Fetal and infant outcomes in obese pregnant women

doi:10.1017/CBO9780511782466.007

6 - Fetal and infant outcomes in obese pregnant women

from Section 2 - Pregnancy outcome

Published online by Cambridge University Press: 05 August 2012

Ruth Bell ,

Peter W. G. Tennant and

Judith Rankin

Edited by

Matthew W. Gillman and

Lucilla Poston

Show author details

Matthew W. Gillman: Affiliation:
Harvard Medical School
Lucilla Poston: Affiliation:
King's College London

Book contents

Get access

Summary

Introduction

Fetal loss, stillbirth, infant death, and major structural congenital anomalyare among the most serious adverse outcomes that have been associated withmaternal obesity. This chapter summarizes the available epidemiologicalevidence, and discusses potential explanations and public healthimplications.

Maternal obesity and the risk of fetaland infant death

Fetal death and maternal obesity

Fetal death is the delivery of a fetus or infant that shows no signs of life.Fetal deaths are categorized as stillbirths or miscarriages on the basis ofgestational age at delivery. A stillbirth is the delivery of a baby at agestational age beyond the accepted threshold for viability that shows nosigns of life, and a miscarriage is a fetal loss at an earlier gestationalage. h e gestational age threshold dei ning stillbirth varies betweencountries, from 20 weeks in the United States [1], 24 weeks in the UK [2],and 28 weeks in other parts of Europe [3].

Around 1 in 200 births in developed countries ends in a stillbirth [4, 5],with limited evidence of improvement in recent years [1, 2]. Known maternalrisk factors for stillbirth include advanced age, nulliparity, ethnicbackground, maternal diabetes, hypertension, obesity, and smoking [ 6– 8]. he majority of stillbirths, around 85%, occur before the onset of labor(antepartum stillbirths) and the remainder occur during labor (intrapartumstillbirths) [2]. In epidemiological studies, a high proportion ofstillbirths, 10% to 70% depending on cause of death classii cation, aredescribed as “unexplained,” with no apparent underlying cause [5, 9]. Whileclinically many stillbirths occur unexpectedly in apparently uncomplicatedpregnancies, if exhaustive post-mortem investigations are undertaken, anunderlying cause can be identified in most cases [5]. However, in routineclinical practice, permission for autopsy is frequently either denied or notsought. The most frequent disorders include placental pathology, infection,umbilical cord abnormalities, congenital anomalies, and maternal medicaldisorders including diabetes and hypertension [9].

Keywords

BMI congenital anomaly fetal loss public health pregnancy maternal obesity neonatal mortality

Information

Type: Chapter
Information: Maternal Obesity , pp. 56 - 69

DOI: https://doi.org/10.1017/CBO9780511782466.007 [Opens in a new window]

Publisher: Cambridge University Press

Print publication year: 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Book purchase

Temporarily unavailable

References

MacDorman, M Kirmeyer, S Fetal and perinatal mortality, United States, 2005 Natl Vital Stat Rep 2009 57 1 Google Scholar

Centre for Maternal and Child Enquiries (CMACE) Perinatal Mortality 2008: United Kingdom London 2010

Gissler, M Mohangoo, A D Blondel, B Perinatal health monitoring in Europe: results from the EURO-PERISTAT project Inform Health Soc Care 2010 35 64 Google Scholar

Stanton, C Lawn, J E Rahman, H Wilczynska-Ketende, K Hill, K Stillbirth rates: delivering estimates in 190 countries Lancet 2006 367 1487 Google Scholar

Flenady, V Middleton, P Smith, G Stillbirths: the way forward in high-income countries Lancet 2011 377 1703 Google Scholar

Fretts, R C Etiology and prevention of stillbirth Am J Obstet Gynecol 2005 193 1923 Google Scholar

Reddy, U Laughon, S Sun, L Prepregnancy risk factors for antepartum stillbirth in the United States Obstet Gynecol 2010 116 1119 Google Scholar

Flenady, V Koopmans, L Middleton, P Major risk factors for stillbirth in high-income countries: a systematic review and meta-analysis Lancet 2011 377 1331 Google Scholar

Smith, G C Fretts, R C Stillbirth Lancet 2007 370 1715 Google Scholar

Chu, S Y Kim, S Y Lau, J Maternal obesity and risk of stillbirth: a metaanalysis Am J Obstet Gynecol 2007 197 223 Google Scholar

Getahun, D Ananth, C Kinzler, W Risk factors for antepartum and intrapartum stillbirth: a population-based study Am J Obstet Gynecol 2007 196 499 Google Scholar

Khashan, A Kenny, L The effects of maternal body mass index on pregnancy outcome Eur J Epidemiology 2009 24 697 Google Scholar

Sebire, N J Jolly, M Harris, J P Maternal obesity and pregnancy outcome: a study of 287,213 pregnancies in London Int J Obesity Related Metabol Disord 2001 25 1175 Google Scholar

