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 Table of Contents  
EDITORIAL
Year : 2014  |  Volume : 1  |  Issue : 3  |  Page : 136-137

Maternal obesity and pregnancy outcome


1 Ex. Senior Deputy Director, National Institute of Reproductive Health, Mumbai, Maharashtra, India
2 Director, Unit of Endocrine and Metabolic Disorders, Medical Research Centre, Kasturba Health Society, Mumbai, Maharashtra, India

Date of Web Publication19-Sep-2014

Correspondence Address:
Rashmi S Shah
Ex. Senior Deputy Director, National Institute of Reproductive Health, Mumbai, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2347-9906.141138

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How to cite this article:
Shah RS, Vaidya RA. Maternal obesity and pregnancy outcome. J Obes Metab Res 2014;1:136-7

How to cite this URL:
Shah RS, Vaidya RA. Maternal obesity and pregnancy outcome. J Obes Metab Res [serial online] 2014 [cited 2019 Jul 19];1:136-7. Available from: http://www.jomrjournal.org/text.asp?2014/1/3/136/141138

Obesity is a health problem that is increasing in prevalence globally with a higher prevalence in females than males. The prevalence of overweight and obesity have reached epidemic proportions and is seen not only in industrialized countries but is now emerging as a serious problem in the developing countries too affecting children, adolescents, and adults. [1],[2] Children born to obese mothers are also more susceptible to obesity in adolescence and adulthood. A study was undertaken by Pandey et al., wherein body mass index (BMI) was calculated in 2421 children between the ages of 4 and 15 years (1346 boys and 1075 girls) belonging to the upper socioeconomic strata of society. Their data revealed that the prevalence of overweight girls was 16%, and obese girls was 9.1%. Thus one-fourth of the girls were together in the category of overweight and obesity. [3]

In some countries, including India, the epidemic of obesity is seen alongside continuing problems of undernutrition, creating a double burden. [3],[4],[5] Wang et al. analyzed data from the India National Family Health Surveys (NFHS, 1992-1993, 1998-1999 and 2005-2006) to examine the prevalence and trends of overweight, obesity, and undernutrition in recent decades in India. The data revealed that the prevalence of overweight was low, while that of undernutrition remained high. Overweight was more prevalent among female, urban, and high-socioeconomic-status (SES) groups. The prevalence of overweight and obesity had increased slightly over the past decade but in some urban and high-SES groups it reached a relatively high level. [6] Another interesting study by Michelle et al., in which data were collected from women in 36 developing countries in the age group 20-49 years, revealed that the prevalence of overweight in young women residing in both urban and rural areas were higher than those in underweight women, especially in countries at higher levels of socioeconomic development. In Indian women (n = 7608), 26.4% of them were overweight in urban areas as against 5.6% in rural areas. It was interesting to note that in this study, 23.1% of urban women were found to be underweight and an alarming 48.2% rural women were detected to be underweight. [7] Another survey carried out in three South Asian countries (Bangladesh, Nepal, and India), between 1996 and 2006, revealed that whereas the prevalence of underweight had remained high in Bangladesh, Nepal, and India, the prevalence of overweight-obesity in women of reproductive age has risen. Overweight-obesity in Indian women (n = 161,755) had increased from 10.6% to 14.8%. [8]

The obesity epidemic affects all, including women of reproductive age. Compared with normal-weight women, obese women have a higher prevalence of infertility. Once overweight women conceive, they are considered a high-risk state because pregnancy is associated with many complications. Even a moderately overweight pregnant woman would be at risk for gestational diabetes and hypertensive disorders of pregnancy, and the risk gets still higher in women with overt obesity. An obese pregnant woman is at a higher risk of preeclampsia, preterm labor, stillbirth, cesarean deliveries and there is a higher incidence of anesthetic and postoperative complications in these deliveries. These women are more prone to develop overt diabetes and chronic hypertension in the future as well.

