Maternal Obesity, Excessive Gestational Weight Gain and Pregnancy Outcomes Final Report

This review, conducted by the Saskatchewan Prevention Institute (Prevention Institute), aimed to: (a) examine the relationship between maternal obesity and pregnancy outcomes (i.e., maternal outcomes and neonatal, infant and child outcomes); and (b) assess the association between excessive gestational weight gain (GWG) and pregnancy outcomes (i.e., maternal outcomes and neonatal, infant and child outcomes). The document reports on findings from a review of the literature on maternal obesity, excessive gestational weight gain and pregnancy outcomes, A search was performed in two computerized databases: MEDLINE and PubMed. Primary search terms included maternal obesity and excessive gestational weight gain, cross-referenced with pregnancy outcomes, pregnancy-induced hypertension, preeclampsia, gestational diabetes mellitus, miscarriage, caesarean section, type 2 diabetes, breastfeeding outcomes, large-for-gestational-age infants, macrosomia and postpartum weight retention. Studies were also located by reviewing reference lists and bibliographies in selected articles. According to the available evidence, the most common health effects of maternal obesity on the mother include hypertension (pre-existing and pregnancy-induced), preeclampsia, diabetes mellitus (pregestational and gestational), and the need for caesarean section. The most common health outcome of maternal obesity on the newborn is macrosomia or a large-for-gestational-age neonate (LGA). Furthermore, macrosomia has been associated with the following pregnancy outcomes, including: caesarean birth, prolonged labour, birth trauma, cephalopelvic disproportion, birth asphyxia, and increased risk of perinatal mortality. There is also evidence to suggest that maternal obesity is linked to obesity in the child, adolescent and adult offspring, although the causal nature of this relationship is unclear at present. The most identified health risk of excessive GWG in the literature is the delivery of a LGA infant/macrosomia. As is the case with other health problems, the obesity epidemic disproportionately affects lower-socioeconomic groups, including ethnic minorities and individuals residing in rural communities. Socio-demographic and maternal characteristics of excessive gestational weight gain in Canada include having a body mass index (BMI) > 27, giving birth for the first time, having a lower level of education, being a young mother, and being Aboriginal. Because recent research suggests the in utero environment may program the fetus for elevated risk of later obesity, attempts should be made to prevent or reduce obesity prior to pregnancy. Practitioners and educators may wish to begin counselling adolescent and young women prior to pregnancy regarding maternal obesity and the associated costs for the mother and her fetus/neonate/child. Limited data exists regarding effective interventions for pregnant, obese women and even less information on promising or …