Cnattingius, S Lambe, M Trends in smoking and overweight during pregnancy: prevalence, risks of pregnancy complications, and adverse pregnancy outcomes Seminars Perinatology 2002 26 286 Google Scholar

Smith, G Shah, I White, I Maternal and biochemical predictors of antepartum stillbirth among nulliparous women in relation to gestational age of fetal death BJOG 2007 114 705 Google Scholar

Hauger, M S Gibbons, L Vik, T Belizán, J M Prepregnancy weight status and the risk of adverse pregnancy outcome Acta Obstet Gynecol Scand 2008 87 953 Google Scholar

Tennant, P W G Rankin, J Bell, R Maternal body mass index and the risk of fetal and infant death: a cohort study from the North of England Human Reprod 2011 26 1501 Google Scholar

Salihu, H Dunlop, A Hedayatzadeh, M Extreme obesity and risk of stillbirth among black and white gravidas Obstet Gynecol 2007 110 552 Google Scholar

Centre for Maternal and Child Enquiries Maternal Obesity in the UK: Findings from a National Project London: CMACE 2010

Metwally, M Ong, K J Ledger, W L Li, T C Does high body mass index increase the risk of miscarriage after spontaneous and assisted conception? A meta-analysis of the evidence Fertil Steril 2008 90 714 Google Scholar

Kramer, M S Liu, S Luo, Z C Analysis of perinatal mortality and its components: time for a change? Am J Epidemiol 2002 156 493 Google Scholar

Nohr, E A Bech, B H Davies, M J Prepregnancy obesity and fetal death: a study within the Danish National Birth Cohort Obstet Gynecol 2005 106 250 Google Scholar

Mathews, T MacDorman, M F Infant mortality statistics from the 2006 period linked birth/infant death data set Natl Vital Stat Rep 2010 58 1 Google Scholar

Smith, L K Manktelow, B N Draper, E S Springett, A Field, D J Nature of socioeconomic inequalities in neonatal mortality: population based study BMJ 2010 341 c6654 Google Scholar

UN Inter-agency Group for Child Mortality Estimation Levels and Trends in Child Mortality United Nations Childrens Fund 2010

Kramer, M S The epidemiology of adverse pregnancy outcomes: an overview J Nutr 2003 133 1592S Google Scholar

D H Health Inequalities Unit Review of the Health Inequalities Infant Mortality PSA Target London Department of Health 2007

Cedergren, M I Maternal morbid obesity and the risk of adverse pregnancy outcome Obstet Gynecol 2004 103 219 Google Scholar

Kristensen, J Vestergaard, M Wisborg, K Kesmodel, U Secher, N J Pre-pregnancy weight and the risk of stillbirth and neonatal death BJOG 2005 112 403 Google Scholar

Chen, A Feresu, S A Fernandez, C Rogan, W J Maternal obesity and the risk of infant death in the United States Epidemiology 2009 20 74 Google Scholar

Nohr, E Vaeth, M Bech, B Maternal obesity and neonatal mortality according to subtypes of preterm birth Obstet Gynecol 2007 110 1083 Google Scholar

Villamor, E Cnattingius, S Interpregnancy weight change and risk of adverse pregnancy outcomes: a population-based study Lancet 2006 368 1164 Google Scholar

Bodnar, L M Ness, R B Markovic, N Roberts, J M The risk of preeclampsia rises with increasing prepregnancy body mass index Ann Epidemiol 2005 15 475 Google Scholar

Chu, S Y Callaghan, W M Kim, SY Maternal obesity and risk of gestational diabetes mellitus Diabetes Care 2007 30 2070 Google Scholar

McDonald, S Han, Z Mulla, S Beyene, J Overweight and obesity in mothers and risk of preterm birth and low birth weight infants: systematic review and meta-analyses BMJ 2010 341 c3428 Google Scholar

Nelson, S M Matthews, P Poston, L Maternal metabolism and obesity: modifiable determinants of pregnancy outcome Hum Reprod Update 2010 16 255 Google Scholar

Sattar, N Ramsay, J Crawford, L Cheyne, H Greer, I Classic and novel risk factor parameters in women with a history of preeclampsia Hypertension 2003 42 39 Google Scholar

Wolf, M Kettyle, E Sandler, L Obesity and pre-eclampsia: the potential role of inflammation Obstet Gynecol 2001 98 757 Google Scholar

Nohr, E A Vaeth, M Baker, J L Combined associations of prepregnancy body mass index and gestational weight gain with the outcome of pregnancy Am J Clin Nutr 2008 87 1750 Google Scholar

Gardosi, J Clausson, B Francis, A Maternal obesity and the risk of stillbirth in small-for-gestational-age babies identified by customised birthweight centiles Arch Dis Child (Fetal Neonatal Ed) 2008 93 Fa5 Google Scholar

