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Query: UMLS:C0028754 (obesity)
 124,988 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Over one third of reproductive age women are obese, and this marked prevalence is impacting pregnancy. Obese women face many challenges from preconception to postpartum. They are at increased risk for both maternal and fetal complications including gestational diabetes, hypertension, preeclampsia, congenital anomalies, stillbirth, fetal macrosomia, cesarean delivery, venous thromboembolism, wound complications, breast-feeding difficulty, postpartum depression, postpartum weight retention, and neonatal death. This discussion is designed to help clinicians understand how obesity affects pregnancy, how to counsel patients regarding gestational weight gain, and how to implement management strategies during pregnancy to optimize health outcomes for these patients.
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PMID:The clinical approach to obesity in pregnancy. 2502 97

Genetic variants in the FTO (fat mass- and obesity-associated) gene have the highest association of all obesity-associated genes. Its placental expression was shown to relate to birth weight, suggesting that it may participate in the control of fetal weight gain. To gain more insight into the implication of FTO in fetal growth, we measured its placental expression in samples including extremes of abnormal fetal growth, such as after intrauterine growth restriction (IUGR) or macrosomia in both rats and humans. In rats, fetal growth was modulated by maternal nutritional modifications. In humans, placental villi were collected from pathological pregnancies (i.e. with IUGR or fetal macrosomia). Placental FTO mRNA expression was reduced by IUGR but was not significantly affected by macrosomia in either rats or humans. Our data suggest that placental FTO may participate in interactions between the in utero environment and the control of fetal growth under IUGR conditions by modulating epigenetic processes.
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PMID:Placental expression of the obesity-associated gene FTO is reduced by fetal growth restriction but not by macrosomia in rats and humans. 2505 79

The global obesity epidemic is changing the face of maternal-fetal medicine. One in five women is obese at time of conception, and increasing numbers of parturients have undergone bariatric surgery. Recent publication of large, population-based studies and comparison studies of preoperative and post-operative pregnancies have highlighted new risks and benefits to the mother and child. Pregnancy after bariatric surgery appears to effectively reduce the risk of complications such as fetal macrosomia, gestational diabetes mellitus, and hypertensive disorders of pregnancy; however, women who become pregnant after bariatric surgery may constitute a unique obstetric population with an increased risk for preterm and small-for-gestational-age infants. In this article, we provide an overview of the current knowledge of the impact of maternal bariatric surgery on neonatal and pregnancy outcomes.
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PMID:Pregnancy and neonatal outcome after bariatric surgery. 2522 55

Gestational diabetes mellitus (GDM) complicates 3-15% of pregnancies depending upon the geographic location and ethnic groups, and its incidence is estimated to increase even further due to the increasing rates of obesity in the general population and the trend towards advanced maternal age in pregnancy. GDM is associated with adverse pregnancy outcome such as an increased rate of fetal macrosomia, neonatal metabolic disturbances, and maternal injuries. It has been shown that there is an inverse relation between maternal glycemic control and the risk of complications. When diet and exercise therapy fail in achieving good glycemic control, pharmacological intervention is warranted. This chapter deals with the evidence regarding the various pharmacological interventions for glycemic control in women with GDM, when to start, and what pharmacological agent to use.
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PMID:Management of diabetes and pregnancy--when to start and what pharmacological agent to choose? 2526 63

The rapidly rising number of individuals who are overweight and obese has been called a worldwide epidemic of obesity with >35% of adults today considered to be overweight or obese. Women are more likely to be overweight and obese than their male counterparts, which has far-reaching effects on reproductive health and specifically pregnancy, with obese women facing an increased risk of gestational diabetes, preeclampsia, operative delivery, fetal macrosomia, and neonatal morbidity. The etiology of obesity is highly complex encompassing genetic, environmental, physiologic, cultural, political, and socioeconomic factors, making it challenging to develop effective interventions on both a local and global scale. This article describes the extent and the cost of the obesity epidemic, which, although historically seen as a disease of high-income countries, is now clearly a global epidemic that impacts low- and middle-income countries and indigenous groups who bear an ever-increasing burden of this disease.
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PMID:The worldwide epidemic of female obesity. 2548 57

