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Chapter 33 - Obesity in Pregnancy

Published online by Cambridge University Press:  29 September 2017

Martin Olsen
Affiliation:
East Tennessee State University
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Obstetric Care , pp. 296 - 307
Publisher: Cambridge University Press
Print publication year: 2017

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References

Gynecologists ACOG Obesity in Pregnancy. American Congress of Obstetricians and Gynecologists; 2015.Google Scholar
World Health Organization. Obesity: Preventing and Managing the Global Epidemic. Geneva, Switzerland: 2000.Google Scholar
Sebire, NJ, Jolly M, Harris, JP, et al. Maternal obesity and pregnancy outcome: a study of 287,313 pregnancies in London. International Journal of Obesity and Related Metabolic Disorders. 2001;25:1175–82.CrossRefGoogle Scholar
Weiss, JL, Malone, FD, Emig, D, Ball, RH, Nyberg, DA, Comstock, CH, et al. Obesity, obstetric complications and cesarean delivery rate–a population-based screening study. American Journal of Obstetrics and Gynecology. 2004;190(4):1091–7.Google Scholar
Lee, KK, Raja EA, Lee, AJ, Bhattacharya, S, Bhattacharya, Si, Norman, JE, Reynolds, RM. Maternal obesity during pregnancy assocates with premature mortality and major cardiovascular events in later life. Hypertension. 2015;66:938–44.Google Scholar
Centers for Disease Control and Prevention. Healthy weight, overweight, and obesity among adults aged 20 and over, by selected characteristics: United States, selected years 1988–1994 through 2009–2012. US Department of Health and Human Services; 2014.Google Scholar
Statistics NCfH. NCHS Obesity Data. Hyattsville, MD: NCHS, 2014.Google Scholar
McDonnold, M, Mele, LM, Myatt, L, Hauth, JC, Leveno, KJ, Reddy, UM, et al. Waist-to-hip ratio versus body mass index as predictor of obesity-related pregnancy outcomes. American Journal of Perinatology. 2016 May;33(6):618–24. doi: 10.1055/s-0035-1569986. Epub 2016 Jan 20.Google ScholarPubMed
Hu, FB, Stampfer, MJ, Manson, JE, Rimm, E, Colditz, GA, Rosner, BA, et al. Dietary fat intake and the risk of coronary heart disease in women. New England Journal of Medicine. 1997;337(21):1491–9.CrossRefGoogle ScholarPubMed
2015–2020 Dietary Guildelines for Americans. National Agricultural Library of the United States Department of Agriculture,. 8th ed. December 2015. Available at: https://health.gov/dietaryguidelines/2015/guidelines/, accessed April 26, 2017.Google Scholar
Larsson, SC, Orsini, N. Red meat and processed meat consumption and all-cause mortality: A meta-analysis. American Journal of Epidemiology. 2014;179(3):282–9.Google Scholar
Pate, RR et al. Physical activity and public health. Journal of the American Medical Association. 1995;273(5):402–7.Google ScholarPubMed
Gibbs, BG. Socioeconomic status, infant feeding practices, and early childhood obesity. Pediatric Obesity.9(2):135–46.Google Scholar
Burgio, E, Lopomo A, Migliore, L. Obesity and diabets: From genetics to epigenetics. Molecular Biology Reports. 2015;42:799818.Google Scholar
Chiolero, A, Faeh D, Paccaud, F, Cornuz, J. Consequences of smoking for body weight, body fat distribution, and insulin resistance. The American Journal of Clinical Nutrition. 2008;87:801–9.CrossRefGoogle ScholarPubMed
Waring, ME, Moore Simas TA, Rosal, MC, Pagoto, SL. Pregnancy intention, receipt of pre-conception care, and pre-conception weight counseling reported by overweight and obese women in late pregnancy. Sexual and Reproductive Health. 2015;6(2):110–1.CrossRefGoogle ScholarPubMed
