Effects of Obesity in Pregnancy

Abstract

Obesity is a major health problem that affects many people. The current professional recommendations for weight gain in pregnancy among overweight and obese women are both vague and variable, in that they are generalized to the population rather than catered to individual risk factors. Women who exhibit excessive weight gain and obesity prior to and throughout pregnancy are more likely to experience worsening metabolic and cardiac complications, higher rates of maternal morbidity and mortality, as well as poorer neonatal and fetal outcomes. Women who have preexisting cardiac or metabolic conditions have exacerbated symptoms throughout pregnancy due to the increased cardiac and metabolic demands. In addition, many develop secondary cardiac and metabolic complications into the immediate postpartum period that persist beyond that as well. It is important to discuss the problems that women face in regards to obesity during pregnancy because of the lack of emphasis on risk reduction strategies to prevent and minimize cardiac and metabolic manifestations and ramifications that arise as a result. Although a significant amount of research has been conducted that proves the negative effects of obesity and excessive weight gain on pregnancy, effective management and treatment has done very little to remedy the root of the problem; the lack of focus in developing preventative strategies to reduce risk factors that perpetuate high maternal and fetal morbidity and mortality. The main focus of this thesis is a comprehensive review of the literature pertaining to the issue of excessive weight gain and obesity within the context of pregnancy. It will consist of a description of the extent to which excessive weight gain and obesity is significant to the degree of risk and likelihood of pregnancy complications, a description of the current weight gain recommendations in pregnancy, and an outline of the normal cardiac and metabolic changes and demands that occur as a result of pregnancy. Furthermore, an understanding of the most common conditions associated with obesity and excessive weight gain during pregnancy will be discussed in terms of definition, pathophysiology, symptomology and patient outcomes, and treatment. In addition, the neonatal and fetal complications as well as the long-term maternal consequences that arise secondary to maternal obesity and excessive weight gain throughout pregnancy will be explored. Excessive weight gain and obesity prior to and throughout pregnancy is a serious risk factor that greatly contributes the development of gestational hypertension and preeclampsia, gestational diabetes mellitus, cardiovascular disease and peripartum cardiomyopathy, as well as and numerous adverse neonatal and fetal outcomes. In this respect, preventions and future strategies must be focused on conducting more research and implementing more teaching to promote healthy lifestyle choices, including weight loss, maintenance, and control, prior to, throughout, and following pregnancy, in order to improve maternal cardiovascular and metabolic health, decrease maternal mortality rates, as well as increase positive pregnancy outcomes.