For obese women, deinitions used in studies of adverse out comes vary widely, and BMIs from >30 kg/mrto >50 kg/mrhave served as thresholds (Crane, 2013; Denison, 2008; Stamilio, 2014). Of outcomes, Mariona (2017) reviewed maternal deaths in Michigan and found that the risk of a maternal death was nearly fourfold higher in obese women. Women with supermorbid obesity experience very high rates of maternal and neonatal complications including preeclampsia, fetal overgrowth, and cesarean delivery, with even higher rates of meconium aspiration, ventilator support, and neonatal death (Marshall, 2014; Smid, 2016). Data from one large study is shown in Figure 48-5.
Especially striking are the markedly elevated rates of hypertension and gestational diabetes. As discussed previously,
Obesity and gestational diabetes are inextricably linked as shown in Table 48-2. heir coexistence with and adverse efects on pregnancy outcomes are discussed in Chapter 57 (pp. 1097 and 1111).
Nonalcoholic fatty liver disease is associated with several adverse pregnancy outcomes. In a cohort of 110 women with NAFLD, risks for preeclampsia, preterm birth, low-birthweight neonates, cesarean delivery, and gestational diabetes were elevated (Hagstrom, 2016). In one prospective study of 476 pregnancies, first-trimester sonographic evidence of maternal NAFLD was strongly associated with gestational diabetes (De Souza, 2016a,b). Meyer and associates (2013) found that overweight and obese gravidas had a higher proportion of low-density lipoprotein III (LDL-III) compared with that of
TABLE 48-2. Adverse Pregnancy Effects in Overweight and Obese Women 18.5-24.9 n = 621,048 2.3 2.7 3.u 20.9 6.6 25.2 2.0
Prevalence (%) with Odds Ratio
Overweight 8MI 25-29.9 Obese 8MI > 30 n = 228,945 4.3 (OR 1n.91n, 1.86-1n.96) 4.3 (OR 1n.60, 1.56-1n.64) 4.1 (OR 1.09, 1.05-1.13) 23.8 (OR 1.19, 1.17-1n.21) 8.3 (OR 1.28, 1.26-1n.31) 31.5 (OR 1.37, 1.34-1.39) 2.4 (OR 1.22, 1n.17-1.28) n = 78,043 8.6 (OR 4.04,n3.94-4.15) 8.1 (OR 3.17, 3.0u-3.25) 4.8 (OR 1.28, 1.23--1n.34) 29.7 (OR 1.60, 1.57--1.64) 11.5 (OR 1.85, 1.81-1.89) 39.3 (OR 1.92, 1.88-1n.96) 2.3 (OR 1.14, 1.08-1.21) 8.4 (OR 1.29, 1.26-1.31) 8.7 (OR 1.34, 1.31-1.37)