causes of obesity in pregnancy

Lifestyle intervention to limit gestational weight gain: the Norwegian Fit for Delivery randomised controlled trial. This project was initiated in response to a number of factors, including: (1) growing evidence that obesity is clearly associated with increased morbidity and mortality for both mother and baby; (2) national and regional prevalence rates are currently unknown; and (3) there is no national clinical guideline available in the UK with regard to clinical care and provision of services for women with obesity in pregnancy. Metabolically, obese women have increased insulin resistance in early pregnancy, which becomes manifest clinically in late gestation as glucose intolerance and fetal overgrowth. The .gov means its official. Genes can directly cause obesity in such disorders as Prader-Willi syndrome. It should be noted that maternal obesity is not an independent risk factor for shoulder dystocia.33 Thus, it is macrosomia rather than maternal obesity that is the main risk factor for shoulder dystocia. A weight loss of 4.5 kg between two pregnancies has been shown to reduce the risk of developing gestational diabetes by up to 40%.57 A 10% weight loss over six months is suggested to be an ideal amount, which is safe and possible to sustain in the long term. Sagedal LR, Vistad I, Overby NC, et al. Obesity in pregnancy is associated with unfavorable clinical outcomes for both mother and child. In the majority of cases, IUFD was caused by a combination of abnormal placental function and arterial hypertension (e8). Babies of obese mothers are at increased risk of stillbirth, congenital anomalies, prematurity, macrosomia and neonatal death. The RCOG 53rd Study Group on Obesity and Reproductive Health reported that while there is a good body of observational evidence showing a positive association between maternal BMI and risk of pregnancy-related complications, there is now a clear need for prospective randomized studies in obese pregnant women to assess the effects of diet, physical activity and lifestyle changes on maternal, fetal and neonatal outcomes.84 The group also highlighted a need for further clarification on optimal weight gain in pregnancy for different subsets of the population, with the recognition that weight gain is partly dependent upon maternal BMI at the start of pregnancy. Overall, however, it is clear that higher pre-pregnancy BMI is associated with an increased risk of a number of pregnancy complications and adverse pregnancy outcomes. "Obesity itself is an inflammatory condition. pastries. Federal government websites often end in .gov or .mil. Apart from an increased risk of asphyxiawhich is also reflected in the increased infant cerebral palsy ratescausative factors included congenital anomalies and sudden infant death syndrome (19, e13, e14). Does obesity increase the risk of miscarriage in spontaneous conception: a systematic review. Experience following biliopancreatic diversion, Dumping syndrome: pathophysiology and treatment. The https:// ensures that you are connecting to the Does high weight in pregnant women increase the risk of - inviTRA Friis CM, Qvigstad E, Paasche Roland MC, et al. Weight loss from an initial BMI of = 25 kg/m2 reduced the risk of neonatal mortality during the first 28 days after birth (20). Mothers after gestational diabetes in Australia (MAGDA): a randomised controlled trial of a postnatal diabetes prevention program. In some people, obesity can be traced to a medical cause, such as Prader-Willi syndrome, Cushing syndrome and other conditions. But several strategies may increase your chances of pregnancy. At best, a weight reduction of 10 to 15% within one year can be expected from lifestyle interventions. 3. Outcomes of pregnancy after bariatric surgery. Bethesda, MD 20894, Web Policies Pregnancy. How Obesity Affects Health and Pregnancy: An Expert Explains - Flo Metformin treatment of obese pregnant women was evaluated in 2 randomized controlled trials where it reduced weight gain during pregnancy but did not lower the risk of gestational diabetes and neonatal macrosomia (31, 32). BMI greater than or equal to 30.0. Obesity in Pregnancy: Risks and Management | AAFP It can lead to serious complications.. PreeclampsiaPreeclampsia is a serious form of gestational hypertension that usually happens in the second half of pregnancy or soon after childbirth. Oxford, UK: Wiley-Blackwell. According to a survey conducted in 2013, 9.6% (n = 7116; 95% confidence interval (CI): [7.2; 12.7]) of all women between 18 and 29 years were obese (1). * All recommendations are from the Institute of Medicine, with the exception of underweight women . The risk of pregnancy complications in women with an even higher BMI is likely to be even greater, but to date there have been few published data on women with extreme obesity. High pregnancy weight gain was strongly associated with the birth of an LGA infant, with this being more pronounced in the lower BMI categories. Careers, Unable to load your collection due to an error. According to the 2013-2014 NHANES data, 37% of women between the ages of 20-39 have obesity