Phatak, M Ramsay, J Impact of maternal obesity on procedure of mid-trimester anomaly scan J Obstet Gynaecol 2010 30 447 Google Scholar

Franklin, K Holmgren, P Jonsson, F Snoring, pregnancy-induced hypertension, and growth retardation of the fetus Chest 2000 117 137 Google Scholar

Thompson, D R Clark, C L Wood, B Zeni, M B Maternal obesity and risk of infant death based on Florida birth records for 2004 Pub Health Rep 2008 123 487 Google Scholar

Leung, T Y Leung, T N Sahota, D S Trends in maternal obesity and associated risks of adverse pregnancy outcomes in a population of Chinese women BJOG 2008 115 1529 Google Scholar

Baeten, J M Bukusi, E A Lambe, M Pregnancy complications and outcomes among overweight and obese nulliparous women Am J Public Health 2001 91 436 Google Scholar

WHO Expert, Consultation Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies Lancet 2004 363 157 Google Scholar

Heslehurst, N Sattar, N Rajasingham, D Maternal obesity and ethnic groups: trends in 552,303 births over thirteen years in England, UK Arch Dis Child (Fetal Neonatal Ed) 2010 95 Fa33 Google Scholar

Rankin, J Pattenden, S Abramsky, L Prevalence of congenital anomalies in five British regions, 1991–1999 Arch Dis Child (Fetal Neonatal Ed) 2005 90 Fa374 Google Scholar

Heron, M Hoyert, D Murphy, S Deaths: final data for 2006 Natl Vital Stat Rep 2009 57 1 Google Scholar

Rasmussen, S A Chu, S Y Kim, S Y Schmid, C H Lau, J Maternal obesity and risk of neural tube defects: a metaanalysis Am J Obstet Gynecol 2008 198 611 Google Scholar

Stothard, K J Tennant P, W Bell, R Rankin, J Maternal overweight and obesity and the risk of congenital anomalies JAMA 2009 301 636 Google Scholar

Anderson, J L Waller, D K Canfield, M A Maternal obesity, gestational diabetes, and central nervous system birth defects Epidemiology 2005 16 87 Google Scholar

Blomberg, M I Källén, B Maternal obesity and morbid obesity: the risk for birth defects in the offspring Birth Defects Res A Clin Mol Teratol 2010 88 35 Google Scholar

Hendricks, K A Nuno, O M Suarez, L Larsen, R Effects of hyperinsulinemia and obesity on risk of neural tube defects among Mexican Americans Epidemiology 2001 12 630 Google Scholar

Källén, K Maternal smoking, body mass index, and neural tube defects Am J Epidemiol 1998 147 1103 Google Scholar

Li, Z Liu, J Ye, R Maternal prepregnancy body mass index and risk of neural tube defects: a population-based case-control study in Shanxi province, China Birth Defects Res A Clin Mol Teratol 2010 88 570 Google Scholar

Oddy, W H De Klerk, N H Miller, M Payne, J Bower, C Association of maternal pre-pregnancy weight with birth defects: evidence from a case-control study in Western Australia Aust N Z J Obstet Gynaecol 2009 49 11 Google Scholar

Rankin, J Tennant P, W Stothard, K J Maternal body mass index and congenital anomaly risk: a cohort study Int J Obesity 2010 34 1371 Google Scholar

Shaw, G M Velie, E M Schaffer, D Risk of neural tube defect-affected pregnancies among obese women JAMA 1996 275 1093 Google Scholar

Shaw, G M Carmichael, S L Prepregnant obesity and risks of selected birth defects in offspring Epidemiology 2008 19 616 Google Scholar

Waller, D K Mills, J L Simpson, J L Are obese women at higher risk for producing malformed offspring? Am J Obstet Gynecol 1994 170 541 Google Scholar

Waller, D K Shaw, G M Rasmussen, S A Prepregnancy obesity as a risk factor for structural birth defects Arch Pediat Adol Med 2007 161 745 Google Scholar

Watkins, M L Scanlon, K S Mulinare, J Khoury, M J Is maternal obesity a risk factor for anencephaly and spina bifida? Epidemiology 1996 7 507 Google Scholar

Watkins, M L Rasmussen, S A Honein, M A Botto, L D Moore, C A Maternal obesity and risk for birth defects Pediatrics 2003 111 1152 Google Scholar

Werler, M M Louik, C Shapiro, S Mitchell, A A Prepregnant weight in relation to risk of neural tube defects JAMA 1996 275 1089 Google Scholar

Cedergren, M I Selbing, A J Källén, B A J Risk factors for cardiovascular malformation – a study based on prospectively collected data Scand J Work Environ Health 2002 28 12 Google Scholar