American Congress of Obstetricians and Gynecologists. Motivational Interviewing: A Tool for Change. ACOG Committee Opinion 2009.Google Scholar
Schummers, L, Hutcheon JA, Bodnar, LM, Lieberman, E, Himes, KP. Risk of adverse pregnancy outcomes by prepregnancy body mass index. Obstetrics and Gynecology. 2015;125:133–43.Google Scholar
Thompson, WG, Cook DA, Clark, MM, Bardia, A, Levine, J. Treatment of obesity. Mayo Clinic Proceedings. 2007;82(1):93102.Google Scholar
Finkelstein, EA. Meta- and cost-effectiveness analysis of commercial weight loss strategies. Obesity. 2014;22:1942–51.CrossRefGoogle ScholarPubMed
Hayes, L, Mcparlin C, Kinnuned, TI, Poston, L, Robson, SC, Bell, R. Change in level of physical activity during pregnancy in obese women: Findings from the UPBEAT pilot trial. BMC Pregnancy and Childbirth. 2015; 15(52):18.CrossRefGoogle ScholarPubMed
Hainer, V, Aldhoon-Hainerová I. Tolerability and safety of the new anti-obesity medications. Drug Safety. 2014;37:693702.CrossRefGoogle ScholarPubMed
Syngelaki, A, Nicolaides KH, Balani, J, Hyer, S, Akolekar, R, Kotecha, R, Pastides, A, Shehata, H. Metformin versus placebo in obese pregnant women without diabetes mellitus. New England Journal of Medicine. 2016;374:434–43.Google Scholar
Maggard, MA, Shugarman, LR, Suttorp, M, Maglione, M, Sugerman, HJ, Livingston, EH, Nguyen, NT, Li, Z, Mojica, WA, Hilton, L, Rhodes, S, Morton, SC, Sheikelle, PG. Meta-analysis: surgical treatment of obesity. Annals of Internal Medicine. 2005(142):547–99.Google Scholar
De-Regil, LM, Palacios C, Lombardo LK, Pena-Rosas, JP. Vitamin D supplementation for women during pregnancy (Review). Cochrane Database of Systemic Reviews. 2016(1):1123.Google Scholar
Suarez, L FM, Brender, JD, Canfield, M, Zhu, H, Hendricks, KA. Neural tube defects on the Texas–Mexico border: What we’ve learned in the 20 years since the Brownsville Cluster. Birth Defects Research. 2012;94:882–92.Google Scholar
Bird, JK, Ronnenberg AG, Choi, SW, Du, F, Mason, JB, Liu, Z. Obesity is associated with increased red blood cell folate despite lower dietary intakes and serum concentrations. The Journal of Nutrition. 2015;145:7986.Google Scholar
Garcia-Valdes, L, Campoy C, Hayes, H, Florido, J, Rusanova, I, Miranda, MT, McArdle, HJ. The impact of maternal obesity on iron status, placental transferrin receptor expression and hepcidin expression in human pregnancy. International Journal of Obesity. 2015;39:571–8.CrossRefGoogle ScholarPubMed
Gesche, J, Nilas L. Pregnancy outcome according to pre-pregnancy body mass index and gestational weight gain. International Journal of Gynecology and Obstetrics. 2015;129:240–3.Google Scholar
Berggren, EK, Stuebe AM, Boggess, KA. Excess maternal weight gain and large for gestational age risk among women with gestational diabetes. American Journal of Perinatology. 2015;32:251–6.Google ScholarPubMed
Walter, JR, Perng W, Kleinman, KP, Rifas-Shiman, SL, Rich-Edwards, JW, Oken, E. Associations of trimester-specific gestational weight gain with maternal adiposity and systolic blood pressure at 3 and 7 years postpartum. American Journal of Obstetrics and Gynecology. 2015;212(499):e112.Google Scholar
Seneviratne, S, McCowan LM, Cutfield, WS, Derraik, JGB, Hofman, PL. Exercise in pregnancies complicated by obesity: Achieving benefits and overcoming barriers. American Journal of Obstetrics and Gynecology. 2015:442–9.Google Scholar