and rates continue to rise. Heslehurst N, Lang R, Rankin J, Wilkinson JR, Summerbell CD. A recent doctoral thesis by Noora Houttu from the University of Turku reveals that overweight and, specifically, obesity during pregnancy cause BMI, body mass index; ICU, intensive care unit; CI, confidence interval; n, cases per subgroup; N, size of the subgroup; OR, odds ratio. Metformin versus placebo in obese pregnant women without diabetes mellitus. Acute Abdominal Pain in Adults: Evaluation and Diagnosis Jansson T, Powell TL. National consensus standards of care are now being developed and will soon be available to guide clinical management. Obesity and pregnancy | The BMJ Recommendations based on the project's findings will be made available to health-care providers, commissioners and policy makers, with the aim of improving care and service provision for women with obesity in pregnancy. An internet-based prospective study of body size and time-to-pregnancy. Following delivery, obese women have an increased risk of postpartum haemorrhage. A registry study from the US analyzing 239 127 IVF cycles showed that pregnancy rates and implantation rates declined by 1% with every increase in BMI by 5 kg/m2 (6). Although further research is required, there now appears to be sufficient evidence for maternity services to implement strategies to reduce the risks related to pregnancies in women with obesity. Obesity and pregnancy: mechanisms of short term and long term - The BMJ This is supported by the close correlation between maternal fasting glucose levels and fetal weight (23, 28, e17). INTRODUCTION. Guelinckx I, Devlieger R, Donceel P, et al. If you're pregnant with triplets or more, talk to your health care provider about your weight gain goals. Maternal prepregnancy obesity and cause-specific stillbirth. 22 also performed a separate meta-analysis of 12 studies, which included only women without co-morbidities. An estimated 11% of all neonatal deaths can be attributed to the consequences of maternal overweight and obesity. 37. Anderson JL, Waller DK, Canfield MA, Shaw GM, Watkins ML, Werler MM. In addition, the branch supports studies of lifestyle interventions before and during pregnancy that aim to improve . There are currently no national-level data in the UK on the prevalence of obesity in pregnancy. Overweight and obesity are defined as abnormal or excessive fat accumulation that presents a risk to health. The same applies to excessive weight gain during pregnancy. Kiel DW, Dodson EA, Artal R, Boehmer TK, Leet TL. BMI is calculated by dividing a person's weight in kilograms by the square of their height in metres (kg/m2). American College of Obstetricians and Gynecologists. In light of the increased risks for patients with BMIs greater than 30 kg per m2, physicians may consider additional testing beyond early glucose screening, such as measuring baseline 24-hour urine protein, creatinine, and transaminase levels, and performing questionnaire screening for obstructive sleep apnea. Gestational weight gain was also reduced by lifestyle interventions; however, no or no clinically relevant reduction of maternal or fetal morbidity was observed in these studies (33 39, e47 e51). A study on women with regular ovulations desiring to have children (after exclusion of tubal and androgenic abnormalities, n = 3029) found that within one year 17% of subjects had a spontaneous pregnancy not ending in miscarriage (5). The interaction of obesity with other risk factors is also highlighted by the large case-control study of Jacobsen et al. However, no specific ancillary preoperative tests are indicated. Yao R, Ananth CV, Park BY, Pereira L, Plante LA. In the North East of England, BMI recorded at the booking visit in 36,821 pregnancies showed a significant increase in the prevalence of obesity from 9.9% to 16% (P < 0.01) between 1990 and 2004.8 In Glasgow, a comparison of booking BMI between two randomly selected groups of women who booked for antenatal care in 1990 and in 20022004 also showed an increase in obesity prevalence from 9.4% to 18% (P = 0.003).9 Sebire et al. Ultimately, long-term reduction of maternal and fetal morbidity can only be achieved by dietary and lifestyle changes maintained beyond pregnancy. Association of Anaesthetists of Great Britain and Ireland. The prevalence of fetal malformations was significantly correlated with the severity of obesity (Table 2) and the risk increase was independent of gestational diabetes (16). Obesity-related maternal and fetal increases in morbidity during pregnancy are well supported by evidence from studies. Gaillard R, Steegers EA, Duijts L, et al. Inclusion in an NLM database does not imply endorsement of, or agreement with, Wang C, Wei Y, Zhang X, et al. Heslehurst N, Ells LJ, Simpson H, Batterham A, Wilkinson J, Summerbell CD. Maternal and fetal morbidity risks associated with pregnancy will be discussed in the following. Effect of metformin on maternal and fetal outcomes in obese pregnant women (EMPOWaR): a randomised, double-blind, placebo-controlled trial. Obesity in Pregnancy - Optimizing outcomes for mom and baby Neonates of obese mothers had a higher percentage of adipose tissue (e19, e20). ACOG Committee opinion no. Maternal obesity increases the risk of fetal macrosomia, as demonstrated by the results of a meta-analysis including 21 studies: 13.4% with obesity (n = 31 756) versus 7.8% with normal weight (n = 57 392, pooled OR: 2.11 [1.97; 2.27]) (25). Physicians should encourage a gradual increase in physical activity up to a goal of 30 minutes of moderate-intensity exercise daily.7, Bariatric surgery may be an option for patients who are planning to have children in the future. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Early administration of epidural anesthesia can be advantageous as, in case an emergency cesarean section is indicated at a later stage of labor, it avoids the risks associated with general anesthesia (e34). Obesity is a condition in which excess body fat has accumulated to such an extent that health may be adversely affected.1 The worldwide prevalence of obesity has increased markedly over the past few decades and the World Health Organization (WHO) has described this trend as a global epidemic posing a serious threat to public health.1 Obesity carries considerable human cost; it is associated both with an increased risk of mortality from all causes and with specific increased risks of coronary heart disease, stroke, type 2 diabetes, some types of cancer, respiratory problems and musculoskeletal disorders.2, In 1993, the prevalence of obesity in the general population in England was 13% in men and 16% in women.3 In 2006, 13 years later, this had increased to 24% in both men and women.4 This reflects similar trends seen in other developed countries. McKinnon CJ, Hatch EE, Rothman KJ, et al. By contrast, weight loss between 2 pregnancies has a positive effect on neonatal outcomes (e45). The https:// ensures that you are connecting to the A sibling study confirmed the significance of maternal obesity as a risk factor for IUFD and postnatal mortality, regardless of genetic predisposition or familial factors (e9). NICHD Obesity and Overweight Research Information Furthermore, a trend towards increased perinatal mortality was observed (1.7% [10/596] versus 0.7% [17/2356], adjusted OR: 2.39 [0.98; 5.85], p = 0.06) (e38). Controlling your blood pressure . Losing weight if you have overweight/obesity (prior to pregnancy-related weight gain). Obesity is the most common health problem in women of reproductive age. Such patients pose particular management problems relating both to increased risks of specific complications, and to medical, surgical and technical challenges in providing safe maternity care. On the one hand, macrosomia appears to be the consequence of increased maternal blood glucose levels, resulting from obesity-related insulin resistance which can already be detected below the diagnostic threshold for gestational diabetes (26, 27, e22). 1Department of Gynecology and Obstetrics, Rostock University Medical Center, Rostock, Germany, 2Department of Gynecology and Obstetrics, Ulm University Medical Center, Ulm, Germany. Moll U, Olsson H, Landin-Olsson M. Impact of pregestational weight and weight gain during pregnancy on long-term risk for diseases. From choosing baby's name to helping a teenager choose a college, you'll make . Here again, maternal gestational weight gain was an additional independent risk factor (e17, e18). Poston L, Bell R, Croker H, et al. Intrauterine exposure to obesity is also associated with an increased risk of developing obesity and metabolic disorders in childhood. Thus, with an annual infant mortality of about 2400 cases in Germany, 264 deaths could have been avoided. Monitor your weight gain during pregnancy. In the triennium 20032005, 28% of all women who died in the UK were classified as obese.25 These deaths in obese women are associated with many causes of direct and indirect death, including preeclampsia and pulmonary embolism. UKOSS was established in 2005 to describe the epidemiology of a variety of uncommon disorders in pregnancy. Gestational weight gain and preterm birth in obese women: a systematic review and meta-analysis. 75 examined the risk of four pregnancy outcomes (preeclampsia, caesarean section, LGA and SGA) by obesity class and total gestational weight gain. Could having a high BMI affect my ability to get pregnant? The time until pregnancy occurs is longer in obese women compared to women of normal weight (3, e1 e3). Research suggests that as birth weight increases, so does the risk of childhood obesity. However, after adjustment this association was no longer significant (adjusted OR: 1.2 [0.98; 1.37]). Dr. Kahan says that obesity during pregnancy is particularly concerning because it can transfer many health risks to the baby. The OR of a caesarean section was 1.46 (95% CI 1.341.60) and 2.05 (95% CI 1.862.27), respectively, among overweight and obese women compared with women with a normal weight. There were some data to suggest beneficial effects on fetal growth and the need for more high-quality trials in this area was highlighted. Maternal folate deficiency in pregnancy is associated with fetal congenital malformations,54 