The obesity epidemic is a problem of global importance with a profound impact on maternal-fetal health. Maternal overweight and obesity causes pregnancy complications such as gestational diabetes, hypertension and preeclampsia and affects fetal growth. Maternal obesity offers an altered genetic, hormonal and biochemical environment for the developing fetus/embryo and influences fetal growth and organ development. Offspring of obese mothers are subject to an increased risk of fetal demise, congenital anomalies and disrupted growth patterns, causing an increase in perinatal mortality. The impact of maternal obesity extends beyond intrauterine and neonatal life to childhood, adolescence and adulthood.

Keywords:
Obesity, Fetal programming, Pregnancy complications, Congenital anomalies, Macrosomia, Childhood obesity
1.
Kanagalingam MG, Forouhi NG, Greer IA, Sattar N: Changes in booking body mass over a decade: retrospective analysis from a Glasgow Maternity Hospital. BJOG 2005;112:1431-1433.
2.
Heslehurst N, Ells LJ, Simpson H, Batterham A, Wilkinson J: Trends in maternal obesity incidence rates, demographic predictors, and health inequalities in 36,821 women over a 15-year period. BJOG 2007;114:187-194.
3.
Willis K, Sheiner E: Bariatric surgery and pregnancy: the magical solution? J Perinat Med 2012;8:1-8.
4.
Thangaratinam S, Rogozińska E, Jolly K, Glinkowski S, Duda W, Borowiack E, Coomarasamy A, Khan KS: Interventions to reduce or prevent obesity in pregnant women: a systematic review. Health Technol Assess 2012;16:iii-iv, 1-191.
5.
Froen JF, Arnestad M, Frey K, Vege A, Saugstad OD: Risk factors for sudden intrauterine unexplained death: epidemiologic characteristics of singleton cases in Oslo, Norway, 1986-1995. Am J Obstet Gynecol 2001;184:694-702.
6.
Ramachenderan J, Bradford J, McLean J: Maternal obesity and pregnancy complications: a review. Aust NZ J Obstet Gynaecol 2008;48:228-245.
7.
Han JC, Lawlor DA, Kimm SY: Childhood obesity. Lancet 2010;375:1737-1748.
8.
Henriksen T: The macrosomic fetus: a challenge in current obstetrics. Acta Obstet Gynecol Scand 2008;87:134-145.
9.
Whitaker KL, Jarvis MJ, Beeken RJ, Boniface D, Wardle J: Comparing maternal and paternal intergenerational transmission of obesity risk in a large population-based sample. Am J Clin Nutr 2010;91:1560-1567.
10.
Yogev Y, Ben-Haroush A, Chen R, Rosenn B, Hod M, Langer O: Diurnal glycemic profile in obese and normal weight nondiabetic pregnant women. Am J Obstet Gynecol 2004;191:949-953.
11.
Practice Committee of American Society for Reproductive Medicine: Obesity and reproduction: an educational bulletin. Fertil Steril 2008;90:S21-S29.
12.
Hajer GR, van Haeften TW, Visseren FL: Adipose tissue dysfunction in obesity, diabetes, and vascular diseases. Eur Heart J 2008;29:2959-2971.
13.
Schmatz M, Madan J, Marino T, Davis J: Maternal obesity: the interplay between inflammation, mother and fetus. J Perinatol 2010;30:441-446.
14.
Fujita K, Nishizawa H, Funahashi T, Shimomura I, Shimabukuro M: Systemic oxidative stress is associated with visceral fat accumulation and the metabolic syndrome. Circ J 2006;70:1437-1442.
15.
Aye IL, Powell TL, Jansson T: Review: Adiponectin - The missing link between maternal adiposity, placental transport and fetal growth? Placenta 2013;34(suppl):S40-S45.
16.
Catalano PM: Obesity, insulin resistance, and pregnancy outcome. Reproduction 2010;140:365-371.
17.
Herrera E, Amusquivar E: Lipid metabolism in the fetus and the newborn. Diabetes Metab Res Rev 2000;16:202-210.
18.
Jarvie E, Hauguel-de-Mouzon S, Nelson SM, Sattar N, Catalano PM, Freeman DJ: Lipotoxicity in obese pregnancy and its potential role in adverse pregnancy outcome and obesity in the offspring. Clin Sci (Lond) 2010;119:123-129.
19.
