Pregnancy and obesity: A review and agenda for future research
ABSTRACT At present, more than 60% of American women of childbearing age are either overweight or obese. As the obesity epidemic in the United States and many other countries continues to grow unchecked, there is greater interest in the relationship between obesity and other major health issues. This paper reviews the literature on the relationship between obesity and pregnancy. We begin with a discussion of the relationship between excess body weight and fertility and then turn to the relationship between maternal body weight and pregnancy-related complications. The role of pregnancy as a possible risk factor for the development of obesity is noted. The studies investigating the efficacy of behavioral interventions to control excessive weight gain during pregnancy or help women lose weight after childbirth are then reviewed. The paper concludes with an agenda for future research examining the relationship between obesity and pregnancy.
- SourceAvailable from: Annick Bogaerts
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- "It is well documented that a high pre-pregnancy BMI (Guelinckx et al., 2008; Heslehurst et al., 2008) and excessive GWG (Nohr et al., 2008; Institute of Medicine, 2009) are both associated with obstetric complications including hypertensive disorders, gestational diabetes mellitus (GDM), caesarean section (CS) and higher postpartum weight retention (PPWR) (Heslehurst et al., 2008; Poobalan et al., 2009; Nelson et al., 2010). Foetal risks include miscarriage, neural-tube defects, heart defects, macrosomia and stillbirth (Callaway et al., 2006; Sarwer et al., 2006). Complications are even higher when pre-pregnancy obesity is combined with excessive GWG, especially the increased risk of caesarean delivery, macrosomia and postpartum weight retention (Cedergren, 2006; Nohr et al., 2008; Institute of Medicine, 2009). "
ABSTRACT: Background: Maternal obesity is a growing public health concern in Belgium as well as in other European countries and is now becoming the most common risk factor associated with pregnancy complications with impact on the health of the women and her offspring. At this moment, there is no specific management strategy for obese pregnant women and mothers, focusing on physical health and psychological well-being. Objectives: We aimed (1) to study the influence of socio-demographic and obstetrical correlates on pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) in different regions of Flanders, Belgium, (2) to review the literature on the onset and progression of labour in normal weight and obese pregnant women, (3) to compare levels and evolution of anxiety and depressed mood during pregnancy between obese women and normal-weight women, (4) to examine whether a prenatal lifestyle intervention programme, based on principles of motivational interviewing, in obese pregnant women reduces GWG and lowers levels of anxiety and depressed mood during pregnancy, (5) to examine associations between inter-pregnancy weight change from the first to the second pregnancy and the risk for adverse perinatal outcomes during the second pregnancy and finally (6) to study predictors of postpartum weight retention (PPWR) in obese mothers at six months after delivery in order to provide clues for the design of interventions aimed at preventing weight retention related to childbearing. Methods: We performed an epidemiological study, an intervention study during pregnancy with postpartum follow up and a literature review. Results: One in three Flemish women start pregnancy being overweight or obese and this prevalence has slowly been rising since 2009 in the Flanders. We identified women at risk for a high pre-pregnancy BMI and excessive GWG, both being important predictors for increased pregnancy and birth related complications. In a literature review, we showed that the combination of a higher incidence of post-term deliveries and increased inadequate contraction pattern during the first stage of labour in obese women suggests an influence of obesity on myometrial activity. Given the low compliance for adequate GWG in obese women in the general Flemish population and their increased psycho-social vulnerability compar-ed to the normal weight pregnant women, counselling obese pregnant women can lead to a reduced GWG and increased psychological comfort. Stabilizing inter-pregnancy maternal weight for all women is an important target for reducing adverse perinatal outcomes in the subsequent pregnancy. Psychological discomfort during pregnancy does impact on PPWR in obese mothers six months after delivery. Discussion and conclusion: Focusing on weight management in obese women before, during and after a pregnancy has advantages for both the mother and her infant. Theoretical and practice based training modules should be developed and focus on: (1) awareness of techniques for identifying the clearly identified risk groups with a high pre-pregnancy BMI and excessive GWG, (2) the increased perinatal risks, (3) an adapted perinatal management and (4) counselling techniques for an adequate weight management and psychological wellbeing in obese pregnant women. To achieve better care for the future, we must focus on tackling maternal obesity. This means that obese women should be reached before they get pregnant for the first time. Targeting primary and community based care, promotion and education are challenging, but the psychosocial context should be acknowledged.
