Weight loss is tremendously diicult for obese individuals. If achieved, long-term maintenance poses equally daunting challenges. Obstetrician-gynecologists are encouraged to aid weight 4.42 loss in obese adult women. Successful approaches include behavioral, pharmacological, and surgical techniques or a combination of these methods (Dixon, 2016). Dietary changes and exercise reduce weight and rates of the associated metabolic syndrome (Garvey, 2016; Martin, 2016). When used in conjunction with bariatric surgery, glucose control in those with type 2 diabetes is improved (Schauer, 2014). However, both surgical and medical interventions are associated with appreciable long-term failure rates-up to 50 percent in patients with type 2 diabetes undergoing bariatric surgery (Mingrone, 2015).
Obese women unequivocally have reproductive disadvantages (American Society for Reproductive Medicine, 2015).r1his translates into diiculty in achieving pregnancy, early and recurrent pregnancy loss, preterm delivery, and several obstetrical, medical, and surgical complications with pregnancy, labor, delivery, and the puerperium (American College of Obstetricians and Gynecologists, 2015). Also, oral contraceptive failure may be more likely in overweight women (Chap. 38, p. 691). Last, infantsand later, adult children-of obese mothers have correspondingly higher morbidity rates (Godfrey, 2017; Reynolds, 2013).
Obesity complicating pregnancy has grown substantially in this country. Our experience at Parkland Hospital over three epochs is shown in Figure 48-4.
For overweight women, higher rates of adverse outcomes complicate pregnancy (Schummers, 2015). Shown in Table 48-2 are results from ive studies including more than 1 million singleton pregnancies. Although not as magniied as in the obese cohort, rates of almost all complications are signiicantly greater in overweight women than in those whose BMI is normal.
obesity and the metabolic syndrome are charac terized by insulin resistance, which causes low grade inlammation and endothelial activation (Ma, 2016). hese latter efects playra central role in preeclampsia (Chap. 40, p. 715). he overwhelming evidence between rising maternal BMI and the incidence of preeclampsia is depicted in Figure 48-6. Similar observations were reported from a large Canadian study and by the Safe Labor Consortium (im, 2016; Schummers, 2015).
Obesity and hypertension are common cofactors in peripartum heart failure (Cunningham, 1986,r2012). Stewart and colleagues (2016) prospectively studied the efect of obesity on cardiac remodeling in pregnancy among 14 normal and 9 overweight or obese women (Fig. 4-8, p. 61).
FIGURE 48-4 Increasing prevalence of obesity during four epochs in pregnant women classified at the time of their first prenatal visit at Parkland Hospital. regressed to normal by 3 months postpartum.
or women (Fig. 48-7). This, however,