A retrospective data analysis study undertaken in 287213 pregnancies (normal weight mothers = 61.7%, moderately obese mothers = 27.5% and very obese mothers = 10.9%) showed that compared to women with normal BMI, gestational diabetes mellitus, preeclampsia, induction of labor, cesarean section, postpartum hemorrhage, thromboembolism, genital tract infection, wound infection, and intrauterine death were significantly more common in obese pregnant women. In all cases, increasing maternal BMI was associated with increased magnitude of risk. [9] Increased risk of pregnancy complications and adverse fetal outcome were also shown in a longitudinal prospective study undertaken in 422 obese pregnant women as compared to 422 nonobese pregnant mothers. [10] The infants born to obese women are at a higher risk of having perinatal complications as compared to normal-weight women. The incidence of low Apgar scores, severe birth defects particularly neural tube and structural cardiac defects, fetal macrosomia is higher in these infants. The infants of overweight mothers have high incidences of birth injuries and shoulder dystocia and require admission to neonatal intensive care units more often than do infants of normal-weight mothers. Thus, many of the published studies including data by Kumari et al. and a case report by Galvankar et al. reported in this issue of the JOMR have shown that obesity during pregnancy increases both maternal and fetal morbidity. [11 ],[12],[13],[14],[15],[16],[17]

The average cost of hospital prenatal and postnatal care is higher for overweight mothers than for normal-weight mothers and infants of overweight mothers require admission to neonatal intensive care units more often than do infants of normal-weight mothers. [14] Long-term complications include worsening of maternal obesity and development of obesity in the infant. [14] As obesity is considered to be a modifiable risk factor, preconception counseling and creating awareness regarding health risks associated with overweight and obesity should be encouraged. [9] Limiting BMI-specific weight gain during pregnancy through pregnancy-appropriate diet (quality and quantity assured macro- and micro-nutrients), and antenatal exercises may reduce maternal obesity-related risks for mother and her offspring. Several systematic and/or meta-analyses to this effect though point toward directionality of benefit but are not conclusive to inform evidence-based practice guidelines. [18],[19],[20] However, healthy changes to be made prior to or during pregnancy by overweight and obese women so as to avert obesity-related adverse pregnancy outcome require well-planned healthy life-style modules for improving maternal and newborn health. Current literature offers study protocols for such a purpose [21],[22] that hopefully provide a path that overcomes the barriers to or enhances enablers to making such healthy changes. [23]

 
  References Top

1.Obesity: Preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser 2000;894:i-xii, 1-253.  Back to cited text no. 1
[PUBMED]    
2.Popkin BM, Adair LS, Ng SW. Global nutrition transition and the pandemic of obesity in developing countries. Nutr Rev 2012;70:3-21.  Back to cited text no. 2
    
3.Pandey S, Bhaskaran A, Agashe S, Vaidya R. A cross-sectional study of childhood and adolescent obesity in affluent school children from western suburbs of Mumbai 2001-2002 and 2013-2014. J Obes Metab Res 2014;1:7-13.  Back to cited text no. 3
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4.World Health Organization. Department of nutrition for health and development. WHO global database on body mass index (BMI): An interactive surveillance tool for monitoring nutrition transition. Public Health Nutr 2006;9:658-60.  Back to cited text no. 4
    
5.Vaidya AD. The formidable challenge of underweight, overweight and obese children in India (Editorial). J Obes Metab Res 2014;1:4-5.  Back to cited text no. 5
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6.Wang Y, Chen HJ, Shaikh S, Mathur P. Is obesity becoming a public health problem in India? Examine the shift from under - To overnutrition problems over time. Obes Rev 2009;10:456-74.  Back to cited text no. 6
    
7.Mendez MA, Monteiro CA, Popkin BM. Overweight exceeds underweight among women in most developing countries. Am J Clin Nutr 2005;81:714-21.  Back to cited text no. 7
    
