Maternal Obesity Poses Infant Health Challenges

George C. Lu, MD

George C. Lu, MD

Dr. Lu graduated from Northeastern Ohio Universities College of Medicine. He completed residencies at Summa Akron City Hospital and the University of Pittsburgh, and completed a fellowship in the Division of Maternal-Fetal Medicine at the University of Alabama.

Maternal obesity has led to a marked increase in high-risk pregnancies, which require specialized medical care. More than one-third of the U.S. population is considered obese, with a BMI >30. Comorbidities that accompany obesity lead to increased risk for women and their fetuses. Additionally, obesity complicates imaging of the fetus, increasing the risk of missing potential medical issues during examination.

George C. Lu, MD, maternal-fetal medicine physician with High Risk Pregnancy Center of Kansas City, encourages primary care physicians to discuss risks with their overweight patients before they try to conceive. “Primary care physicians play a crucial role,” Dr. Lu said. “Overweight patients should be counseled on weight reduction and the importance of adopting a healthy lifestyle to benefit mother and child.”

Increases in Congenital Anomalies in Obese Versus Nonobese Gravidas

Before Conception

If a woman with obesity is considering pregnancy, she should be screened for existing and potential comorbidities including:

  • Autoimmune diseases
  • Cardiovascular disease
  • Diabetes mellitus
  • Hypertension

Uncontrolled disease factors during pregnancy can affect a baby’s health and development after birth. Disease management and optimization of a patient’s medical regimen prior to conception can dramatically improve the health of mother and fetus and reduce instances of:

  • Gestational diabetes
  • Preeclampsia
  • Birth defects
  • Delivery by Cesarean section
  • Surgery complications

“In many cases, if a chronic disease is under control prior to conception, pregnancy does not exacerbate the condition,” Dr. Lu noted. “The fetus is generally at greater risk of harm from the mother’s unmanaged disease than from medication taken to control that disease.”

Absolute Risks Per 10000 Pregnancies for BMI Categories 20, 25 and 30

During Pregnancy

Disease course optimization should continue during pregnancy by:

  • Using the lowest dosage of medications necessary to manage the disease
  • Researching which medications are approved for use during pregnancy; most medications can be used during pregnancy, especially after the first trimester

Additionally, women who are considering pregnancy should be placed on folic acid supplementation to reduce incidence of neural tube or other folic acid-sensitive congenital anomalies.

Detection of Fetal Anomalies

Pre-conception Nutrition

One theory suggests maternal obesity and poor fetal health are linked to improper nutrition, with adverse outcomes including low birth weight, preterm birth and intrauterine growth restriction. Studies have shown that women with obesity tend to follow poor quality diets during pregnancy compared with women with preconception BMIs in the normal range. “Anything physicians can do to assist women of childbearing age with losing weight, changing unhealthy lifestyle habits and managing their chronic conditions will improve her health and the health of her baby,” Dr. Lu said.

For female patients who are not contemplating pregnancy, primary care physicians can help them determine which method of contraception will be most effective in preventing pregnancy. An estimated 50% of U.S. pregnancies are unintendedlargely due to noncompliance (45%), with birth control failure representing a small percentage (5%). Many medications, such as seizure medication, interfere with oral contraceptives, but many new contraception options are now on the market.

Weight reduction prior to conception to reduce or eliminate comorbidities is ideal. By utilizing advances in maternal-fetal medicine and seeking proper care, the pregnancies of overweight women with chronic medical conditions can now be managed successfully.