Maternal obesity on the increase

March 31, 2008 - Obesity in expectant mothers is on the increase and is posing serious problems for maternity hospitals according to an article commissioned by Vhi Healthcare and published in the current issue of Irish Medical Times.  The article was co-authored by Dr Sinead Barry* and Professor Michael Turner*, from the Coombe Women and Infants University Hospital, and highlights the serious implications that obesity poses to both mothers and their babies during pregnancy.

Over the last decade, the number of women classified as obese at their antenatal visit has almost doubled from 9.4% to 18.4% and that this in turn, had led to an increase in complications with pregnancies. 

Professor Turner commented, “Women who are planning a pregnancy should look carefully at their lifestyles and understand the risks associated with obesity – both for themselves and for their babies.  Ideally we suggest that any lifestyle issues should be addressed before pregnancy, as the importance of a healthy diet and weight for potential mothers cannot be overemphasised.”

Some of the complications identified by the authors included:
Cardiovascular:
Cardiovascular complications are strongly associated with obesity in the general population. These problems are even greater during pregnancy as pregnancy causes a wide range of cardiovascular changes.  Obesity places additional pressure on the heart and this can cause damage. 

High blood pressure
 Studies have shown that obese women more than double their risk of developing pre-eclampsia, an extremely serious condition. Obesity and high blood pressure coexist, which makes the separation of pregnancy-induced hypertension (PIH) and obesity-induced hypertension difficult

Gestational Diabetes
Gestational diabetes is a glucose intolerance which can develop in pregnancy and can lead to an increased risk of developing diabetes type 2 in later life. Statistics show that within 15 years of having gestational diabetes, 70% of obese women develop type 2 diabetes.

Delivery and surgical complications
The challenges of obesity are evident in Irish delivery suites. Obtaining good quality external fetal heart rate and uterine contraction patterns in obese women is a challenge. Women classified as obese are likely to have pre-existing medical conditions, such as hypertension or diabetes, which increases anaesthetic risks.  Other problems include failure of epidural insertion, intubation difficulties and difficulty in monitoring blood pressure.   

Fetal Complications
For the fetus, maternal obesity can mean increased fetal monitoring, increased need for antenatal fetal assessments, increased admissions to the neonatal unit and increased childhood illnesses which may progress to lifelong illness.

Infants who are at the highest end of the spectrum in terms of birth weight or who grow rapidly in infancy are at a significant risk of subsequent obesity. Obese babies are nine times more likely to become obese adults than normal weight babies. Some of the medical conditions associated with obesity in childhood include: developmental delay, hypertension, diabetes, and sleep apnoea.

The authors concluded by stating that the incidence of maternal obesity in pregnancy is increasing and therefore that in the short-term the maternal and fetal complications of pregnancy will also increase.  They highlighted the fact that there are also longer term intergenerational implications and called for further research studies to determine ways to prevent obesity and its complications. 

The full version of this article is published in the current issue of Irish Medical Times and can be accessed also on www.imt.ie.  The article was commissioned by Vhi Healthcare, Ireland’s largest private health insurer, as part of an on-going clinical series looking at key challenges facing Irish health practitioners.

ENDS

* Notes to editors: about the authors:

Dr. Sinead C. Barry BSc PhD is a graduate of University College Dublin.  She is a Senior House Officer in Obstetrics & Gynaecology in the Coombe Women and Infants University Hospital.  She published extensively in the area of Cystic Fibrosis during her time at the National Referral Centre for Adult Cystic Fibrosis at St. Vincent’s University Hospital. Dr Barry’s current area of research interest is maternal obesity and its implications for mother and baby.

Prof. Michael J. Turner MAO FRCOG FRCPI, is a graduate of University College Dublin.  He is the UCD Professor of Obstetrics & Gynaecology in the Coombe Women and Infants University Hospital and also in St Vincent’s University Hospital.  His research interests include labour, infertility and cervical precancer.

ENDS