Managing Obesity During Pregnancy
▸ Up the ante on kick counts. Because the risk of stillbirth is significantly increased in the obese pregnant woman (even the patients without hypertensive disorders or other complications), fetal monitoring with kick counts is all the more important.
The cost/potential benefit of more extensive evaluation is unclear for the obese woman without any medical or obstetric complications (and fetal assessment is more difficult in the obese patient), but certainly a lower threshold for more formal testing should be considered for women who do have complications and for women in whom a “red flag” is raised.
A patient whose baby appears to be very large on ultrasound or in the clinical exam, for instance, or a patient whose baby is well above the 90th percentile too early in gestation might benefit from more formal evaluation of fetal well-being, even if glucose and blood pressure tests are normal.
Vitals
Source Elsevier Global Medical News
Source Elsevier Global Medical News
Complications of Obesity in Pregnancy
Obesity is one of the world's fastest growing and most insidious pandemics. At least 400 million adults worldwide, and one-third of adult Americans fit the criteria for obesity (JAMA 2010;303:235-41). Indeed, obesity is increasingly being diagnosed at earlier ages; it is estimated that between 16% and 33% of U.S. children and adolescents are obese.
It is particularly distressing when obesity impacts women of child-bearing age because they, along with their offspring, are the populations most vulnerable to the consequences of obesity. There are many long-term, downstream consequences of obesity for pregnant women, including a significantly higher risk of developing type 2 diabetes, hypertension, and cardiovascular disease. Additionally, the offspring of these women face significant health consequences in utero, during birth, as well as for many years afterward. Children born to obese women are more likely to be large for gestational age, delivered by cesarean section, or have birth defects and are at significantly greater risk of becoming obese and developing obesity-related complications, such as type 2 diabetes, in adolescence and adulthood.
Because obesity is so prevalent among women of child-bearing age, we have decided to devote a Master Class to discussing the potential complications of obesity during pregnancy and how best to manage and/or prevent those complications. The goal is to give practitioners the basic knowledge they need to identify those at-risk obese patients so they can institute appropriate preventive and therapeutic measures.
Patrick Catalano, M.D., professor and chair of the department of reproductive biology at Case Western Reserve University, is one of the world's leading experts on the short- and long-term consequences of obesity for pregnant women and their offspring. He served on the Institute of Medicine committee that in 2009 reexamined guidelines on weight gain during pregnancy. He also is leading the effort to inform physicians and the public about the costly complications of obesity in pregnancy and in finding ways to prevent these complications from occurring in the first place. Dr. Catalano's research focus is on insulin resistance and glucose metabolism in pregnancy and the role of placental cytokines in the regulation of fetal growth and adiposity.
