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Pregnancy

OBesity Project. Pregnancy. Obesity: Increases obstetric risk during pregnancy. Obesity and Obstetric Risk. Prevalence in reproductive age females (according to CDC): Obesity 30.2% Overweight 56.7%. Obesity and Obstetric Risk in Early Pregnancy. First Trimester pregnancy loss

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Pregnancy

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  1. OBesity Project Pregnancy

  2. Obesity: Increases obstetric risk during pregnancy.

  3. Obesity and Obstetric Risk Prevalence in reproductive age females (according to CDC): Obesity 30.2% Overweight 56.7%

  4. Obesity and Obstetric Risk in Early Pregnancy • First Trimester pregnancy loss • Increased risk first trimester loss (OR 1.2) • Increased risk recurrent pregnancy loss (OR 3.5) • Increased risk loss after IVF or ICSI (OR 1.77)

  5. Obesity and Risk of Congenital Abnormality • Increased risk for fetal malformations • Neural tube defects (OR 1.8) • Congenital heart disease (OR 1.18) • Omphalocele (OR 3.3)

  6. Obesity and Risk of Congenital Abnormality • Mechanism responsible for malformations not well understood • Possible unrecognized type 2 DM • Obesity limits the ability of ultrasound to detect malformations

  7. Obesity and Obstetric Complications in Late Pregnancy • Association with preterm delivery (PTD) risk • Spontaneous PTD is related to low BMI, poor maternal weight gain • PTD in obese population probably related to indicated deliveries due to medical or obstetrical complications

  8. Obesity and Obstetric Complications in Late Pregnancy • Increased risk for gestational HTN, preeclampsia, GDM • GDM due to decreased insulin sensitivity compared to nonobese • Obesity/ metabolic syndrome also associated with probable increase in other preexisting medical problems such as nonalcoholic fatty liver and sleep apnea, which were previously seen only in older populations

  9. Obesity and Obstetric Complications in Late Pregnancy

  10. Obesity and Obstetric Complications in Late Pregnancy • IUFD risk • Risk is 2x in overweight and 2.5x in obese • Pathophysiology is unknown

  11. Obesity and Obstetric Complications in Late Pregnancy • Increased risk of macrosomia • Increased risk C/S and complications • Wound infection • Blood loss • Thromboembolism • Endometritis • VBAC less successful

  12. Delivery Issues • Obese women are at higher risk of other complications at delivery and post-partum • Obstetric hemorrhage (1.6X) • Shoulder dystocia • Thromboembolism • Difficulty Breast Feeding

  13. Risk of Children Born to Obese Mothers • Long term risks to children born to obese mothers • Both maternal obesity and fetal macrosomia approximately double the risk of adolescent obesity and metabolic syndrome (obesity, hypertension, glucose intolerance, dyslipidemia) • Increased risk of Autism

  14. Metabolic Aging Fetal-Neonatal Metabolic programming of Obesity Adult Metabolic syndrome T2DM and Obesity In utero Programming of Obesity and Metabolic Dysfunction Pregnancy Increased Insulin resistance (Obesity/GDM) Childhood Obesity ? Pre-metabolic syndrome Catalano; JCEM, 2003

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