Maternal obesity is of major consequence, affecting every aspect of maternity care including both short- and long-term effects on the health of the offspring. Obese mothers are at a higher risk of developing gestational diabetes and pre-eclampsia, potentially exposing the foetus to an adverse intrauterine environment. Maternal obesity is linked to foetal macrosomia, resulting in increased neonatal and maternal morbidity. Foetal macrosomia is a result of a change in body composition in the neonate with an increase in both percentage fat and fat mass. Maternal obesity and gestational weight gain are associated with childhood obesity, and this effect extends into adulthood. Childhood obesity in turn increases chances of later life obesity, thus type 2 diabetes, and cardiovascular disease in the offspring. Further clinical trials of lifestyle and, potentially, pharmacological interventions in obese pregnant women are required to determine whether short- and long-term adverse effects for the mother and child can be reduced.
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PMID:Impact of maternal obesity on perinatal and childhood outcomes. 2549 83

Obesity has increased dramatically in the United States over the last several decades, with approximately 40% of pregnant women now considered overweight or obese. Obesity has been shown to be associated with numerous poor pregnancy outcomes, including increased rates of preeclampsia, gestational diabetes, fetal macrosomia, stillbirth, postterm pregnancy, and increased rates of cesarean delivery. Many of these complications have been found to increase even further with increasing body mass index in a dose-response fashion. In this review, the association of obesity with maternal, fetal, and pregnancy outcomes is discussed as are the recommendations for caring for the obese gravida.
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PMID:Pregnancy risks associated with obesity. 2600 70

Fetal macrosomia is associated with a 14-fold increased risk of brachial plexus birth palsy (BPBP), and is a predictor of childhood obesity. The purpose of this study was to identify the relationships between BPBP, fetal macrosomia, and childhood obesity. We retrospectively reviewed 214 children with BPBP. The average age was 8 years and 53% had a Narakas 1 grade BPBP. Overall, 49% of children were normal weight, 22% overweight, and 29% obese. Of the children with a history of fetal macrosomia, 41% were obese; a statistically significant difference. Overall quality of life scores, however, were not correlated with obesity.
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PMID:Obesity in children with brachial plexus birth palsy. 2616 65

In humans, obesity before and during pregnancy is associated with both fetal macrosomia and growth restriction, and long-term cardiovascular risk in the offspring. We aimed to determine whether overweighted pregnant guinea pig sows results in an increased fetal weight at term and the effects on the vascular reactivity in fetal systemic and umbilical arteries. Pregnant guinea pigs were classified as control (n=4) or high weight (HWS, n=5) according to their pre-mating weight, and their fetuses extracted at 0.9 gestation (~60 days). Segments of fetal femoral and umbilical arteries were mounted in a wire myograph, where the contractile response to KCl (5-125 mM), and the relaxation to nitric oxide synthase-dependent agents (insulin, 10-10-10-7 and acetylcholine, 10-10-10-5) and nitric oxide [sodium nitroprusside (SNP), 10-10-10-5] were determined. Fetuses from HWS (HWSF) were grouped according to their body weight as low (85 g) fetal weight, based on the confidence interval (76.5-84.9 g) of the control group. No HWSF were observed in the normal range. Umbilical arteries from HWSF showed a lower response to KCl and insulin compared with controls, but a comparable response with SNP. Conversely, femoral arteries from HWSF showed an increased response to KCl and acetylcholine, along with a decreased sensitivity to SNP. These data show that overweight sows have altered fetal growth along gestation. Further, large and small fetuses from obese guinea pig sows showed altered vascular reactivity at umbilical and systemic vessels, which potentially associates with long-term cardiovascular risk.
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PMID:Pre-gestational overweight in guinea pig sows induces fetal vascular dysfunction and increased rate of large and small fetuses. 2649 Jul 62

Obesity, in childhood or in adulthood, remains to be a global health problem. The worldwide prevalence of obesity has increased in the last few decades, and consequently, the women of our time suffer more gestational problems than women in the past. The prevalence of obesity is greater in older women than in younger ones and in women with low educational level than in their counterparts with a higher level of education. Maternal obesity during pregnancy may increase congenital malformations and neonatal morbidity and mortality. Maternal obesity is associated with a decreased intention to breastfeed, decreased initiation of breastfeeding, and decreased duration of breastfeeding. We discuss the current epidemiological evidence for the association of maternal obesity with congenital structural neural tube and cardiac defects, fetal macrosomia that predisposes infants to birth injuries and to problems with physiological and metabolic transition, as well as potential for long-term complications secondary to prenatal and neonatal programming effects compounded by a reduction in sustained breastfeeding.
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PMID:Maternal Obesity and its Short- and Long-Term Maternal and Infantile Effects. 2675 75


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