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- "The exact reason is unknown, but an altered inflammatory reaction and metabolic and vascular abnormalities related to maternal obesity in pregnancy may contribute (Ramsay et al., 2002; Challier et al., 2008; Madan et al., 2009). Indeed, obesity in pregnancy is associated with metabolic imbalance including hyperinsulinemia, dyslipidemia, impaired endothelial function, higher blood pressure and inflammatory up-regulation (Kirschner et al., 1990; Ramsay et al., 2002; Sarwer et al., 2006; Challier et al., 2008; Denison et al., 2010). Accurate dating in early pregnancy is crucial but can be challenging in obese pregnant women. "
ABSTRACT: BACKGROUND: the incidence of obesity increases in all developed countries to frightful percentages, also in women of reproductive age. Maternal obesity is associated with important obstetrical complications; and this group also exhibits a higher incidence of prolonged pregnancies and labours. OBJECTIVE: to review the literature on the pathophysiology of onset and progression of labour in obese woman and translate this knowledge into practical recommendations for clinical management. METHODS: a literature review, in particular a critical summary of research, in order to determine associations, gaps or inconsistencies in this specific but limited body of research. FINDINGS: the combination of a higher incidence of post-term childbirths and increased inadequate contraction pattern during the first stage of labour suggests an influence of obesity on myometrial activity. A pathophysiologic pathway for altered onset and progression of labour in obese pregnant women is proposed. CONCLUSIONS: analysis of the literature shows that obesity is associated with an increased duration of pregnancy and prolonged duration of first stage of labour. IMPLICATIONS FOR PRACTICE: an adapted clinical approach is suggested in these patients.Midwifery 02/2013; 29(12). DOI:10.1016/j.midw.2012.12.013 · 1.71 Impact Factor
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- "These high rates of obesity among childbearing women raise several important public health implications, including the increased risk of complications during pregnancy , such as gestational diabetes mellitus (GDM), cesarean delivery, and preeclampsia. Risks for the offspring include congenital malformations, stillbirth, macrosomia, shoulder dystocia, and neonatal intensive care stay         . Estimates across studies range from about 40% to 70% of women exceeding the 1990 IOM weight gain guidelines    ; estimates with the 2009 guidelines  are few. "
ABSTRACT: Objectives. To describe psychosocial factors identified as contributors of weight gain in the general population and to examine the relationship between these factors and gestational weight gain among low socioeconomic status, African American, overweight pregnant women. Methods. African American women (n = 120) with a pregravid body mass index ≥25 kg/m(2) completed measures of eating, sleep, and depressed mood between 14 and 24 weeks of gestation. Weight was tracked. Descriptive statistics, correlations, and linear regression modeling were used to characterize the sample and examine predictors of gestational weight gain. Results. Four percent screened positive for night eating syndrome, with 32% consuming at least 25% of their daily caloric intake after dinner (evening hyperphagia). None met criteria for binge eating disorder; 4% reported occasional binge episodes. Cognitive restraint over eating was low. Participants slept 7.1 (SD = 1.9) h per night and reported 4.3 (SD = 3.6) awakenings per week; 18% reported some level of depressed mood. Night and binge eating were related to each other, sleep quality, and depressed mood. Eating due to cravings was the only psychosocial variable to predict gestational weight gain. Conclusions. Depressed mood, night eating, and nighttime awakenings were common in this cohort, while cognitive restraint over eating was low. Most psychosocial variables were not predictive of excess gestational weight gain.Obstetrics and Gynecology International 11/2012; 2012:878607. DOI:10.1155/2012/878607