In recent years, the prevalence of obesity in the United States has risen dramatically, especially among women of reproductive age. Research that has specifically evaluated pregnancy outcomes among obese parturients has allowed for a better understanding of the myriad adverse perinatal complications that are observed with significantly greater frequency in the obese pregnant population. The antepartum, intrapartum, intraoperative, postoperative, and postpartum periods are all times in which the obese pregnant woman is at greater risk for adverse maternal-fetal outcomes, compared with her ideal bodyweight counterpart. Comorbid medical conditions that commonly are associated with obesity further accentuate perinatal risks. All obese pregnant women should be counseled regarding these risks, and strategies should be used to improve perinatal outcome whenever possible. Obese women of reproductive age ideally should be counseled before conception and advised to achieve ideal bodyweight before pregnancy.
The clear but unfortunate trend toward a sedentary lifestyle and unhealthy eating habits has contributed to the so-called “obesogenic” state of United States society. Ironically, and despite the introduction and availability of dietetic, fat-free, low-fat, sugar-free, and low-calorie foods and beverages, not to mention the ubiquitous presence of health clubs in most communities, there are more obese Americans today than at any previous time in our history. Although the number of obese Americans stood at just 13% in 1962, two-thirds of Americans are now classified as overweight or obese (62% of women). Since 1980, obesity rates have doubled for adults and tripled for children aged 12-19 years. Only 1 state (Colorado) has a current prevalence of obesity <20%. This unfortunate “state of the weight” in the United States ultimately may undo the steady gains in overall health that Americans have enjoyed since the dawn of the 20th century. Even the most dreadful of obstetric complications, maternal death, appears to be on the rise, with obesity being cited as an important contributor.
Obesity has long been perceived as a risk factor in pregnancy. Research over several decades has demonstrated consistently that the obese pregnant woman is at risk for a multitude of adverse maternal, fetal, and neonatal outcomes. Recently, mounting epidemiologic evidence suggests that infants of obese mothers are at greater risk for lifelong metabolic complications that include diabetes mellitus, heart disease, and obesity through intriguing mechanisms of “in-utero programming” of adult disease. Obesity is also proving to be a significant contributor to the increased use of women’s health care services, adding measurable cost. At a time when health expenditures are being scrutinized at every level, it is difficult to ignore this increasing financial and resource burden of caring for obese patients during pregnancy and beyond. The practitioner of contemporary obstetrics needs no “p value” or “relative risk” statistics to be keenly aware of the prevalence of obesity within the pregnant population and the complications and challenges that are posed by obesity in the care of these patients. The purpose of this article is to present those risks and review suggested treatment strategies for the care of these high-risk patients.
Cause
The “multifactorial milieu” of environmental, behavioral, genetic, and socioeconomic factors is the likely primary contributor to the occurrence of obesity. However, the recent dramatic increase in obesity is thought to be related to the imbalance of caloric intake vs expenditure. The factors that contribute to the achievement and maintenance of a healthy weight are essentially those acts and behaviors that can be considered a “healthy lifestyle.” The consumption of less processed foods, fruits and vegetables, nuts and whole grains, and low-fat protein sources and the avoidance of refined sugar are all beneficial. Sustained physical activity, ideally on a daily basis is also important. The US Surgeon General recommends at least 30 minutes of moderate physical activity daily. Rare disorders such as Cushing’s syndrome, partial lipodystrophy, adiposogenital dystrophy, craniopharyngioma, and hypothalamic disease may cause obesity, but their contribution to the cause is believed to be <1%.
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