Obesity, O&G and Risk Diana Hamilton-Fairley Consultant Obstetrician and Gynaecologist Guys and St. Thomas’ NHS Foundation Trust

Aims  Obesity is a public health issue  Impact of obesity on women’s health  Weight loss does make a difference  Clinicians have a powerful role to play

Health Risks Which of these is the greatest risk to health?

Risk  The possibility of suffering harm or loss; danger.  A factor, thing, element, or course involving uncertain danger;  The danger or probability of loss to an insurer.  One considered with respect to the possibility of loss: a poor risk.

The Epidemic  “Child obesity has doubled in a decade”  21% increased risk of cancer in girls  Double the risk of dying before 50

Reproductive Years – Obesity, Hirsutism and Menstruation P<0.01 % PCOS

Implications  Anovulation  Menorrhagia  Endometrial Hyperplasia  Anaemia  Hirsutism / Acne  Psychological impact

Obesity and Ovulation induction P<0.02 NSP<0.01

Obesity and Miscarriage  Risk of miscarriage before a live birth in 13,123 consecutive pregnancies BMI >

Reproductive Years Pregnancy - Gestational Diabetes  Nulliparous women Prepregnancy weight Baeton et al.2001 Am J Pub Health 91; BMI (71.7%) (18.2%) >30 (10.1%)

Pre-eclampsia and Eclampsia BMI > Baeton et al.2001 Am J Pub Health 91;

Delivery at <32 weeks BMI > Baeton et al.2001 Am J Pub Health 91;

Caesarean Delivery BMI > Baeton et al.2001 Am J Pub Health 91;

Other increased risks in pregnancy  Congenital abnormality3 fold  Thromboembolism12 fold  Failed Trial of Labour87% vs 20-40%

Shoulder Dystocia and neonatal injury   BMI > 30kg/m 2   Second stage >20 mins   Birthweight > 4.5kg Mehta et al J Perinatology 26;85-8

Infant Death BMI > Baeton et al.2001 Am J Pub Health 91;

Mean maternal glucose concentrations and infant mortality

Obese Parents  Increase the risk of obese children –Increased risk of early onset Type 2 DM –Increased risk of metabolic syndrome  Glucose intolerance, raised VLDL, Decreased HDL, Hypertension, Increased risk for cardiovascular disease –Increased risk of cancer  Increased risk of dying before children reach adulthood

Disease for which Obesity is a risk factor DiseaseRisk Risk in PCOS Diabetes3.8 5 fold Cardiovascular disease 2.1 Stroke > IHD 0.7 (NS) Hypertension5.6 Endometrial Cancer 3 – 10 fold Depends

Risk factors in endometrial cancer Risk factors in endometrial cancerRisk Fold risk Obesity Nulliparity 2*2*2*2* Late Menopause 2.4* “bloody menopause” 4*4*4*4* Diabetes 2.8* Hypertension 1.5* Unopposed E2 9.5 Complex Hyperplasia 29*

Risk of Surgery  Obesity increases your risk of needing a Hysterectomy –Infection 15.3% vs 11.3% (p<0.01) –Bleeding no difference –Increased duration of surgery –Increased LOS  Manual Handling  Surgical difficulty

Weight loss

Obesity and PCOS  Does weight loss treat symptoms?

Does weight loss improve outcome  In pregnancy reduces  Congenital abnormality  Miscarriage  GDM, macrosomia  Pre-eclampsia  Prematurity  Caesarean section  Postpartum  Type 2 DM  Hypertension  Cancer (Endometrial)

Treatment algorithm for obesity Treatment algorithm for obesity

What is our role?  Young fit women - INFORMATION  Actively treat obesity in gynaecology and subfertility clinics  Pre-conception obesity clinics  Pregnancy advice on weight gain  Postpartum follow-up and support

Obesity is a Public Health Issue We all have a role to play in reducing the risks