Practice points
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Prepregnancy. As previously mentioned the CEMACH report has highlighted obesity as a serious medical condition which should involve preconceptual counselling. The report especially recommends this for women prior to embarking
The effect of adiposity is manifest in nearly every aspect of female reproductive life whether as a metabolic or reproductive complication or as a technical problem affecting clinical issues such as ultrasound scanning or surgery (Table 1). The 2002–2004 Confidential Enquiries into Maternal and Child Health (CEMACH) first highlighted obesity as a significant risk for maternal death, with 35% of the women who died being obese; 50% more than in the general population.1 The 2003–2005 report recommended preconception counselling for women with a body mass index (BMI; kg/m2) >30.2 In addition, offspring of obese mothers have a higher perinatal morbidity and long-term health problems. Maternal obesity is an increasing big problem in clinical obstetric practice, with epidemiological data indicating that the prevalence of obesity has doubled over the last ten years.3
Amenorrhoea and infertility among obese women is more common than in their lean counterparts. Obesity is associated with miscarriage in both women with polycystic ovarian syndrome (PCOS) and in those with normal ovarian morphology. It is believed that up to 50% of obese women have PCOS compared with 30% of lean.4
A recent meta-analysis of 13 studies examined patient predictors for outcome of gonadotrophin ovulation induction in women with normogonadotrophic anovulatory infertility. This work
It is recognised that obesity is a risk factor for many maternal obstetric complications including pre-eclampsia and gestational diabetes mellitus (GDM). The mechanisms involved are complex but one possible unifying hypothesis may be encompassed by the ‘metabolic’ syndrome as discussed in previous chapters.
It is clear that there is an increased requirement for careful surveillance of obese pregnant women at each stage of pregnancy. However, randomised controlled trials of interventions for obese pregnancy are not available and are therefore urgently required. Prepregnancy. As previously mentioned the CEMACH report has highlighted obesity as a serious medical condition which should involve preconceptual counselling. The report especially recommends this for women prior to embarkingPractice points
None declared.
None.
Obesity is a public health crisis and 20% of women of childbearing age in Europe are now obese, making it the most common co-morbidity in pregnancy [1]. Maternal obesity is associated with increased risk of antenatal and peripartum complications for women and offspring including hypertension, gestational diabetes mellitus, cesarean section and post-partum hemorrhage [1–10]. The risk of adverse outcomes has a linear relationship with increasing body mass index (BMI) [3,4], for example each BMI unit increase above 35 kg/m2 is associated with a 8% increase in pre-eclampsia [2].
However, a study that excluded women with foetal anomalies and diabetes found that the risk of stillbirth remained in obese women, again suggesting that these risk factors are independent [21]. Overweight and obese women should be advised to take a higher prenatal and antenatal folic acid dose [52] and a raised level of suspicion is needed for obese women during foetal anomaly screening. Morbidly obese women are twice as likely to suffer antepartum stillbirth (aOR 2.79 (95% CI 1.94–4.02)), and similarly for obese women (aOR 1.99 (95% CI 1.57–2.51) than normal-weight women [8].