and supplementing the diet with folic acid 400 g daily if there is doubt about adequate dietary intake has been recommended for many years.45 Studies have linked maternal obesity with an increased risk of neural tube defects; although the mechanism for this association remains unknown, obese women have been found to have lower levels of serum folate than non-obese women of child-bearing age.55 Data from the National Health and Nutrition Examination Survey (NHANES) in the USA showed that women with a BMI 27 were less likely to use nutritional supplements and were less likely to receive folate through diet than women with a BMI <27. Usha Kiran TS, Hemmadi S, Bethel J, Evans J. It is clear that careful weight management during pregnancy can help minimize the risks of adverse outcomes associated with maternal obesity, although it is important to be aware of the potential risk of increasing the incidence of SGA babies. What Causes Obesity in Women and How to Manage It | Juniper Parenting is one of the most complex and challenging jobs you'll face in your lifetime -- but also the most rewarding. Garnaes KK, Morkved S, Salvesen O, Moholdt T. Exercise training and weight gain in obese pregnant women: a randomized controlled trial (ETIP trial). Causes of Obesity | Overweight & Obesity | CDC A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This Series in The Lancet Diabetes & Endocrinology examines the growing burden of maternal obesity worldwide in terms of its impact on clinical management and intergenerational health, and highlights the need for a focus on the pre-pregnancy period, along with a whole-of-society intervention approach, to reverse the cycle of ill health propagate. Muktabhant B, Lawrie TA, Lumbiganon P, Laopaiboon M. Diet or exercise, or both, for preventing excessive weight gain in pregnancy. 548: weight gain during pregnancy. fried food. The reduction of fertility associated with obesity cannot be fully attributed to abnormalities of the menstrual cycle. Obstetric and neonatal risks among obese women without chronic disease. Summary Obesity during pregnancy increases the risk of complications for both the pregnant person and the child. Obesity in pregnancy: a study of the impact of maternal obesity on NHS maternity services. Mutsaerts MA, van Oers AM, Groen H, et al. Pregnant women's obesity linked to changes in low-grade - Flipboard The high rates of obesity in women of child bearing age, has made obesity the most common medical problem in pregnancy. Obesity in pregnancy - ScienceDirect Perhaps most striking is the fact that 57% of women with a known BMI dying from VTE in pregnancy in the UK are obese.16 A retrospective case-control study in Denmark of 129 women with deep vein thrombosis or pulmonary embolism during pregnancy or the puerperium and 258 controls (pregnant women with no VTE) showed a significant association between VTE and obesity defined as BMI 30 (adjusted OR 5.3, 95% CI 2.113.5).17 The United Kingdom Obstetric Surveillance System (UKOSS), recently reported that a BMI 30 was associated with an adjusted OR of 2.65 (95% CI 1.096.45) for antenatal pulmonary thromboembolism (PTE).18 This association is not surprising given the associated problems of reduced mobility, co-morbid conditions that predispose to thrombosis, such as preeclampsia, and an increased frequency of operative delivery, especially when superimposed upon the doubling of risk of VTE seen in non-pregnant women with a BMI 30, possibly related to higher levels of coagulation factors VIII and IX.19 In non-pregnant women, the risk of VTE is exaggerated by concomitant use of oestrogen-containing hormonal contraception. These weight gain ranges were associated with the lowest risk of overall adverse maternal and perinatal outcome, and are lower than the IOM recommendations. The site is secure. ABSTRACT: Obstetrician-gynecologists are the leading experts in the health care of women, and obesity is the most common medical condition in women of reproductive age. Paladini D. Sonography in obese and overweight pregnant women: clinical, medicolegal and technical issues. 95% CI: [0.43; 0.48], p = 0.91, No change in body fat composition and obesity rate, Despite significant reduction in gestational weight gain, no impact on primary EP; no advantage regarding maternal and fetal morbidity (secondary EP); 6-month follow-up with significantly lower subscapular skin fold thickness in the intervention group (infant); persistent low sugar and saturated fat consumption (mother), Study population: Obesity in 26%; mean BMI of 26.8 kg/m, No significant difference; no trend; small study population; only 50% adherence according to protocol; analysis of secondary EP without reduction of GDM prevalence (WHO definition 2013), 8.0 kg (diet) vs. 8.5 kg (activity) vs. 6.5 kg (combination) vs. 8.8 kg (control), Intervention with nutritional counseling (7 ) and/or counselling on physical activity (5 ); study inclusion at 15 weeks gestation on average; combined intervention with reduction in weight gain; each intervention alone without significant effect; no reduction in metabolic parameters (HOMA-IR, glucose, GDM); no