabetes, thromboembolism, macrosomia, and spontaneous intrauterine demises in the latter half of pregnancy. Obese women also require instrument or Cesarean section delivery more often than average-weight women. Following Cesarean section delivery, obese women have a higher incidence of wound infection and disruption. Irrespective of the delivery mode, children born to obese mothers have a higher incidence of macrosomia and associated shoulder dystocia, which can be highly unpredictable. In addition to being large at birth, children born to obese mothers are also more susceptible to obesity in adolescence and adulthood. Prevention is the best way to prevent this problem. As pregnancy is the worst time to lose weight, women with a high BMI should be encouraged to lose weight prior to conceiving. During preconception counseling, they should be educated about the complications associated with high a BMI. Obese women should also be screened for hypertension and diabetes mellitus. In early pregnancy, besides being watchful about the higher association of miscarriage, obese women should be screened with ultrasound for congenital anomalies around 18 to 22 weeks. The ultrasound should be repeated close to term to check on the estimated fetal weight to rule out macrosomia. Obese pregnant women are screened for gestational diabetes around 24 to 28 weeks. During the second half of pregnancy, one needs to closely watch for signs and symptoms of pregnancy-induced hypertension. Once in labor, an early anesthesia consultation is highly recommended irrespective of delivery mode. When Cesarean section is performed, many obstetricians prefer an incision above the pannus to avoid skin infection. However, the incision should be decided upon the discretion of the surgeon. Peripartum, special attention is given to avoid thromboembolism by using compression stockings and early ambulation.

Pregnancy-induced hypertension caused by all-trans retinoic acid treatment in acute promyelocytic leukemia

“…Pregnancy-induced hypertension is a maternal hypertension syndrome diagnosed during the later part of pregnancy, usually after the 20th week of gestation (10). Due to the prompt aggravation of the function of the kidneys and heart, it was suggested that the pregnancy-induced hypertension in the present study may have resulted from ATRA management.…”

Female Obesity and its Consequences: A Review

“…Those that conceive have increased rates of sporadic miscarriages 10,11 and congenital anomalies including neural tube defects. 12 In pregnancies that progress weight loss is discouraged 13 In pregnancy the complications include pre-eclampsia/eclampsia, 3 iatrogenic preterm delivery and post-dates. 12,14 The babies have the risks of polyhydramniosis, macrosomia and intra-uterine deaths.…”

“…12,14 The babies have the risks of polyhydramniosis, macrosomia and intra-uterine deaths. 3 The rates of induction of labour are high due to post-dates and macrosomic foetuses. During labour there are difficulties in sigthing intravenous canulae and epidural anaesthesia.…”

“…3,14 Educating women on the negative impact of obesity on maternal and neonatal health 15 should be done pre-conceptually. Multidisciplinary team 16 approach involving dieticians would be helpful.…”

“…2 The World Health Organisation characterises obesity as a pandemic issue with more females being affected than males. 3 It causes significant maternal and fetal morbidity and mortality. Obesity is associated with co-morbidities like hypertension, cardiovascular diseases and type 2diabetes mellitus.…”