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Obesity and pregnancy: mechanisms of short term and long term adverse consequences for mother and child

Published on Feb 8, 2017in BMJ27.604
· DOI :10.1136/bmj.j1
Patrick M. Catalano60
Estimated H-index: 60
(Case Western Reserve University),
Kartik Shankar37
Estimated H-index: 37
(University of Arkansas for Medical Sciences)
Sources
Abstract
Obesity is the most common medical condition in women of reproductive age. Obesity during pregnancy has short term and long term adverse consequences for both mother and child. Obesity causes problems with infertility, and in early gestation it causes spontaneous pregnancy loss and congenital anomalies. Metabolically, obese women have increased insulin resistance in early pregnancy, which becomes manifest clinically in late gestation as glucose intolerance and fetal overgrowth. At term, the risk of cesarean delivery and wound complications is increased. Postpartum, obese women have an increased risk of venous thromboembolism, depression, and difficulty with breast feeding. Because 50-60% of overweight or obese women gain more than recommended by Institute of Medicine gestational weight guidelines, postpartum weight retention increases future cardiometabolic risks and prepregnancy obesity in subsequent pregnancies. Neonates of obese women have increased body fat at birth, which increases the risk of childhood obesity. Although there is no unifying mechanism responsible for the adverse perinatal outcomes associated with maternal obesity, on the basis of the available data, increased prepregnancy maternal insulin resistance and accompanying hyperinsulinemia, inflammation, and oxidative stress seem to contribute to early placental and fetal dysfunction. We will review the pathophysiology underlying these data and try to shed light on the specific underlying mechanisms.
  • References (2)
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References2
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#4Ann L. YaktineH-Index: 16
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 li...
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The third edition of this work is a reference guide for a new generation of obstetricians and gynaecologists.
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#1Pengpeng Wang (Fudan University)H-Index: 2
#2Wenjuan Ma (University of Medicine and Health Sciences)H-Index: 1
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Abstract Objectives Based on a prospective birth cohort, we aimed to investigate the associations between maternal circulating metals exposure and gestational weight gain (GWG) across pregnancy, and explore whether maternal inflammatory cytokines could contribute to the GWG changes associated with metals exposure. Methods A total of 234 pregnant women from the Shanghai Maternal-Child Pairs cohort were enrolled in this panel study. 547 blood and serum samples were collected from pregnant women du...
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#1Stephanie A. Leonard (Stanford University)H-Index: 18
#2Suzan L. Carmichael (Stanford University)H-Index: 43
Last. Barbara Abrams (University of California, Berkeley)H-Index: 33
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BACKGROUND: An association between prepregnancy body mass index (BMI) and severe maternal morbidity (SMM) has been reported, but evidence has been mixed and potential explanations have not been examined. OBJECTIVE: To evaluate the association between prepregnancy BMI and SMM in a large, diverse birth cohort and assess potential mediation by obesity-related co-morbidities and caesarean birth. METHODS: This cohort study used linked birth certificate and hospitalisation discharge records from Calif...
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#1Romy Gaillard (Erasmus University Medical Center)H-Index: 9
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#1Xiaosong Yuan (Nanjing Medical University)H-Index: 3
#2Yanfang Gao (Nanjing Medical University)H-Index: 1
Last. Jun Xu (Nanjing Medical University)H-Index: 1
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#1Lyda Jadresic (Gloucestershire Hospitals NHS Foundation Trust)H-Index: 3
#2Howard Au (HKU: University of Hong Kong)
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#1Ayoub Mitha (KI: Karolinska Institutet)
#2Ruoqing Chen (KI: Karolinska Institutet)H-Index: 1
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#1Redin A. Spann (UMMC: University of Mississippi Medical Center)H-Index: 3
#2Bernadette E. Grayson (UMMC: University of Mississippi Medical Center)H-Index: 24
Approximately 250,000 individuals seek bariatric surgery each year in the USA for the long-term resolution of obesity-related comorbidities. Greater than 80% of these individuals are women and approximately half are of child-bearing age. Although there are many positive metabolic benefits that are realized through surgical weight loss for both men and women, the various long-term hormonal, molecular, nutrient, and epigenetic changes following bariatric surgery have not been evaluated for the sur...
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#1Mahrokh Dolatian (Shahid Beheshti University of Medical Sciences and Health Services)H-Index: 12
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#1Karen L. Lindsay (UCI: University of California, Irvine)H-Index: 14
#1K. Lindsay (UCI: University of California, Irvine)
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Abstract Childhood obesity constitutes a major global public health challenge. A substantial body of evidence suggests that conditions and states experienced by the embryo/fetus in utero can result in structural and functional changes in cells, tissues, organ systems and homeostatic set points related to obesity. Furthermore, growing evidence suggests that maternal conditions and states experienced prior to conception, such as stress, obesity and metabolic dysfunction, may spill over into pregna...
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CONTEXT: Higher blood glucose level during gestational periods has been consistently associated with increased risk of adverse birth outcomes. Evidence on the association between higher HbA1c within the normal range and adverse birth outcomes is limited. OBJECTIVE: We aimed to examine the association between HbA1c within the normal range and the risk of adverse birth outcomes. DESIGN AND SETTING: The data were abstracted from the Information System of Guangdong Women and Children Hospital, China...
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