Heerwagen MJ, Miller MR, Barbour LA, Friedman JE: Maternal obesity and fetal metabolic programming: a fertile epigenetic soil. Am J Physiol Regul Integr Comp Physiol 2010;299:R711-R722.
20.
Furukawa S, Fujita T, Shimabukuro M, Iwaki M, Yamada Y: Increased oxidative stress in obesity and its impact on metabolic syndrome. J Clin Invest 2004;114:1752-1761.
21.
Higgins L, Mills TA, Greenwood SL, Cowley EJ, Sibley CP, Jones RL: Maternal obesity and its effect on placental cell turnover. J Matern Fetal Neonatal Med 2013, E-pub ahead of print.
22.
Hayes EK, Lechowicz A, Petrik JJ, Storozhuk Y, Paez-Parent S: Adverse Fetal and Neonatal Outcomes Associated with a Life-Long High Fat Diet: Role of Altered Development of the Placental Vasculature. PLoS One 2012;7:e33370.
23.
Ray JG, Vermeulen MJ, Schull MJ, McDonald S, Redelmeier DA: Metabolic syndrome and the risk of placental dysfunction. J Obstet Gynaecol Can 2005;27:1095-1101.
24.
Moyer-Mileur LJ, Slater H, Thomson JA, Mihalopoulos N, Byrne J, Varner MW: Newborn Adiposity Measured by Plethysmography Is Not Predicted by Late Gestation Two-Dimensional Ultrasound Measures of Fetal Growth. J Nutr 2009;139:1772-1778.
25.
Farley DM, Choi J, Dudley DJ, Li C, Jenkins SL, Myatt L, Nathanielsz PW: Placental amino acid transport and placental leptin resistance in pregnancies complicated by maternal obesity. Placenta 2010;31:718-724.
26.
Moyer-Mileur LJ, Slater H, Thomson JA, Mihalopoulos N, Byrne J, Varner MW: Newborn Adiposity Measured by Plethysmography Is Not Predicted by Late Gestation Two-Dimensional Ultrasound Measures of Fetal Growth. J Nutr 2009;139:1772-1778.
27.
Olson G: Obesity and implications for future generations. Am J Obstet Gynecol 2012;206:255-257.
28.
Muhlhausler B, Ong Z: The fetal origins of obesity: early origins of altered food intake. Endocr Metab Immune Disord Drug Targets 2011;11:189-197.
29.
Metwally M, Ong KJ, Ledger WL, Li TC: Does high body mass index increase the risk of miscarriage after spontaneous and assisted conception? A meta-analysis of the evidence. Fertil Steril 2008;90:714-726.
30.
Landres IV, Milki AA, Lathi RB: Karyotype of miscarriages in relation to maternal weight. Hum Reprod 2010;25:1123-1126.
31.
Bellver J, Melo MA, Bosch E, Serra V, Remohí J, Pellicer A: Obesity and poor reproductive outcome: the potential role of the endometrium. Fertil Steril 2007;88:446-451.
32.
Clark AM, Thornley B, Tomlinson L, Galletley C, Norman RJ: Weight loss in obese infertile women results in improvement in reproductive outcome for all forms of fertility treatment. Hum Reprod 1998;13:1502-1505.
33.
Reddy UM, Branum AM, Klebanoff MA: Relationship of mass index and height to twinning. Obstet Gynecol 2005;105:593-597.
34.
Naeye RL: Maternal body weight and pregnancy outcome. Am J Clin Nutr 1990;52:273-279.
35.
Maxwell C, Glanc P: Imaging and obesity: a perspective during pregnancy AJR Am J Roentgenol 2011;196:311-319.
36.
Hendler I, Blackwell SC, Bujold E, Treadwell MC, Wolfe HM, Sokol RJ, Sorokin Y: The impact of maternal obesity on midtrimester sonographic visualization of fetal cardiac and craniospinal structures. Int J Obes Relat Metab Disord 2004;28:1607-1611.
37.
Dashe JS, McIntire DD, Twickler DM: Effect of maternal obesity on the ultrasound detection of anomalous fetuses. Obstet Gynecol 2009;113:1001-1007.
38.
Aagaard-Tillery KM, Flint Porter T, Malone FD, Nyberg DA, Collins J, Comstock CH, Hankins G, Eddleman K, Dugoff L, Wolfe HM, D'Alton ME: Influence of maternal BMI on genetic sonography in the FaSTER trial. Prenat Diagn 2010;30:14-22.
39.
