Risks and management of obesity in pregnancy: current controversies

Abstract

To explore recent developments in obesity-related topics of interest and importance to obstetricians. Specifically addressed are the impact of gestational weight gain on perinatal risk, the increased risk of congenital anomalies in offspring, developmental origins of health and disease in offspring, and reproductive issues following bariatric surgery. Limiting maternal weight gain in obese women to less than 15 lb may favorably attenuate perinatal risk (macrosomia, cesarean delivery, preeclampsia) but increase risk for small-for-gestational-age newborns. Obese women are at significantly increased risk for offspring to develop open neural tube defects and congenital heart disease as well as other anomalies. Impaired sonographic visualization in this population may impede prenatal diagnosis of these serious birth defects. Intrauterine nutritional overabundance may cue adaptive fetal responses predisposing to childhood and adult obesity as well as the metabolic syndrome. Bariatric surgery, the only effective treatment for morbid obesity, causes lifelong physiologic and anatomic changes associated with significant reproductive implications. Procedures can predispose to caloric and micronutrient deficiencies, improved fertility and fecundity, and late surgical complications. Pregnancy outcomes are typically similar to those of women without previous bariatric surgery and better than those of untreated morbidly obese women. Obesity and its surgical treatment are associated with lifelong health implications for the mother as well as her offspring. An appreciation of these obesity-related reproductive issues is critical for optimal care of this growing segment of the female population.