Obesity in pregnancy: A new chapter in obstetrics

Abstract

Obesity is a worldwide health problem affecting more than 35% of the adult population in the USA. Obesity is the greatest epidemic ever experienced by humans and resulting from increasing population increasing lifespan, urbanization, plentiful food and physical inactivity. The rate of obesity has doubled over the past decade. Percentage of women who are overweight or obese has increased by 60% over the past 30 years. The mean BMI has increased over the past 20 years leading to adverse metabolic effects on blood pressure, cholesterol and triglyceride concentration and insulin resistance, thereby increasing the risk: (1) for coronary disease and ischemic stroke, (2) for type 2 diabetes, and (3) for polycystic ovary syndrome (PCOS). Maternal obesity in pregnancy (MOP) has been associated with fertility implications both genders pregnancy complication, such as preterm delivery, shoulder dystocia, and adverse outcome including hypertensive disorders, gestational diabetes and need for operative delivery (cesarean section and instrumental vaginal delivery). Maternal obesity also has a significant impact on fetal development on neonatal period and overall on childhood development. Modification to routine prenatal care has been suggested for this population such as screening for diabetes in early pregnancy, limiting gestational weight gain, routine ultrasound for gestational age, fetal anatomic survey and antenatal surveillance with NST and BPP scoring and fetal echocardiography, screening for fetal aneuploidy. Obesity can affect screening test performance. Cell-free fetal DNA screening is more likely to result in test failure, low-dose aspirin to reduce the risk of preeclampsia and evaluation by anesthesiologist. Delivery timing and indications for labor induction should not be altered based on maternal obesity. For women undergoing cesarean delivery, prophylactic antibiotics should be administered based on maternal weight.