Stothard KJ, Tennant PW, Bell R, Rankin J: Maternal overweight and obesity and the risk of congenital anomalies: a systematic review and meta-analysis. JAMA 2009;301:636-650.
40.
Rasmussen SA, Chu SY, Kim SY, Schmid CH, Lau J: Maternal obesity and risk of neural tube defects: a metaanalysis. Am J Obstet Gynecol 2008;198:611-619.
41.
Werler MM, Louik C, Shapiro S, Mitchell AA: Prepregnant weight in relation to risk of neural tube defects. JAMA 1996;275:1089-1092.
42.
Hendler I, Blackwell SC, Bujold E, et al: The impact of maternal obesity on midtrimester sonographic visualization of fetal cardiac and craniospinal structures. Int J Obes Relat Metab Disord 2004;28:1607-1611.
43.
Timor-Tritsch IE, Fuchs KM, Monteagudo A, D'alton ME: Performing a fetal anatomy scan at the time of first-trimester screening. Obstet Gynecol 2009;113:402-407.
44.
Yagel S, Cohen SM, Messing B: First and early second trimester fetal heart screening. Curr Opin Obstet Gynecol 2007;19:183-190.
45.
Maxwell C, Glanc P: Imaging and obesity: a perspective during pregnancy. AJR Am J Roentgenol 2011;196:311-319.
46.
Torloni MR, Betrán AP, Daher S, Widmer M, Dolan SM, Menon R, Bergel E, Allen T, Merialdi M: Maternal BMI and preterm birth: a systematic review of the literature with meta-analysis. J Matern Fetal Neonatal Med 2009;22:957-970.
47.
Sebire NJ, Jolly M, Harris JP, Wadsworth J, Joffe M, Beard RW, Regan L, Robinson S: Maternal obesity and pregnancy outcome: a study of 287,213 pregnancies in London. Int J Obes Relat Metab Disord 2001;25:1175-1182.
48.
Ehrenberg HM, Iams JD, Goldenberg RL, Newman RB, Weiner SJ, Sibai BM, Caritis SN, Miodovnik M, Dombrowski MP; Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units Network (MFMU): Maternal obesity, uterine activity, and the risk of spontaneous preterm birth. Obstet Gynecol 2009;113:48-52.
49.
Baeten JM, Bukusi EA, Lambe M: Pregnancy complications and outcomes among overweight and obese nulliparous women. Am J Public Health 2001;91:436-440.
50.
Stotland NE, Washington AE, Caughey A: Prepregnancy body mass index and the length of gestation at term. Am J Obstet Gynecol 2007;197:378.e1-e5.
51.
Denison FC, Price J, Graham C, Wild S, Liston WA: Maternal obesity, length of gestation, risk of postdates pregnancy and spontaneous onset of labour at term. BJOG 2008;115:720-725.
52.
Abrams BF, Laros RK Jr: Prepregnancy weight, weight gain, and birth weight. Am J Obstet Gynecol 1986;154:503-509.
53.
Frentzen B, Dimperio D, Cruz A: Maternal weight gain: effect on infant birth weight among overweight and average-weight low-income women. Am J Obstet Gynecol 1988;159:1114-1117.
54.
Johnson JW, Longmate JA, Frentzen B: Excessive maternal weight and pregnancy outcome. Am J Obstet Gynecol 1992;167:353-370.
55.
Mahony R, Foley M, McAuliffe F, O'Herlihy C: Maternal weight characteristics influence recurrence of fetal macrosomia in women with normal glucose tolerance. Aust NZ J Obstet Gynaecol 2007;47:399-401.
56.
Bhattacharya S, Campbell DM, Liston WA, Bhattacharya S: Effect of Body Mass Index on pregnancy outcomes in nulliparous women delivering singleton babies. BMC Public Health 2007;7:168.
57.
Rasmussen S, Albrechtsen S, Irgens LM, Dalaker, Maartmann-Moe H, Vlatkovic L, et al: Risk factors for unexplained antepartum fetal death in Norway 1967-1998. Early Hum Dev 2003;71:39-52.
58.
American College of Obstetricians and Gynecologists (ACOG): Fetal macrosomia. Washington, DC, 2000. ACOG practice bulletin; no. 22.
59.
Ecker JL, Greenberg JA, Norwitz ER, Nadel AS, Repke JT: Birth weight as a predictor of brachial plexus injury. Obstet Gynecol 1997;89:643-647.
60.
Henriksen T: The macrosomic fetus: a challenge in current obstetrics. Acta Obstet Gynecol Scand 2008;87:134-145.
