Obesity in women: anaesthetic implications for peri‐operative and peripartum management

Abstract

Summary The prevalence, healthcare and socio‐economic impact of obesity (defined as having a body mass index of ≥ 30 kg.m‐2) are disproportionately higher in women than men. A combination of biological and social factors, including the adaptation of energy homeostasis to the increased demands of pregnancy and lactation and poor access to healthy foods or exercise facilities, contribute to the increasing prevalence of obesity in women. Obesity‐related physiological changes stem from mass loading and increased metabolism of adipose tissue, as well as secretion of bioactive substances from adipocytes leading to chronic low‐grade inflammation. As a result, obesity is associated with increased risks of: infertility; malignancy; sleep‐disordered breathing; cardiovascular disease; diabetes; and thromboembolism. Hence, obese women are at markedly increased risk of peri‐operative morbidity and mortality and require comprehensive evaluation and targeted comorbidity optimisation by a multidisciplinary team. In addition to routine obstetric challenges, pregnancy in women with obesity further exacerbates the above risks, making multidisciplinary management starting at pre‐conception even more important. Weight loss, lifestyle management and optimisation of comorbidity are the cornerstone of reducing obesity‐related risks. The anaesthetist plays a vital role within the multidisciplinary team by emphasising weight loss as part of pre‐operative comorbidity optimisation, formulation of individualised peri‐operative management plans, supervising postoperative care in the high dependency or intensive care settings and providing safe labour analgesia and careful peripartum management for obese parturients.

Investigation of serum neprilysin levels in overweight and normal weight young women

“…14 This has prompted researchers to study obesity from a wide perspective and especially in women. 1,2,[14][15][16] In the present study, we compared overweight/ obese and normal weight young women in terms of biochemical, lipid and glycemic parameters.…”

“…Obesity in women increases the risk of developing comorbidities including endocrine, cardiovascular and musculoskeletal diseases, malignities, infertility and depression. 2 In addition, overweight and obesity are known to be closely linked with insulin resistance, resulting in increased risk of metabolic syndrome. 3 It has been reported that young women (18-36 years) gain weight at a higher rate than women in any other age group, although little is known about the determinant of weight gain in young women.…”

Year 2021 in review - Anaesthesiology in obstetrics

“…Další publikované články se zaměřují na stále častější problematiku obezity, drogové závislosti či diabetu v těhotenství a s tím spojených perioperačních komplikací. Jedním z těchto článků je i souhrnná práce týkající se obezity u rodiček z anesteziologického pohledu [52].…”

Anesthetic management of patients with class 3 obesity undergoing elective Cesarean delivery: a single-centre historical cohort study

“…5 Complications from anesthesia, as well as overall morbidity and mortality, are higher in patients with obesity than in the general population. 2,6,7 Most studies regarding obstetric anesthesia for patients with obesity use the World Health Organization definition of obesity, which is a body mass index (BMI) of 30.0 kgÁm -2 or more. Nevertheless, this universal definition of obesity does not recognize the subtleties related to management of this group of patients.…”

“… 5 Complications from anesthesia, as well as overall morbidity and mortality, are higher in patients with obesity than in the general population. 2 , 6 , 7 …”