Finer, LB, Zolna MR. Shifts in intended and unintended pregnancies in the United States, 2001–2008. American Journal of Public Health. 2014;104:S43–S8.CrossRefGoogle ScholarPubMed
Kapadia, MZ, Park CK, Beyene, J, Giglia, L, Maxwell, C, and McDonald, SD. Can we safely recommend getational weight gain below the 2009 guidelines in obese women? A systematic review and meta-analysis. Obesity Reviews. 2015;16:189206.Google Scholar
Reddy, UM, Branum AM, Klebanoff, MA. Relationship fo maternal body mass index and height to twinning. Obstetrics and Gynecology. 2005;105(3):593–7.Google Scholar
Stothard, KJ, Tennant PW, Bell, R, Rankin, J. Maternal overweight and obesity and the risk of congenital anomalies. Journal of the American Medical Association. 2009;301:636–50.Google Scholar
Blomberg, MI, Källén B. Maternal obesity and morbid obesity: The risk for birth defects in the offspring. Birth Defects Research. 2010;88:3540.CrossRefGoogle ScholarPubMed
Boots, C SM. Does obesity increase the risk of miscarriage in early conception: A systematic review. Seminars in Reproductive Medicine. 2011;29(6):507–13.CrossRefGoogle ScholarPubMed
Kroenke, K, Williams, JB, Lowe, B. The Patient Health Questionnaire Somatic, Anxiety, and Depressive Symptom Scales. General Hospital Psychiatry. 2010;32(4):345.Google Scholar
Chung, F, Liao, P, Sasaki, E, Shapiro, C, Sun, Y. High STOP-Bang score indicates a high probability of obstructive sleep apnoea. British Journal of Anaesthesiology. 2012;108(5):768–75.CrossRefGoogle ScholarPubMed
O’Brien, TE, Chan, WS. Maternal body mass index and the risk of preeclampsia: A systematic overview. Epidemiology. 2003;14:368–74.Google Scholar
Aagaard-Tillery, KM, Malone, FD, Nyberg, DA, Collins, J, Comstock, CH, Hankins, G, Eddleman, K, Dugoff, L, Wolfe, HM, D’Alton, ME. Influence of maternal BMI on genetic sonography in the FaSTER trial. Prenatal Diagnosis. 2010;30:1422.CrossRefGoogle ScholarPubMed
Thornburg, LL, Ho, M, Pressman, EK. Fetal anatomic evaluation in the overweight and obese gravida. Ultrasound in Obstetrics and Gynecology. 2009;33:670–5.Google Scholar
Dashe, JS, Twickler, DM. Effect of maternal obesity on the ultrasound detection of anomalous fetuses. Obstetrics and Gynecology. 2009;113:1001–7.Google Scholar
Tsai, P-JS, Zalud, MD. Obesity and the challenges of ultrasound fetal abnormality diagnosis. Best Practice and Research Clinical Obstetrics and Gynaecology. 2015;29:320–7.Google Scholar
Siega-Riz, AM, Moos, M-K, Deierlein, A, Mumford, S, Knaack, J, Thieda, P, Lux, L, Lohr, KN. A systematic review of outcomes of maternal weight gain according to the Institute of Medicine recommendations: Birthweight, fetal growth, and postpartum weight retention. American Journal of Obstetrics and Gynecology. 2009;201(339):e114.CrossRefGoogle Scholar
Campbell, MK, Xie, B, Kouniakis, G, Huang, W, Han, V. Determinants of small for gestational age birth at term. Paediatric and Perinatal Epidemiology. 2012;26(6):525–33.Google Scholar
Cody, F, Daly, S, et al. The effect of maternal obesity on sonographic fetal weight estimation and perinatal outcome in pregnancies complicated by fetal growth restriction. Journal of Clinical Ultrasound.44(1):34–9.Google Scholar
Yao, R, Park, BY, Pereira, L, Plante, LA, Perinatal Research Consortium. Obesity and the risk of stillbirth: A population-based cohort study. American Journal of Obstetrics and Gynecology. 2014;210(5):457.e19.Google Scholar
Pevzner, L, Rayburn, WF, et al. Effects of maternal obesity on duration and outcomes of prostaglandin cervical ripening and labor induction. Obstetrics and Gynecology. 2009;114(6):1315–21.Google Scholar
