Pelvic infection 0.6 0.7 (OR 1.16, 1.06-1.26) 0.8 (OR 1.28, 1.15-1n.43)
Wound infection or complication 0.4 0.5 (OR 1.42, 1.28-1.58) 1.0 (OR 2.70, 2.42-3.01)
Large for gestational age 8.7 13.1 (OR 1.57, 1.54-1.61) 16.3 (OR 2.04, 1.99-2.10)
Macrosomia 2.0 3.6 (OR 1.81, 1.74-1.88) 5.1 (OR 2.60, 2.50-2.71) Stillbirth 0.3 1.8 (OR 5.89, 5.57-6.22) 0.5 (OR 1.71, 1.56-1.87) aOdds ratios with 95% CI are significant when compared to normal BMI group. BMI = body mass index.
Data from Kim, 2016; Lisonkova, 2017; Ovesen, 20n1n1; Schummers, 2015; Sebire, 2001n.
normal-weight women. LDL-III predominance is a hallmark of ectopic liver fat accumulation that is typical of NAFLD. At Parkland Hospital, we are now frequently encountering obese gravidas who have NAFLD and evidence of steatohepatitis manifest by elevated serum hepatic transaminase levels. In rare cases, liver biopsy is necessary to exclude other causes.
In addition to these metabolic complications, quality-of-life measures are also negatively afected by obesity during pregnancy (Amador, 2008; Ruhstaller, 2017). One systematic review found significantly higher risks ofdepression in overweight and obese women during and after pregnancy (Molyneaux, 2014). Obese women were also significantly more likely to experience anxiety during pregnancy.
Stillbirths are more prevalent as the degree of obesity accrues (Ovesen, 2011; Schummers, 2015). In a review of almost 100 -15-:))..)S 10)):)0'3E 5 0 30 20
FIGURE 48-6 Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study: frequency of preeclampsia according to BMI. (Data from the HAPO Study Cooperative Research Group, 2008.)
D Controls (BMI <30) (n 3752) D Obese (BMI 30-35) (n = 1473) • Morbidly obese (BMI >35) (n = 877) 4.8 8.3
FIGURE 48-5 Incidence of selected pregnancy outcomes in 16,102 women enrolled in the FASTER (First-and Second-Trimester Evaluation of Risk) trial according to BMI. (Data from Weiss, 2004.) studies, obesity was the highest ranking modifiable risk factor for stillbirth (Flenady, 201l). In super-morbidly obese compared with normal-weight gravidas, Yao and associates (2014) found 5.7 and l3.6-fold higher stillbirth rates at 39 and 41 weeks' gestation, respectively. Remarkably, 25 percent of term stillbirths in this study involved obese women. Chronic hypertension with superimposed preeclampsia associated with obesity is one cause of excessive stillbirths.