Obstetric management of obesity in pregnancy

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Summary

Rates of obesity among the pregnant population have increased substantially and adiposity has a damaging effect on every aspect of female reproductive life. This review summarises epidemiological data concerning obesity-related complications of pregnancy. Obesity is linked to a number of adverse obstetric outcomes as well as increased maternal and neonatal morbidity and mortality. These complications include miscarriage, congenital abnormalities, pre-eclampsia, gestational diabetes mellitus, iatrogenic preterm delivery, postdates pregnancy with increased rates of induction of labour, caesarean section, postpartum haemorrhage, shoulder dystocia, infection, venous thromboembolism, and increased hospital stay. It is important to consider obese pregnant women as a high risk group with a linear increase in risk of complications associated with their degree of obesity. Their obstetric management should be consultant-led and involve a multidisciplinary team approach to improve outcome.

Introduction

The effect of adiposity is manifest in nearly every aspect of female reproductive life whether as a metabolic or reproductive complication or as a technical problem affecting clinical issues such as ultrasound scanning or surgery (Table 1). The 2002–2004 Confidential Enquiries into Maternal and Child Health (CEMACH) first highlighted obesity as a significant risk for maternal death, with 35% of the women who died being obese; 50% more than in the general population.1 The 2003–2005 report recommended preconception counselling for women with a body mass index (BMI; kg/m2) >30.2 In addition, offspring of obese mothers have a higher perinatal morbidity and long-term health problems. Maternal obesity is an increasing big problem in clinical obstetric practice, with epidemiological data indicating that the prevalence of obesity has doubled over the last ten years.3

Section snippets

Miscarriage

Amenorrhoea and infertility among obese women is more common than in their lean counterparts. Obesity is associated with miscarriage in both women with polycystic ovarian syndrome (PCOS) and in those with normal ovarian morphology. It is believed that up to 50% of obese women have PCOS compared with 30% of lean.4

A recent meta-analysis of 13 studies examined patient predictors for outcome of gonadotrophin ovulation induction in women with normogonadotrophic anovulatory infertility. This work

Maternal obstetric complications

It is recognised that obesity is a risk factor for many maternal obstetric complications including pre-eclampsia and gestational diabetes mellitus (GDM). The mechanisms involved are complex but one possible unifying hypothesis may be encompassed by the ‘metabolic’ syndrome as discussed in previous chapters.

Conclusion

It is clear that there is an increased requirement for careful surveillance of obese pregnant women at each stage of pregnancy. However, randomised controlled trials of interventions for obese pregnancy are not available and are therefore urgently required.

Practice points

  • •

    Prepregnancy. As previously mentioned the CEMACH report has highlighted obesity as a serious medical condition which should involve preconceptual counselling. The report especially recommends this for women prior to embarking

Conflict of interest statement

None declared.

Funding sources

None.

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