Khalil, H S Saleh, A M Subhani, S N Maternal obesity and neonatal congenital cardiovascular defects Int J Gynaecol Obstet 2008 102 232 Google Scholar

Martínez-Frías, M L Frías, J P Bermejo, E Pre-gestational maternal body mass index predicts an increased risk of congenital malformations in infants of mothers with gestational diabetes Diabet Med 2005 22 775 Google Scholar

Mills, J L Troendle, J Conley, M R Carter, T Druschel, C M Maternal obesity and congenital heart defects: a population-based study Am J Clin Nutr 2010 91 1543 Google Scholar

Watkins, M L Botto, L D Maternal prepregnancy weight and congenital heart defects in offspring Epidemiology 2001 11 439 Google Scholar

Slickers, J E Olshan, A F Siega-Riz, A M Honein, M A Aylsworth, A S Maternal body mass index and lifestyle exposures and the risk of bilateral renal agenesis or hypoplasia Am J Epidemiology 2008 168 1259 Google Scholar

Ma, C Carmichael, S L Scheuerle, A E Canfield, M A Shaw, G M Association of microtia with maternal obesity and periconceptional folic acid use Am J Med Genet A 2010 152 2756 Google Scholar

Draper, E Rankin, J Tonks, A Recreational drug use – a major risk factor for gastroschisis? Am J Epidemiology 2008 167 485 Google Scholar

Carmichael, S L Rasmussen, S A Shaw, G M Prepregnancy obesity: a complex risk factor for selected birth defects Birth Defects Res A Clin Mol Teratol 2010 88 804 Google Scholar

Balsells, M Garcia-Patterson, A Gich, I Corcoy, R Maternal and fetal outcome in women with type 2 versus type 1 diabetes mellitus: a systematic review and metaanalysis J Clin Endocrinol Metab 2009 94 4284 Google Scholar

Wee, C C Hamel, M B Huang, A Obesity and undiagnosed diabetes in the U.S Diabetes Care 2008 31 1813 Google Scholar

Zabihi, S Loeken, M R Understanding diabetic teratogenesis: where are we now and where are we going? Birth Defects Res A Clin Mol Teratol 2010 88 779 Google Scholar

Wentzel, P Can we prevent diabetic birth defects with micronutrients? Diabetes Obes Metab 2009 11 770 Google Scholar

Loeken, M R Free radicals and birth defects J Matern Fetal Neonatal Med 2004 15 6 Google Scholar

Correa, A Gilboa, S M Besser, L M Diabetes mellitus and birth defects Am J Obstet Gynecol 2008 199 237e1 Google Scholar

Czeizel, A Periconceptual folic acid and multivitamin supplementation for the prevention of neural tube defects and other congenital abnormalities Birth Defects Res A Clin Mol Teratol 2009 85 260 Google Scholar

Mojtabai, R Body mass index and serum folate in childbearing age women Eur J Epidemiology 2004 19 1029 Google Scholar

Ray, J G Wyatt, P R Vermeulen, M J Meier, C Cole D, E Greater maternal weight and the ongoing risk of neural tube defects after folic acid flour fortification Obstet Gynecol 2005 105 261 Google Scholar

Keen, C Clegg, M Hannah, L The plausibility of micronutrient deficiency being a significant contributing factor to the occurrence of pregnancy complications J Nutrition 2003 133 1597S Google Scholar

Kimmons, J Blanck, H Tohill, B Zhang, J Khan, L Associations between body mass index and the prevalence of low micronutrient levels among US adults MedGenMed 2006 8 59 Google Scholar

Flegal, K Carroll, M Ogden, C Curtin, L Prevalence and trends in obesity among US adults, 1999–2008 JAMA 2010 303 235 Google Scholar

Martin, J Hamilton, B Sutton, P Births: final data for 2007 Natl Vit Stat Rep 2010 58 1 Google Scholar

Cragan, J Gilboa, S Including prenatal diagnoses in birth defects monitoring: experience of the Metropolitan Atlanta Congenital Defects Program Birth Defects Res A Clin Mol Teratol 2009 85 20 Google Scholar

Waitzman, N Romano, P Scheffler, R Estimates of the economic costs of birth defects Inquiry 1994 31 188 Google Scholar

Jamison, D Shahid-Salles, S Jamison, J Lawn, J Zupan, J Lopez, A Mathers, C Ezzati, M Jamison, D Murray, C Global Burden of Disease and Risk Factors Washington, DC The World Bank 2006

McLaren, L Socioeconomc status and obesity Epidemiol Rev 2007 29 29 Google Scholar

Kulhmann, A Dietz, P Galavotti, C England, L Weight management interventions for pregnant or postpartum women Am J Prev Med 2008 34 523 Google Scholar

Accessibility standard: Unknown

Accessibility compliance for the PDF of this book is currently unknown and may be updated in the future.