Obesity in pregnancy

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Assessment and possible supplementation of vitamin B12, folate, iron, and calcium for women who have undergone bariatric surgery Possible use of graduated compression stockings, hydration, and early mobilization during and after cesarean delivery Anesthesiology consult (prior to delivery date if possible) Continuation of nutrition counseling and exercise program after delivery, and consultation with weight loss specialists before attempting another pregnancy. KEY FINDINGS AND RECOMMENDATIONS Suggested weight gain during pregnancy varies based on BMI prior to conception Obesity in pregnancy is correlated with a number of possible complications for both the mother and child, and these complications tend to increase with the severity of obesity in the mother. Diet modification is very important, before, during, and after pregnancy, to ensure the best obstetric outcome Regular exercise is very important to lowering the risk of many obesity related pregnancy complications Bariatric surgery does not exclude women from being able to become pregnant, and if enough time is allowed, can dramatically decrease the risk for obesity related pregnancy complications Obesity in pregnancy can lead to extensive use of health care resources, and primary prevention through preconception weight loss could significantly reduce the resource use and health care cost. Complication possibilities should be discussed with potential obese mothers as early as possible, prior to conception ideally. For the most up-to-date recommendations, please see the 2009 report from the National Institute of Medicine. REFERENCES ---------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------- * Image courtesy of http://www.bebemagico.com/wp-content/uploads/2010/06/obesity-and-pregnancy.jpg 1. ACOG Committee Opinion Number 315, September 2005 (Reaffirmed 2008.) 2. World Health Organization. "Obesity: preventing and managing the global epidemic." Geneva, Switzerland: World Health Organization; 2000. WHO technical report series 894: i-xii, 1-253. 3. National Heart, Lung, and Blood Institute (NHLBI) and National Institute for Diabetes amd Digestive and Kidney Diseases (NIDDK). "Clinical guidelines on the identification, evaluation and treatment of overweight and obesity in adults. The evidence report." Obes Res 1998;6(suppl 2): 51S-210S. 4. Hedley AA, Ogden CL, et al. "Prevalence of overweight and obesity among US children, adolescents, and adults, 1999-2002." JAMA 2004; 291: 2847-50. 5. Institute of Medicine (US). "Nutritional status and weight gain." In: Nutrition during pregnancy. Washington DC: National Academy Press; 1990. p. 27-233, updated 2009. 6. March of Dimes: www.marchofdimes.com Thursday, December 06, 2012 7. Weiss JL, Malone FD, et al. "Obesity, obstetric complications an cesarean delivery rate-a population-based 6
screening study." FASTER Research Consortium. Am J Obstet Gynecol 2004; 190: 1091-7. Thursday, December 06, 2012 8. Baeten JM, Bukusi EA, Lambe M. "Pregnancy complications and outcomes among overweight and obese nullparous women." Am JPublic Health 2001; 91: 436-40. 9. Cedergren MI. "Maternal morbid obesity and the risk of adverse pregnancy outcome." Obstet Gynecol 2004;103: 219-24. 10. Sebire NJ, Jolly M, Harris JP, et al. " Maternal obesity and pregnancy outcome: a study of 287, 213 pregnancies in London." Int J Obes Relat Metab Disord 2001; 25: 1175-82. 11. Young TK, Woodmansee B. "Factors that are associated with cesarean delivery in a large private practice: the importance of prepregnancy body mass index and weight gain." Am J Obstet Gynecol 2002; 187: 312-8; discussion 318-20. 12. Kabiru W, Raynor BD. "Obstetric outcomes associated with increase in BMI category during pregnancy." Am J Obstet Gynecol 2004; 191: 928-32. 13. Myles TD, Gooch J, Santolaya J, "Obesity as an independent risk factor for infectious morbidity in patients who undergo cesarean delivery." Obstet Gynecol 2002; 100: 959-64. 14. Perlow JH, Morgan MA. "Massive maternal obesity and perioperative cesarean morbidity." Am J Obstet Gynecol 1994; 170: 560-5. 15. Hood DD, Dewan DM. "Anesthetic and obstetric outcome in morbidly obese parturients." Anesthesiology 1993; 79: 1210-18. 16. Vesco KK, Dietz PM, Rizzo J, et al. "Excessive gestational weight gain and postpartum weight retention among obese women." Obstet Gynecol 2009 Nov; 114(5): 1069-75. 17. CNattingius S, Bergstron R, Lipworth L, Kramer MS. "Prepregnancy weight and the risk of adverse pregnancy outcomes." N Engl J Med 1998; 338: 147-52. 18. Hendler I, Blackwell SC, et al. "Does advanced ultrasound equipment improve the adequacy of ultrasound visualization of fetal cardiac structures in the obese gravid woman?" Am J Obstet Gynecol 2004; 190: 1616- 19; discussion 1619-20. 19. Shaw GM, Velie EM, Schaffer D. "Risk of neural tube defect-affected pregnancies among obese women." JAMA 1996; 275: 1093-6. 20. Walker DK, Mills JL, Simpson JL, et al. "Are obese women at higher risk for producing malformed offspring?" Am J Obstet Gynecol 1994; 170: 541-8. 21. Werler MM, Louick C, Shapiro S, Mitchell AA. "Prepregnancy weight in relation to risk of neural tube defects." JAMA 1996; 275: 1089-92. 22. Rode L, Nilas L, Wojdemann K, Tabor A. "Obesity-related complications in Danish single cephalic term pregnancies." Obstet Gynecol 2005; 105: 537-42. 23. Stephensson O, Dickman PW, Johansson A, Cnattingius S. "Maternal weight, pregnancy weight gain, and the risk of antepartum stillbirth." Am J Obstet Gynecol 2001; 184: 463-9. 24. Watkins ML, Rasmussen SA, Honein MA, Botto LD, Moore CA. "Maternal obesity and risk for birth 7
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Obesity in pregnancy

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