Maternal Obesity

Afflicting more than 300 million women across the globe, obesity has profound effects on health during pregnancy and on the wellbeing of the unborn child. In the face of such a challenging pandemic, this book reviews the latest research and provides up-to-date advice on clinical management. Maternal Obesity addresses the adverse effects of obesity among women of childbearing age, including infertility, medical complications, problems in labor, and adverse birth outcomes, and it reviews evidence that the obese mother's in utero environment has long-lasting influences on the health of the developing child. Chapters cover basic, clinical, and population perspectives, providing a range of valuable information from mechanistic insight through to public health and policy implications. Invaluable for obstetricians, gynaecologists, paediatricians, general and family physicians, subspecialists in obstetric and paediatric medicine, midwives, and dietitians, as well as researchers and public health policy makers seeking to tackle the burden of maternal obesity-related illness.

A dramatic and worldwide increase is occurring in the prevalence of overweight and obesity in women of childbearing age. Obese women carry a significant excess risk of a variety of serious complications during pregnancy, and in addition, maternal obesity predisposes to obesity in the offspring. This book provides a timely update on the latest knowledge on maternal obesity and pregnancy. A very wide range of issues are covered, including macrosomia and associated shoulder dystocia; the risk of miscarriage, malformations, and complications of pregnancy; the impact of hyperglycemia; clinical management; consequences for anesthesia and ultrasound; impacts on breastfeeding, fertility, and childhood obesity; and pregnancy following gastric surgery. All of the authors are recognized experts in their fields, and the book has been designed to meet the practical needs of obstetricians, gynecologists, internists, and general practitioners.

Obesity and Obstetrics, Second Edition, brings together experts to examine the issues and challenges of obesity and obstetrics, also discussing how obesity affects fertility, reproduction and pregnancy. Beginning with the worldwide epidemic of obesity, chapters then go on to review obesity and hyperglycemia of pregnancy, management of labor, interventions to improve care during pregnancy, and long-term impact of maternal obesity. Provides an essential reference on the significant risk of complications during pregnancy, including early pregnancy loss, recurrent miscarriage and fetal developmental abnormalities Builds foundational knowledge on how maternal obesity predisposes offspring to obesity, highlighting that the prevention of childhood obesity begins during pregnancy Assembles critically evaluated chapters focused on obesity and obstetrics to meet the practical needs of obstetricians, endocrinologists and general practitioners

As women of childbearing age have become heavier, the trade-off between maternal and child health created by variation in gestational weight gain has become more difficult to reconcile. Weight Gain During Pregnancy responds to the need for a reexamination of the 1990 Institute of Medicine guidelines for weight gain during pregnancy. It builds on the conceptual framework that underscored the 1990 weight gain guidelines and addresses the need to update them through a comprehensive review of the literature and independent analyses of existing databases. The book explores relationships between weight gain during pregnancy and a variety of factors (e.g., the mother's weight and height before pregnancy) and places this in the context of the health of the infant and the mother, presenting specific, updated target ranges for weight gain during pregnancy and guidelines for proper measurement. New features of this book include a specific range of recommended gain for obese women. Weight Gain During Pregnancy is intended to assist practitioners who care for women of childbearing age, policy makers, educators, researchers, and the pregnant women themselves to understand the role of gestational weight gain and to provide them with the tools needed to promote optimal pregnancy outcomes.

This book summarizes the effects of overweight/obesity in the childbearing years that can be effectively communicated to patients by their providers in a busy practice setting, and provides concise and understandable summaries of the evidence-based, theory-driven lifestyle interventions that have been shown to be effective for weight loss and modifying the risk of developing diabetes and obesity.

It has become increasingly difficult to keep up with the growing body of literature on the genetics, metabolic phenotype and treatment of obesity. This volume brings together an array of chapters from many of the foremost authorities and researchers in this area. Key advances in the genetics of obesity are summarized and the effects of obesity in pregnancy, childhood and old age explored. By scrutinizing the hormones and enzymes most recently implicated in the development, maintenance and consequences of obesity, the biochemical and physiological background of the abnormal metabolism of obesity is mapped out. Furthermore, a practical update on clinical approach and treatment of obesity is offered. Finally, the social aspects of obesity and the view of the obese body in art throughout the centuries are reflected. A valuable overview of causes, metabolic disturbances and treatment options, this volume will appeal to those with an interest in clinical as well as pathophysiological and genetic aspects of obesity. Furthermore, it will provide useful reading for scientists and students who would like to broaden and update their knowledge in this area.

Background: The prevalence of obesity substantially increases in pregnant women. Maternal obesity is associated with adverse maternal and neonatal outcomes. The increased risk for cesarean section present in obese women has been related to potential impaired uterine contractility. The mechanism that underlies this theory is not clear. In vitro studies have shown that leptin, produced by adipose tissue and the placenta, exerts an inhibitory effect on myometrial contractility. The aim of this thesis was to evaluate the labor process in relation to maternal body mass index (BMI) and the clinical role of leptin in this process. Material and Methods: Studies I-IV are cohort studies. The first two studies analyze the association between labor duration and maternal BMI based on data from the Perinatal Revision South register and the Swedish Pregnancy Register. Study I included 63,829 nulliparous women with a spontaneous onset of labor between 1995 and 2009. Study II included 15,259 nulliparous women with induced labor between 2014 and 2017. In study III, the maternal leptin levels during and after pregnancy were analyzed in 343 obese women with respect to their obesity class (I-III) and degree of gestational weight gain (GWG). In study IV, the association between the maternal leptin levels measured in active labor and duration of the active phase of labor was analyzed in 914 women. Results: The duration of spontaneous labor significantly increased with an increasing maternal BMI; however, the duration of the pushing phase was inversely related to BMI. Time in induced labor increased with maternal BMI; however, the differences between the BMI categories were more pronounced in the latent phase than the active phase. Leptin levels were higher in women with obesity class III than women with class I during and after pregnancy. The degree of GWG in obese women was not associated with maternal leptin. No significant association between maternal leptin and the duration of the active phase of labor was identified in the adjusted analyses. Conclusions: Nulliparous obese women have a higher risk for a prolonged duration of spontaneous and induced labor. This is important to consider prior to diagnosing labor arrest that results in a cesarean delivery. As maternal leptin levels are increased with the degree of obesity during pregnancy, future research on the association of high maternal leptin levels and the duration of labor is warranted.

This volume will explore the epidemiology and the basic mechanisms of each of these prenatal phenomena, in an attempt to explain the role of the prenatal environment in promoting postnatal weight gain. This information will contribute to resolving the nature-nurture controversy. This information provides guidance to clinical practitioners involved in both prenatal and postnatal care. This volume further stimulates research into underlying mechanisms and prevention and treatment of this phenomenon.