Obesity and Pregnancy: Management and Prevention of Risk Factors (Distance Learning Lecture)

Abstract

Obesity is an excessive accumulation of adipose tissue in the body, which leads to increase of body weight by 20 % or more. Obesity in women of reproductive age is associated with a number of general somatic and reproductive problems, which lead to a decrease in fertility. Adipose tissue is the site of peripheral synthesis of many hormones, and is also actively involved in the function of the vascular system and the formation of the immune response, therefore, its excess content is accompanied by metabolic, hormonal, vascular and pro-inflammatory disorders. Before pragnancy, an obese patient should be examined to exclude endocrine disorders. The management of preparation of obese women for pregnancy should include: weight loss, improved insulin sensitivity (with diagnosed carbohydrate metabolism disorders), compensation/elimination of endocrine disorders (if any), support of the luteal phase with progesterone drugs.

After pregnancy has occured, obese women have an increased risk of congenital fetal anomalies, macrosomia, stillbirth, gestational hypertension, gestational diabetes mellitus, preterm birth and a number of other complications. Therefore, the management of pregnancy in a patient with overweight or obesity is associated with many difficulties, with an increased risk of developing serious obstetric and somatic complications in such patients. In this regard, the currently generally accepted rules are physiological weight gain within 9–11 kg, constant monitoring of the health of the pregnant woman and the fetus, which should have an individual approach; proper nutrition, increased physical activity, as well as diagnosis and correction of associated conditions and risk factors.