reduction in LGA rate, Effect demonstrated; 28% of subjects with overweight/obesity; no risk reduction for GDM; intervention without effect on BG levels, but with significant reduction in insulin and leptin levels; subgroup analysis: with obesity risk of abnormal oGTT increased, Inclusion at 13 weeks gestation on average; no differences for PIH, preeclampsia, cesarean section, birth weight, macrosomia >4500 g; 39% risk reduction for GDM with moderate lifestyle intervention in a high-risk group, Significantly more side effects: diarrhea 42% vs. 19% (p <0.0001), vomiting 32% vs. 22% (p = 0.03); no effect on primary and secondary eps, No effect on neonatal weight percentile, but significantly lower maternal weight gain during pregnancy. Maternal Obesity - The Lancet Apart from that, a meta-analysis comprising 18 studies reported the following obesity-associated increases in risk for specific malformations: BMI, body mass index; CI, confidence interval; n, cases per subgroup; N, size of the subgroup. A 5 kg/m2 increase of BMI elevates the relative risk of intrauterine death to 1.24 [1.18; 1.30]. The pathogenesis of fetal macrosomia is complex. Gorber SC, Tremblay M, Moher D, Gorber B. Preeclampsia: Symptoms, Causes, Treatments & Prevention - Cleveland Clinic Many pregnancy complications have been linked to obesity ranging from increased risk of gestational diabetes and hypertension to increased risk of cesarean delivery and postoperative wound infection. Sorbye LM, Klungsoyr K, Samdal O, Owe KM, Morken NH. Effectiveness of lifestyle intervention in subgroups of obese infertile women: a subgroup analysis of a RCT. Likewise, recurrent miscarriage was more common in obese women (0.4% versus 0.1%, OR: 3.51 [1.03; 12.01]). Carmichael SL, Shaw GM, Schaffer DM, Laurent C, Selvin S. Dieting behaviours and risk of neural tube defects, Pregnancy and fertility following bariatric surgery: a systematic review, Pregnancy after bariatric surgery: a comprehensive review, Adverse neonatal outcome after maternal biliopancreatic diversion operation: report of nine cases, Pregnancies in an 18-year follow-up after biliopancreatic diversion, Intravenous nutritional support in pregnancy. Wright C, Sibley CP. National Library of Medicine Limit sugar-sweetened drinks. Body mass index (BMI) offers a useful measure of obesity and is a simple index of weight-for-height used to classify underweight, overweight and obese adults. The association between exposure to high TGs in utero and greater offspring adiposity is consistent with prior data from women with GDM and obesity, 18,19,48-50 and data from 2 general risk pregnancy cohorts measuring TGs in early or midpregnancy. on behalf of UKOSS. Conditions underlying the increased cesarean section rate include preeclampsia, fetal distress, cephalopelvic disproportion, and failure to progress in labor (11, e32). The CEMACH project will assess current service provision for women with obesity in pregnancy, provide national and regional prevalence rates of severe obesity (BMI 35) in pregnancy in the UK, and identify any gaps that may exist in the provision of care for these women. The authors suggested that the overall minimal risk for mother and baby should be taken as the point where there was an equal risk of LGA and SGA babies, which corresponded with a weight gain of 1025 lb (4.59 kg) for Class I obese (BMI 3034.9) women, and a weight gain of 09 lb (04 kg) for Class II obese (BMI 3539.9) and Class III obese (BMI 40) women. 22: Maternal obesity and pregnancy outcome: A scoping study: North East Public Health Observatory (NEPHO), 2006. Breast-feed. The World Health Organization defines obesity as BMI 30 kg/m 2. Faucher MA, Hastings-Tolsma M, Song JJ, Willoughby DS, Bader SG. Other projects include a retrospective observational study investigating the prevalence of maternal obesity and associated demographic factors in a sample of NHS Trusts in England,8 and a cost analysis of the additional care and complications associated with obesity in pregnancy. Randomized trial of a lifestyle program in obese infertile women. Approximately one-third of all women of childbearing age are overweight or obese. Genes also may contribute to a person's susceptibility to weight gain. Classification of weight status according to BMI1, government site. Shaw GM, Wise PH, Mayo J, et al. In the age group from 30 to 39 years, the prevalence increases to 17.9% [14.0; 22.7] (1). The likelihood of conception decreased in a linear fashion by 4% per 1 kg/m2 weight gain, starting from a BMI of 29 kg/m2; this finding remained significant even after adjusting for potential confounders (age, duration of desiring a child, pregnancy, smoking, sperm motility) (hazard ratio [HR]: 0.96 [0.91; 0.99]) (5). This review is based on pertinent publications retrieved by a selective search of PubMed, with special attention to current population-based cohort studies, systematic reviews, meta-analyses, and controlled trials. However, women have even more challenges to contend with, as menopause-related hormone changes can lead to changes in body composition.
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