Obesity in Pregnancy:
Challenges VS Solution
Contents
Influence of Obesity to
Definition Pregnancy
Epidemiology 2 Management
1
Definition
Definition
Obesity
BMI ≥25 kg/m2
BMI in pregnancy
Calculated using the height and weight measured at the first antenatal consultation
Calculated by dividing the woman’s weight in kilograms by the square of her height in
metres (kg/m2)
BMI ~ measure of health?
BMI – good measure of obesity for general population; however, predictors of health
outcomes include BP measurement, waist circumference and blood sugar levels
Diagnostic Criteria of Obesity
2
Epidemiology
2013
3
Influence of Obesity to
Pregnancy
Inflammatory and Metabolic Changes
Chronic positive energy balance
Increased storage of TG and adipocyte
hypertrophy
Secretes diverse cytokines, proteins, and
signals - metabolic and physiologic function
Obesity ~ chronic low-grade inflammation -
insulin resistance
Inflammatory and Metabolic Changes
Placenta
plays a
Factors: HPL, central role in
placental growth
hormone, the process
Women with microRNA of
placental origin,
obesity have decreases in
greater adiponectin,
insulin increases in pro-
inflammatory
resistance cytokines
Antepartum Conditions
Subfertility and
miscarriage Gestational DM
○ Women with obesity may lead to ○ Women with obesity are 3 to 4 times as
menstrual dysfunction likely to have GDM.
○ Obesity can affect endometrial ○ Obesity → increased insulin resistance,
implantation decreased insulin response, insulin-
signaling alterations, and systemic
inflammation, with elevated levels of
inflammatory markers both before and
during pregnancy.
Antepartum Conditions (2)
Hypertensive Disorders
of Pregnancy Depression and Anxiety
○ Women with obesity have increased risk of ○ Positive associations between obesity
preeclampsia, doubling for every increase 5 and maternal depressive symptoms and
to 7 in BMI anxiety both before and after childbirth
○ Pathogenesis of preeclampsia is largely ○ Stigma associated with obesity is highly
unknown, but inflammation and increased prevalent, and women who repeatedly
insulin resistance are believed to play a role experience weight stigma report more
depressive symptoms, maladaptive
eating behaviors, and stress
Fetal Conditions
Congenital Anomalies Macrosomia and LGA Fetal Birth and Stillbirth
• Increased risk of • Positive, dose– • The risk of stillbirth is
structural anomalies response associations 1.3 to 2.1 times as high
esp congenital heart between maternal BMI among women with
defect and neural-tube and both macrosomia obesity as among
defects (birth weight, >4000 g) normal weight women
and LGA (birth weight
>90th percentile for
gestational age and
sex)
Labor, Delivery, and Postpartum Conditions
Severe
maternal • Severe maternal morbidity during hospitalization for delivery among women with obesity
morbidity
Preterm birth • Controversial
Labor and
delivery • Labor induction, oxytocin augmentation, failure of labor to progress, instrumental delivery, shoulder dystocia, post-term birth
complications
• The risk of cesarean in women with obesity is double the risk for normal-weight women, with a dose-response relationship
Cesarean • Higher rate of cesarean: a decreased cervical dilatation rate, shoulder dystocia, excess weight gain
delivery • Complication associated cesarean: anaesthesia-related complications, wound complications, excessive blood loss, venous
thromboembolism, postpartum endometritis, and failure of vaginal birth after caesarean delivery
Labor, Delivery, and Postpartum Conditions (2)
• Higher odds of postpartum haemorrhage than normal-weight women; the highest documented risk among women with a
Postpartum BMI exceeding 35
Hemorrhage • The increased risk may be due to the larger volume of distribution of uterotonic agents and greater difficulty identifying the
fundus and performing bimanual massage
Infection • Higher risk for surgical-site infections
Venous
• 4 times as high among parturient women with a BMI of 40 or more as among those of normal weight
Thromboembolism
• Medical, physiological, psychological, and sociocultural factors may contribute to the poorer breastfeeding outcomes for
Breast-feeding women with obesity
Factors • Key factors include an elevated progesterone level (which prevents the progesterone decline that leads to lactogenesis),
latching difficulties associated with large breasts, caesarean delivery, and depression
4
Management
Gestational Weight Gain
Antepartum Care
Weight Gain Exercise Screening
According to IOM Regular exercise 150 min per High blood pressure, proteinuria,
week or 20-30 min per day depression, substance use, and
of moderate-intensity obstructive sleep apnea
exercise
Antepartum Care (2)
OGTT Prevention Assessment
Screening for pregestational BMI of 35 or higher – 75 mg US assessments at 14 to 16 wga and 28 to 32
type 2 DM at the initial of aspirin daily from 12 wga wga to aid in the detection of late onset FGR
Surveillance of fetal well-being started from 34
prenatal visit with OGTT at
wga with BMI of 40 or higher and by 37 wga
24-28 wga if initial testing is with BMI of 35 to 39
normal
Conclusion
References
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