Collateral Damage: Maternal Obesity During Pregnancy Continues to Rise

摘要

Importance The pandemic of obesity during pregnancy now afflicts 1 out of every 2 pregnant women in the United States. Even though unintended pregnancy has decreased to 45% of all pregnancies, 50% of those unintended pregnancies occur in obese women. Objective This study aims to identify why current lifestyle interventions for obese pregnancy are not effective and what the newer complications are for obesity during pregnancy. Evidence Acquisition Available literatures on current treatments for maternal obesity were reviewed for effectiveness. Emerging maternal and infant complications from obesity during pregnancy were examined for significance. Results Limitations in successful interventions fell into 3 basic categories to include the following: (1) preconception weight loss; (2) bariatric surgery before pregnancy; and (3) prevention of excessive gestational weight gain during pregnancy. Emerging significant physiological changes from maternal obesity is composed of inflammation (placenta and human milk), metabolism (hormones, microbiome, fatty acids), and offspring outcomes (body composition, congenital malformations, chronic kidney disease, asthma, neurodevelopment, and behavior). Conclusions and Relevance Are current prepregnancy lifestyle and behavioral interventions feasible to prevent maternal obesity complications? Epigenetic and metabolomic research will be critical to determine what is needed to blunt the effects of maternal obesity and to discover successful treatment. Target Audience Obstetricians, gynecologists, family physicians, midwives, nurse practitioners, and dietitians Learning Objectives After participating in this activity, the learner should be better able to identify lifestyle interventions used to prevent complications from an obese pregnancy; describe emerging maternal obesity complications; classify the severity of maternal obesity in the United States; and explain barriers to lifestyle intervention success in obese pregnancy.