Abstract
BackgroundLittle is known about reproductive health in severely obese women. In this study, we present associations between different levels of severe obesity and a wide range of health outcomes in the mother and child.MethodsFrom the Danish National Birth Cohort, we obtained self-reported information about prepregnant body mass index (BMI) for 2451 severely obese women and 2450 randomly selected women from the remaining cohort who served as a comparison group. Information about maternal and infant outcomes was also self-reported or came from registers. Logistic regression was used to estimate the association between different levels of severe obesity and reproductive outcomes.Principal FindingsSubfecundity was more frequent in severely obese women, and during pregnancy, they had an excess risk of urinary tract infections, gestational diabetes, preeclampsia and other hypertensive disorders which increased with severity of obesity. They tended to have a higher risk of both pre- and post-term birth, and risk of cesarean and instrumental deliveries increased across obesity categories. After birth, severely obese women more often failed to initiate or sustain breastfeeding. Risk of weight retention 1.5 years after birth was similar to that of other women, but after adjustment for gestational weight gain, the risk was increased, especially in women in the lowest obesity category. In infants, increasing maternal obesity was associated with decreased risk of a low birth weight and increased risk of a high birth weight. Estimates for ponderal index showed the same pattern indicating an increasing risk of neonatal fatness with severity of obesity. Infant obesity measured one year after birth was also increased in children of severely obese mothers.ConclusionSevere obesity is correlated with a substantial disease burden in reproductive health. Although the causal mechanisms remain elusive, these findings are useful for making predictions and planning health care at the individual level.
Highlights
As a consequence of the obesity epidemic, the proportion of severely obese women of childbearing age has increased considerably, which prompts research in the consequences for reproductive health of these women.A large body of data already links prepregnancy obesity with a number of fetal and maternal complications, including subfertility, preeclampsia, gestational diabetes, fetal death, macrosomia and complicated deliveries [1,2,3,4]
Severe obesity is correlated with a substantial disease burden in reproductive health
By linkage to the National Hospital Discharge Register (NHDR) and use of codes from the International Classification of Diseases, 10th Revision (ICD-10), we identified pregnancies complicated by preeclampsia or eclampsia (O14 or O15), pregnancies with chronic or gestational hypertension (I10 through I15 and O10, O11, and O13), and pregnancies with a diagnosis of gestational diabetes (O24)
Summary
As a consequence of the obesity epidemic, the proportion of severely obese women of childbearing age has increased considerably, which prompts research in the consequences for reproductive health of these women.A large body of data already links prepregnancy obesity with a number of fetal and maternal complications, including subfertility, preeclampsia, gestational diabetes, fetal death, macrosomia and complicated deliveries [1,2,3,4]. The obese phenotype covers a wide range of abnormalities depending on the amount, distribution and causes of accumulated fat, most studies have defined obesity as a prepregnant body mass index (BMI = weight[kg]/height[m]2)$30 and analyzed the entire group of obese individuals together. When all obese women are analyzed as one group, the opportunity to study differences in risk across levels of obesity is lost. We compare data on a large contemporary sample of very obese women and a selected group of other women in the same population in order to study the associations between different levels of obesity and a wide range of outcomes in the mother and infant. We present associations between different levels of severe obesity and a wide range of health outcomes in the mother and child
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