[public-health] MEDICAL: CONDITIONS: OBESITY : WOMEN: PREGNANCY AND CHILDBIRTH : CHILDREN: Rise in Obese Pregnant Women Takes its Toll on Mother, Child Both

 

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MEDICAL: CONDITIONS: OBESITY :

WOMEN: PREGNANCY AND CHILDBIRTH : CHILDREN:

Rise in Obese Pregnant Women Takes its Toll on Mother, Child Both

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Rise in Obese Pregnant Women Takes its Toll on Mother, Child Both

Date:  October 14, 2016
Source:  Case Western Reserve University

Summary:

A medical doctor warns that the obesity epidemic is leading to a rise in high-risk pregnancies. There are no standard guidelines for the management of obesity in pregnancy. The American College of Obstetricians and Gynecologists recommends that all pregnant women follow a healthy diet, and consider at least half an hour of moderate physical activity per day during pregnancy. But obese pregnant women represent a relatively new high-risk population that will call for the development of additional tools to help these women reduce these risks before, during and after pregnancy, says this physician.

Journal Reference:

Patrick M Catalano, MD et al.
Clinical management of pregnancy in the obese mother:
before conception, during pregnancy, and post partum.
The Lancet Diabetes and Endocrinology,
October 2016
DOI: 10.1016/S2213-8587(16)30278-9

Science Daily

https://www.sciencedaily.com/releases/2016/10/161014103221.htm

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The epidemic of obesity is felt in prenatal clinics and delivery rooms around the world with a worrisome trend in high-risk pregnancies that could impact mother and child, according to Patrick M. Catalano, MD, the Dierker-Biscotti Women’s Health and Wellness Professor and Director of the Center for Reproductive Health at MetroHealth and Director of the Clinical Research Unit of the Case Western Reserve University. Dr. Catalano collaborated with a team of clinicians and scientists from around the world to address these issues in a series of review papers on maternal obesity published this month in The Lancet Diabetes and Endocrinology.

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“The management of obesity in pregnancy begins before, during and after pregnancy,” said Dr. Catalano. “There is limited evidence based data on how best to mitigate adverse metabolic effects of obesity on mothers (spontaneous miscarriage, gestational diabetes, pre-eclampsia and need for cesarean delivery) and their offspring (congenital anomalies, neonatal adiposity and risk for childhood obesity) once a woman is pregnant. Basic questions as to what is the optimal diet or weight gain during pregnancy need to be addressed. In the interim, until a comprehensive potentially personalized life-course approach is instituted, efforts during pregnancy will by necessity be aimed at recognizing and mitigating the adverse metabolic consequences of maternal obesity during pregnancy on both the mother and her child.”

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He said that lifestyle modifications such as healthy eating, physical activity and behavioral modifications during pregnancy have had limited benefits on improving adverse perinatal outcomes, with the exception of reducing excessive gestational weight gain, on the average of two to five pounds in obese women.

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snip

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There are no standard guidelines for the management of obesity in pregnancy, added Dr. Catalano. The American College of Obstetricians and Gynecologists recommends that all pregnant women follow a healthy diet, and consider at least half an hour of moderate physical activity per day during pregnancy. But Dr. Catalano said that obese pregnant women represent a relatively new high-risk population that will call for the development of additional tools to help these women reduce these risks before, during and after pregnancy. The Case Western scientists are also carrying out a study to determine whether lifestyle changes initiated in the post-partum period will help reduce the risks for a woman’s next pregnancy.

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In 2008, there were almost three overweight or obese women of childbearing age for each underweight woman, according to Dr. Catalano and his colleagues. They are suggesting that clinicians working with overweight or obese women of childbearing age offer pre-conception weight management to improve metabolic health and fertility and decrease early loss of a pregnancy. There should also be screening for diabetes. Once pregnant, women should be instructed on how to maintain a healthy gestational weight gain (through healthy eating and exercise). Studies suggest that 50 to 60 percent of obese women gain more weight in pregnancy than is recommended by the Institute of Medicine (IOM). The review also suggests that clinicians screen for fetal structural problems.

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In mid-pregnancy, the experts say that clinicians should also screen for gestational diabetes and pre-eclampsia, and towards the end of pregnancy there should be an assessment of fetal overgrowth (which is more common among obese pregnant women.) The labor and delivery team should also be aware of the increased risk for a caesarean delivery. Some studies have shown that the induction failure rate is twice as high in obese women compared with women who entered pregnancy with a healthy weight. Obese women in the post-partum period are also at higher risk for venous thromboembolism, difficulty with lactation, and depression.

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New mothers struggling with obesity may also find it more difficult to breastfeed their babies.

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The complete article may be read at the URL above.

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Sincerely,
David Dillard
Temple University
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jwne@temple.edu
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[public-health] MEDICAL: CONDITIONS: OBESITY : WOMEN: PREGNANCY AND CHILDBIRTH : CHILDREN: Rise in Obese Pregnant Women Takes its Toll on Mother, Child Both

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