Flynn, AM, O’Conor, M. Unstressed antepartum cardiotocography in the management of the fetus suspected of growth retardation. BJOG. 2014;121(Suppl 7):14–8.Google Scholar
Bhutta, ZA, Lawn, JE, Rizvi, A, Friberg, IK, Weissman, E, Buchmann, E, Goldenberg, RL. Stillbirths: What difference can we make and at what cost? Lancet. 2011;377(9776):1523–38.Google Scholar
Heslehurst, N, Ells, LF, Rankin, J, Wilkinson, J, Lang, R, Brown, TJ, Summerbell, CD. The impact of maternal BMI status on pregnancy outcomes with immediate short-term obstetric resource implications: A meta-analysis. Obesity Reviews. 2008;9(6):635–83.Google Scholar
Marchi, J, Dencker, A, Olander, EK, Begley, C. Risks associated with obesity in pregnancy, for the mother and baby: A systematic review of reviews. Obesity Reviews. 2015;16:621–38.Google Scholar
Heyborne, KD, Carey, JC. Does 17-alpha hydroxyprogesterone caproate prevent recurrent preterm birth in obese women? American Journal of Obstetrics and Gynecology. 2015;213(844):e16.Google Scholar
Hood, DD . Anesthetic and obstetric outcomes in morbidly obese parturients. Anesthesiology. 1993;79:1210–8.Google Scholar
Tonidandel, A, D’Angelo, R, Harris, L, Tonidandel, S. Anesthetic and obstetric outcomes in morbidly obese parturients: A 20-year follow up retrospective cohort study. International Journal of Obstetric Anesthesia. 2014;23(4):357–64.CrossRefGoogle ScholarPubMed
Soens, MA, Birnbach, DJ, Ranasinghe, JS, Van Zundert, A. Obstetric anesthesia for the obese and morbidly obese patient: An ounce of prevention is worth more than a pound of treatment. Acta Anaesthesiologica Scandinavica. 2008;52(1):619.Google Scholar
Graatsma, EM, van Egmond, LAJ, Mulder, EJH, Visser, GHA. Fetal electrocardiography: Feasibility of long term fetal heart rate recordings. British Journal of Obstetrics and Gynecology. 2009;116:334–8.Google Scholar
Ghaffari, N, Durnwald, MD. The multidisciplinary approach to the care of the obese parturient. American Journal of Obstetrics and Gynecology. 2015:318–25.Google Scholar
Cohen, WR, Ommani, S, Hassan, S, Mirza, FG, Solomon, M, Brown, R, et al. Accuracy and reliability of fetal heart rate monitoring using maternal abdominal surface electrodes. Acta Obstetricia et Gynecologica Scandinavica. 2012;91(11):1306–13.CrossRefGoogle ScholarPubMed
Vahratian, A, Troendle, JF, Savitz, DA, Siega-Riz, AM. Maternal prepregnancy overweight and obesity and the pattern of labor progression in term nulliparous women. Obstetrics and Gynecology. 2004;104:943–51.Google Scholar
Girsen, AI, Naqvi, M, Garabedian, MJ, Lyell, D. Body mass index and operative times at cesarean delivery. Obstetrics and Gynecology. 2014;124(4):684–9.Google Scholar
Weiss, JL, Emig, D, Ball, RH, Nyberg, DA, et al. Obesity, obstetric complications and cesarean delivery rate – A population-based screening study. American Journal of Obstetrics and Gynecology. 2003;190:1091–7.Google Scholar
Kobayashi, N, Induction of labour and intrapartum care in obese women. Best Practice and Research Clinical Obstetrics and Gynaecology. 2015;29(3):394405.Google Scholar
Ovesen, P, Kesmodel, U. Effect of prepregnancy maternal overweight and obesity on pregnancy outcome. Obstetrics and Gynecology. 2011;118:305–12.Google Scholar
Cedargren, M. Maternal morbid obesity and the risk of adverse pregnancy outcome. Obstetrics and Gynecology. 2004;103:219–24.Google Scholar
