pregnancy obesity project. obesity: increases obstetric risk during pregnancy
TRANSCRIPT
PREGNANCY OBesity Project
Obesity: Increases obstetric risk
during pregnancy.
Obesity and Obstetric Risk
Prevalence in reproductive age females (according to CDC):
Obesity 30.2%
Overweight 56.7%
Obesity and Obstetric Risk in Early Pregnancy
• First Trimester pregnancy loss
• Increased risk first trimester loss (OR 1.2)
• Increased risk recurrent pregnancy loss (OR 3.5)
• Increased risk loss after IVF or ICSI (OR 1.77)
Obesity and Risk of Congenital Abnormality
• Increased risk for fetal malformations
• Neural tube defects (OR 1.8)
• Congenital heart disease (OR 1.18)
• Omphalocele (OR 3.3)
Obesity and Risk of Congenital Abnormality
• Mechanism responsible for malformations not well understood
• Possible unrecognized type 2 DM
• Obesity limits the ability of ultrasound to detect malformations
Obesity and Obstetric Complications in Late Pregnancy
• Association with preterm delivery (PTD) risk
• Spontaneous PTD is related to low BMI, poor maternal weight gain
• PTD in obese population probably related to indicated deliveries due to medical or obstetrical complications
Obesity and Obstetric Complications in Late Pregnancy
• Increased risk for gestational HTN, preeclampsia, GDM
• GDM due to decreased insulin sensitivity compared to nonobese
• Obesity/ metabolic syndrome also associated with probable increase in other preexisting medical problems such as nonalcoholic fatty liver and sleep apnea, which were previously seen only in older populations
BMI > 30
Odds Ratio
BMI >35
Odds Ratio
Gestational hypertension
2.5 3.2
Preeclampsia 1.6 3.5
Gestational diabetes 2.6 4.0
Obesity and Obstetric Complications in Late Pregnancy
Obesity and Obstetric Complications in Late Pregnancy
• IUFD risk
• Risk is 2x in overweight and 2.5x in obese
• Pathophysiology is unknown
Obesity and Obstetric Complications in Late Pregnancy
• Increased risk of macrosomia
• Increased risk C/S and complications
• Wound infection
• Blood loss
• Thromboembolism
• Endometritis
• VBAC less successful
Delivery Issues
• Obese women are at higher risk of other complications at delivery and post-partum
• Obstetric hemorrhage (1.6X)
• Shoulder dystocia
• Thromboembolism
• Difficulty Breast Feeding
Risk of Children Born to Obese Mothers
• Long term risks to children born to obese mothers
• Both maternal obesity and fetal macrosomia approximately double the risk of adolescent obesity and metabolic syndrome (obesity, hypertension, glucose intolerance, dyslipidemia)
• Increased risk of Autism
Pregnancy Increased Insulin
resistance(Obesity/GDM)
Childhood ObesityChildhood Obesity? Pre-metabolic ? Pre-metabolic
syndromesyndrome
Fetal-Neonatal Fetal-Neonatal Metabolic programming of Metabolic programming of
ObesityObesity
Adult Metabolic syndromeAdult Metabolic syndromeT2DM and ObesityT2DM and Obesity
In utero Programming of Obesity and Metabolic Dysfunction
MetabolicAging
Catalano; JCEM, 2003
