1. OBesity Project
Pregnancy

2. Obesity: Increases obstetric risk during pregnancy.

3. Obesity and Obstetric Risk
Prevalence in reproductive age females (according to CDC):
Obesity %
Overweight %

4. Obesity and Obstetric Risk in Early Pregnancy
First Trimester pregnancy loss
Increased risk first trimester loss (OR 1.2)
Increased risk recurrent pregnancy loss (OR 3.5)
Increased risk loss after IVF or ICSI (OR 1.77)

5. Obesity and Risk of Congenital Abnormality
Increased risk for fetal malformations
Neural tube defects (OR 1.8)
Congenital heart disease (OR 1.18)
Omphalocele (OR 3.3)

6. Obesity and Risk of Congenital Abnormality
Mechanism responsible for malformations not well understood
Possible unrecognized type 2 DM
Obesity limits the ability of ultrasound to detect malformations

7. Obesity and Obstetric Complications in Late Pregnancy
Association with preterm delivery (PTD) risk
Spontaneous PTD is related to low BMI, poor maternal weight gain
PTD in obese population probably related to indicated deliveries due to medical or obstetrical complications

8. Obesity and Obstetric Complications in Late Pregnancy
Increased risk for gestational HTN, preeclampsia, GDM
GDM due to decreased insulin sensitivity compared to nonobese
Obesity/ metabolic syndrome also associated with probable increase in other preexisting medical problems such as nonalcoholic fatty liver and sleep apnea, which were previously seen only in older populations

9. Obesity and Obstetric Complications in Late Pregnancy
BMI > 30
Odds Ratio
BMI >35
Gestational hypertension
2.5
3.2
Preeclampsia
1.6
3.5
Gestational diabetes
2.6
4.0

10. Obesity and Obstetric Complications in Late Pregnancy
IUFD risk
Risk is 2x in overweight and 2.5x in obese
Pathophysiology is unknown

11. Obesity and Obstetric Complications in Late Pregnancy
Increased risk of macrosomia
Increased risk C/S and complications
Wound infection
Blood loss
Thromboembolism
Endometritis
VBAC less successful

12. Delivery Issues
Obese women are at higher risk of other complications at delivery and post-partum
Obstetric hemorrhage (1.6X)
Shoulder dystocia
Thromboembolism
Difficulty Breast Feeding

13. Risk of Children Born to Obese Mothers
Long term risks to children born to obese mothers
Both maternal obesity and fetal macrosomia approximately double the risk of adolescent obesity and metabolic syndrome (obesity, hypertension, glucose intolerance, dyslipidemia)
Increased risk of Autism

14. In utero Programming of Obesity and Metabolic Dysfunction
Pregnancy
Increased Insulin resistance
(Obesity/GDM)
Metabolic
Aging
Adult Metabolic syndrome
T2DM and Obesity
Fetal-Neonatal
Metabolic programming of Obesity
Childhood Obesity
? Pre-metabolic
syndrome
Catalano; JCEM, 2003