Crane, SS, Dye, TD, et al. Association between pre-pregnancy obesity and the risk of cesarean delivery. Obstetrics and Gynecology. 1997;89(2):213–6.Google Scholar
Chu, SY, Schmid, CH, et al. Maternal obesity and risk of cesarean delivery: A meta-analysis. Obstetrics Reviews. 2007;8(5):385–94.Google ScholarPubMed
Lim, CC . Obesity in pregnancy. Best Practice and Research in Clinical Obstetrics and Gynaecology. 2015;29:309–19.Google Scholar
Tuffaha, HW, Chaboyer, W, Gordon, LG, Scuffham, PA. Cost-utility analysis of negative pressur wound therapy in high-risk cesarean section wounds. Journal of Surgical Research. 2015;195:612–22.Google Scholar
Marrs, CC, Sibai, BM, et al. The relationship between primary cesarean delivery skin incision type and wound complications in women with morbid obesity. American Journal of Obstetrics and Gynecology. 2014;210(319):e14.Google Scholar
Brocato, B, Gomez, LM, Wan, JY, Mari, G. The effect of cesarean delivery skin incision approach in morbidly obese women on the rate of classical hysterotomy. Journal of Pregnancy. 2013;2013:3.Google Scholar
Hofmeyr, J, Mathai, M, Shah, A. Techniques for cesarean section. American Journal of Obstetrics and Gynecology. 2009:431–44.Google Scholar
Houston, M . Postoperative morbidity in the morbidly obese parturient woman: Supraumbilical and low transverse abdominal approaches. American Journal of Obstetrics and Gynecology. 2000;182:1033–5.Google Scholar
Fennimore, R. Panniculectomy at the time of cesarean section and postoperative wound complication in morbidly obese women. Journal of Reproductive Medicine. 2015;60(11–12):535–9.Google Scholar
American College of Obstetricians and Gynecologists . Use of Prophylactic Antibiotics in Labor and Delivery. Practice Bulletin No 120. 2011.Google Scholar
Swank, ML, Nicolaou, DP, McNulty, JA. Increased 3-gram cefazolin dosing for cesarean delivery prophylaxis in obese women. American Journal of Obstetrics and Gynecology. 2015;213(415):e18.Google Scholar
Ahmadzia, HK, Joshi, D, Liao, C, Witter, F, Heine, RP, Coleman, JS. Obstetric Surgical Site Infections: 2 grams compared with 3 grams of cefazolin in morbidly obese women. Obstetrics and Gynecology. 2015;126:708–15.Google Scholar
Bratzler, DW, Olsen, KM, Perl, TM, Auwaerter, PG, Bolon, MK, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. American Journal of Health System Pharmacy. 2013;70:195283.Google Scholar
Childress, KMSC, Ward, DG, Berger, K, Gross, GA. A barrier retractor to reduce surgical site infections and wound disruptions in obese patients undergoing cesarean delivery: a randomized controlled trial. American Journal of Obstetrics and Gynecology. 2016;214(285):e110.Google Scholar
Dahike, JD M, Rouse, DJ, Berghella, V, Baxter, JK, Chauhan, SP. Evidence-based surgery for cesarean delivery. American Journal of Obstetrics and Gynecology. 2013;209(4):294306.Google Scholar
Mackeen, AD, Fleisher, J, Vogell, A, Han, C, Sendecki, J, Pettker, C, Leiby, BE, Baxter, JK, Sfakianaki, A, Berghella, V; CROSS Consortium. Suture compared with staple skin closure after cesarean delivery: A randomized controlled trial. Obstetrics and Gynecology. 2014;123(6):1169–75.Google Scholar
Royal College Obstetrics and Gynecology. Reducing the Risk of Venous Thromboembolism during Pregnancy and the Puerperium. GreenTop Guidlines: RCOG; 2015.Google Scholar
Xu, H, Peipert, JF, Zhao, Q, Madden, T, Secura, GM. Contraceptive failure rates of etonogestrel subdermal implants in overweight and obese women. Obstetrics and Gynecology. 2012;120:21–6.CrossRefGoogle ScholarPubMed