8.Balarajan Y, Villamor E. Nationally representative surveys show recent increases in the prevalence of overweight and obesity among women of reproductive age in Bangladesh, Nepal, and India. J Nutr 2009;139:2139-44.  Back to cited text no. 8
    
9.Sebire NJ, Jolly M, Harris JP, Wadsworth J, Joffe M, Beard RW, 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.  Back to cited text no. 9
    
10.Mandal D, Manda S, Rakshi A, Dey RP, Biswas SC, Banerjee A. Maternal obesity and pregnancy outcome: A prospective analysis. J Assoc Physicians India 2011;59:486-9.  Back to cited text no. 10
    
11.Kumari P, Gupta M, Kahlon P, Malviya S. Association between high maternal body mass index (BMI) and feto-maternal outcome. J Obes Metab Res 2014;3:143-4.  Back to cited text no. 11
    
12.Satpathy HK, Fleming A, Frey D, Barsoom M, Satpathy C, Khandalavala J. Maternal obesity and pregnancy. Postgrad Med 2008;120:E01-9.  Back to cited text no. 12
    
13.Zhao YN, Li Q, Li YC. Effects of body mass index and body fat percentage on gestational complications and outcomes. J Obstet Gynaecol Res 2014;40:705-10.  Back to cited text no. 13
[PUBMED]    
14.Galtier-Dereure F, Boegner C, Bringer J. Obesity and pregnancy: Complications and cost. Am J Clin Nutr 2000;71:1242S-8.  Back to cited text no. 14
    
15.Vasudevan C, Renfrew M, McGuire W. Fetal and perinatal consequences of maternal obesity. Arch Dis Child Fetal Neonatal Ed 2011;96:F378-82.  Back to cited text no. 15
    
16.American College of Obstetricians and Gynecologists. ACOG Committee opinion no. 549: Obesity in pregnancy. Obstet Gynecol 2013;121:213-7.  Back to cited text no. 16
[PUBMED]    
17.Galvankar P, Shah R. Maternal Obesity and Twin Pregnancy: A Case Report and Literature Review. J Obes Metab Res 2014;3:183-5.  Back to cited text no. 17
    
18.Agha M, Agha RA, Sandell J. Interventions to reduce and prevent obesity in pre-conceptual and pregnant women: A systematic review and meta-analysis. PLoS One 2014;9:E95132.  Back to cited text no. 18
    
19.Thangaratinam S, Rogozinska E, Jolly K, Glinkowski S, Duda W, Borowiack E, et al. Interventions to reduce or prevent obesity in pregnant women: A systematic review. Health Technol Assess 2012;16:iii-iv, 1.  Back to cited text no. 19
    
20.Furber CM, McGowan L, Bower P, Kontopantelis E, Quenby S, Lavender T. Antenatal interventions for reducing weight in obese women for improving pregnancy outcome. Cochrane Database Syst Rev 2013;1:CD009334.  Back to cited text no. 20
    
21.John E, Cassidy DM, Playle R, Jewell K, Cohen D, Duncan D, et al. Healthy eating and lifestyle in pregnancy (HELP): A protocol for a cluster randomised trial to evaluate the effectiveness of a weight management intervention in pregnancy. BMC Public Health 2014;14:439.  Back to cited text no. 21
    
22.Seneviratne SN, Parry GK, McCowan LM, Ekeroma A, Jiang Y, Gusso S, et al. Antenatal exercise in overweight and obese women and its effects on offspring and maternal health: Design and rationale of the IMPROVE (Improving Maternal and Progeny Obesity Via Exercise) randomised controlled trial. BMC Pregnancy Childbirth 2014;14:148.  Back to cited text no. 22
[PUBMED]    
23.Sui Z, Turnbull D, Dodd J. Enablers of and barriers to making healthy change during pregnancy in overweight and obese women. Australas Med J 2013;6:565-77.  Back to cited text no. 23
    




 

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