Obesity - Sheiner

Question 1

What are adverse maternal outcomes with obesity in pregnancy?

Answer 1

Infertility/Miscarriage

Type II diabetes risk increased with BMI
GDM risk is increased X 3
-GDMA2 is uncontrolled with diet, need insulin

PET risk is :
- increased X 2-4
- Independent of GDM
- Linear correlation with BMI
Mechanical problems
- pelvic pain
- LBP

Venous thrombosis X 5, PE X 2
-treat postpartum with LMWH (c-section)

Obstructive sleep apnea

Higher rates of C-sections

• heal slower
• increased wound infections (9x higher with obesity and GDM)

Mortality

Question 2

How does obesity relate to infertility?

Answer 2

Fertility is extremely sensitive to bodyweight
A critical threshold of body fat is needed in orderto
enter puberty
Obesity is associated with m enses irregularities ,
chronic oligo / anovulation and infertility
Insulin excess and insulin resistance have been
implicated as main factors responsible for the
association of obesity and infertility
Clinical observations on the effect of BMI on IVF
success are controversial :
In a large study , BMI > 27 was associated with a
lower birth rate per IVF cycle
Higher risk for IVF cycle cancellation in morbidly
obese patients

Possible explanations :
Increased gonadotropin requirement during ovarian
stimulation
Fewer retrieved oocytes
Decreased serum estradiol concentrations
Lower fertilization rates

Question 3

What are associated fetal complications with obestiy in pregnancy?

Answer 3

LGA/Macrosomia
Shoulder dystocia
Fetal birth injury
Hypoglycemia
Hyperbilirubinemia
RDS
Folic acid deficiency is more common
Vitamin D deficiency leading to impaired brain and skin development
Neonatal and infant death

Increased rate of malformations:
Spina bifida
Omphalocele
Heart defects
Multiple Anomalies
Hypospadias
Limb defects
Diaphragmatic hernia
R.R 1.7- 3.6