Bergisson, NE, Secura, GM, Madden, T, Peipert, JF. Preventing unintended pregnancy: The contraceptive CHOICE Project in review. Journal of Women’s Health. 2015;24(5):349–53.Google Scholar
Yamazaki, M, Sobhan, M, Davis, D, Kim, M-J, Soule, L, Willett, G, Yu, C. Effect of obesity on the effectiveness of hormonal contraceptives: An individual participant data meta-analysis. Contraception. 2015;92(5):445–52.Google Scholar
Segall-Gutierrez, P, Liu, X, Stanzcyk, F, Azen, S, Mishell, DR Jr. Follicular development and ovulation in extremely obese women receiving depo-medroxyprogesterone acetate subcutaneously. Contraception. 2010;81(6):487–95.Google Scholar
Lopez, LM, Chen, M, Otterness, C, Westfoft, C, Edelman, A, Helmerhorst, FM. Hormonal contraceptives for contraception in overweight or obese women. Cochrane Database of Systemic Reviews. 2013(4).Google Scholar
, Wojcicki JM. Maternal prepregnancy body mass index and initiation and duration of breastfeeding: A review of the literature. Journal of Women’s Health. 2011;20(3):341–7.Google Scholar
Turcksin, R, Bel, S, Galjaard, S, Devlieger, R. Maternal obesity and breastfeeding intention, initiation, intensity and duration: A systematic review. Maternal & Child Nutrition. 2014;10(2):166–83.Google Scholar
Amir, LH DS. A systematic review of maternal obesity and breastfeeding intention, initiation, and duration. BMC Pregnancy and Childbirth. 2007;7(9):114.Google Scholar
Jarlenski, MP BW, Bleich, SN, Barry, CL, Stuart, EA. Effects of breastfeeding on postpartum weight loss among U.S. women. Preventive Medicine. 2014;69:146–50.Google Scholar
Lipsky, LM, Strawderman, MS, Olson, CM. Maternal weight change between 1 and 2 years postpartum: The importance of 1 year weight retention. Obesity. 2012;20(7):1496–502.Google Scholar
Rooney, B SC. Excess pregnancy weight gain and long-term obesity: One decade later. Obstetrics and Gynecology. 2002;100(2):245–52.Google Scholar
Drake, AJ RR. Impact of maternal obesity on offspring obesity and cardiometabolic disease risk. Reproduction. 2010;140(3):387–98.Google Scholar
Eriksson, JG SS, Salonen, M, Kajantie, E, Osmond, C. Maternal weight in pregnancy and offspring body composition in late adulthood: Findings from the Helsinki Birth Cohort Study. Annals of Medicine. 2015;47:94–9.Google Scholar
Amorim, AA LY. Diet or exercise, or both, for weight reduction in women after childbirth. Cochrane Database of Systemic Reviews. 2013:CD005627.Google Scholar
Chor, J, Chico, P, Ayloo, S, Roston, A, Kominiarek, MA. Reproductive health counseling and practices: a cross-sectional survey of bariatric surgeons. Surgery for Obesity and Related Diseases. 2015;11(1):187–92.Google Scholar
Johansson, K, Cnattingius, S, Näslund, I, Roos, N, Trolle Lagerros, Y, Granath, F, et al. Outcomes of pregnancy after bariatric surgery. New England Journal of Medicine. 2015;372(9):814–24.Google Scholar
Adams, TO HA, Davidson, LE, Laferrere, B, et al. Maternal and neonatal outcomes for pregnancies before and after gastric bypass surgery. International Journal of Obesity. 2015;39:686–94.CrossRefGoogle ScholarPubMed
Devlieger, R GI, Jans, G, Voets, W, Vanholsbeke, C, Vansant, G. Micronutrient levels and supplement intake in pregnancy after bariatric surgery: A prospective cohort study. PLoS One. 2014;9(12):e114192.CrossRefGoogle ScholarPubMed
Kelly, T YW, Chen, C-S, Reynolds, K, He, J. Global burden of obesity in 2005 and projections to 2030. International Journal of Obesity. 2008;32:1431–7.Google Scholar

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