Master Class: Obesity



Obesity not only increases a patient’s lifetime risk of numerous chronic conditions, such as diabetes, heart disease and kidney disease, but it also is a major health issue during pregnancy. Women who are obese in pregnancy have a significantly higher chance of developing adverse perinatal outcomes and experiencing various complications that affect both their health and that of their babies.

With an ever-increasing population of overweight and obese women of reproductive age, as key caregivers for women, we must reexamine our approaches and do much more than microfocusing on a woman’s pre- and postdelivery health. We must play a more active role in helping our patients establish and maintain a healthy lifestyle – one that will help ward off and reduce the incidence of this concerning condition.

Dr. E. Albert Reece

Dr. E. Albert Reece

Over the previous two Master Class installments on obstetrics, we discussed the extent of the obesity epidemic and its link to diabetes, the alarming number of infants, children, and adolescents who are obese, and the implications of these societal and medical trends for ob.gyns.

In the July Master Class, we discussed the importance of appropriately counseling patients on healthy weight gain and physical activity in pregnancy. Because ob.gyns. may be the only health care professionals that many women may see, it is becoming more important that we help our patients and their children attain and maintain positive health and well-being.

In our September installment, Dr. Thomas R. Moore looked at obesity trends through the lens of the Barker Hypothesis, which got us thinking more than 3 decades ago about the role of intrauterine environment in short- and long-term health of offspring. Dr. Moore discussed how obesity in pregnancy appears to program offspring for downstream cardiovascular risk in adulthood.

He told us that we must not only liberally treat gestational diabetes and optimize glucose control during pregnancy, but, most importantly, we also must emphasize to women the importance of having healthy weights at the time of conception.

This month’s Master Class examines this latter concept in more depth. Dr. Patrick Catalano, professor in the department of obstetrics and gynecology and director of the Center for Reproductive Health at MetroHealth Medical Center, Case Western Reserve University, Cleveland, has been at the forefront of research on the physiologic impact of obesity on the placenta and the fetus, and on approaches for addressing maternal obesity and improving perinatal outcomes.

Dr. Catalano explains here why weight loss before pregnancy appears to be important for preventing adverse perinatal outcomes and breaking the intergenerational transfer of obesity.

Dr. Reece, who specializes in maternal-fetal medicine, is vice president for medical affairs at the University of Maryland, Baltimore, as well as the John Z. and Akiko K. Bowers Distinguished Professor and dean of the school of medicine. Dr. Reece said he had no relevant financial disclosures. He is the medical editor of this column. Contact him at [email protected].

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