61.
Lewis DF, Edwards MS, Asrat T, Adair CD, Brooks G, London S: Can shoulder dystocia be predicted? Preconceptual and prenatal factors. J Reprod Med 1998;43:654-658.
62.
Hassan AA: Shoulder dystocia: risk factors and prevention. Aust NZ J Obstet Gynaecol 1988;28:107-109.
63.
Robinson H, Tkatsch S, Mayes DC, Bott N, Okun N: Is maternal obesity a predictor of shoulder dystocia? Obstet Gynecol 2003;101:24-27.
64.
Surkan PJ, Hsieh CC, Johansson AL, Dickman PW, Cnattingius S: Reasons for increasing trends in large for gestational age births. Obstet Gynecol 2004;104:720-726.
65.
Nohr EA, Timpson NJ, Andersen CS, Davey Smith G, Olsen J, Sorensen TI: Severe obesity in young women and reproductive health: the Danish National Birth Cohort. PLoS One 2009;4:e8444.
66.
Ovesen, P, Rasmussen S, Kesmodel U: Effect of Prepregnancy Maternal Overweight and Obesity on Pregnancy Outcome. Obstet Gynecol 2011;118:305-312.
67.
Usha Kiran TS, Hemmadi S, Bethel J, Evans J: Outcome of pregnancy in a woman with an increased body mass index. BJOG 2005;112:768-772.
68.
Chen A, Feresu SA, Fernandez C, Rogan WJ: Maternal obesity and the risk of infant death in the United States. Epidemiology 2009;20:74-81.
69.
Chu SY, Kim SY, Lau J, Schmid CH, Dietz PM, Callaghan WM, Curtis KM: Maternal obesity and risk of stillbirth: a metaanalysis. Am J Obstet Gynecol 2007;197:223.
70.
Flenady V, Koopmans L, Middleton P, Frøen JF, Smith GC, Gibbons K, Coory M, Gordon A, Ellwood D, McIntyre HD, Fretts R, Ezzati M: Major risk factors for stillbirth in high-income countries: a systematic review and meta-analysis. Lancet 2011;377:1331-1340.
71.
Flenady V, Middleton P, Smith GC, Duke W, Erwich JJ, Khong TY, Neilson J, Ezzati M, Koopmans L, Ellwood D, Fretts R, Frøen JF: Lancet's Stillbirths Series steering committee. Stillbirths: the way forward in high-income countries. Lancet 2011;377:1703-1717.
72.
Pirkola J, Pouta A, Bloigu A, Hartikainen AL, Laitinen J, Järvelin MR, et al: Risks of overweight and abdominal obesity at age 16 years associated with prenatal exposures to maternal prepregnancy overweight and gestational diabetes mellitus. Diabetes Care 2010;33:1115-1121.
73.
Whitaker RC, Wright JA, Pepe MS, Seidel KD, Dietz WH: Predicting obesity in young adulthood from childhood and parental obesity. N Engl J Med 1997;37:869-873.
74.
Ong KK: Size at birth, postnatal growth and risk of obesity. Horm Res 2006;65 Suppl 3:65-69.
75.
Eriksson J, Forsen T, Osmond C, Barker D: Obesity from cradle to grave. Int J Obes Relat Metab Disord 2003;27:722-727.
76.
Baird J, Fisher D, Lucas P, Kleijnen J, Roberts H, Law C: Being big or growing fast: systematic review of size and growth in infancy and later obesity. Br Med J 2005;331:929.
77.
Krakowiak P, Walker CK, Bremer AA, Baker AS, Ozonoff S, Hansen RL, Hertz-Picciotto I: Maternal metabolic conditions and risk for autism and other neurodevelopmental disorders. Pediatrics 2012;129:e1121-e1128.
78.
Sheiner E, Levy A, Silverberg D, Menes TS, Levy I, Katz M: Pregnancy after bariatric surgery is not associated with adverse perinatal outcome. Am J Obstet Gynecol 2004;190:1335-1340.
79.
Maggard MA, Yermilov I, Li Z, Maglione M, Newberry S, Suttorp M: Pregnancy and fertility following bariatric surgery: a systematic review. JAMA 2008;300:2286-2296.
80.
Sheiner E, Willis K, Yogev Y: Bariatric surgery: impact on pregnancy outcomes. Curr Diab Rep 2013;13:19-26.
© 2013 S. Karger AG, Basel
2013
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.