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April 6, 2017

Obesity and Pregnancy: Beyond 40 Weeks

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Obesity affects both mother and offspring for the 40-week period of gestation and beyond. It involves preconception, conception, gestation, and postpartum periods. Effects of obesity and pregnancy may be experienced for a lifetime and with future generations.

All health care practitioners should understand the importance of reducing the significant and widespread risks of obesity on mother and child.

Preconception obesity significantly affects reproduction (fertility, hormones, and chromosomes of both eggs and sperm). Parental obesity prior to conception will influence the health of offspring. Achieving a healthy weight prior to conception is advised. Risk reduction should be discussed with couples planning for pregnancy. Reducing preconception obesity improves chances of natural and assisted fertility, reduces rate of early and late pregnancy loss, and helps prevent preterm birth. Patients should be referred to an obesity medicine specialist if necessary. Even modest weight reduction can significantly reduce pregnancy risks for mother and fetus.

After conception, care should focus on risk reduction for mother and offspring. Assessments should be made for sleep apnea, glucose intolerance, and cardiovascular disease. Appropriate weight gain in each trimester should be discussed. Adequate physical activity should be encouraged to reduce risk.

Children of parents with obesity have increased risk of anatomic, developmental, endocrine, metabolic, and growth defects. They have increased risk for preterm birth and both early and late pregnancy loss. Referral to a perinatologist is advisable for co-management.

Obesity affects both mother and fetus during labor and delivery. There are increased maternal risks for induction of labor, cesarean delivery, preterm delivery, anesthesia complications, postpartum hemorrhage, wound complications, DVT/PE, and postpartum depression. Increased fetal/infant risks include preterm delivery, difficult fetal monitoring, shoulder dystocia, blood sugar instability, feeding difficulties, and increased NICU admission.

Long-term maternal effects include type 2 diabetes, persistent obesity, cardiovascular disease, risk of obesity-related cancers, and future high-risk pregnancies.

Long-term effects on offspring include childhood and adult obesity, type 2 diabetes, behavior/developmental disorders, cardiovascular disease, cerebral palsy, brachial plexus injuries, and mood and addiction disorders. Children and adults with obesity also suffer the social bias and discrimination. Education on preventing childhood obesity is advisable.

Risk reduction and optimization of pregnancy includes preconception counseling and testing, preconception medical or surgical weight loss, perinatology consult, maternal/fetal monitoring, limited gestational weight gain, increased physical activity, early planning for delivery and anesthesia, and inter-pregnancy weight management. An obesity medicine specialist can be a valuable team member.

For more on the relationship between obesity and pregnancy, read Obesity and Barriers to Breastfeeding.