Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Postpartum weight management and future pregnancy planning


Obesity and its associated metabolic transformations could constitute a significant burden in the postpartum period with its potential complications and outcomes. This chapter will highlight the effects of obesity beyond the immediate postpartum period and the best evidence to manage obesity as well as future fertility planning.

44.1

Complications of obesity

  • Obesity is associated with

    • Increased risk of overall mortality

    • Lifetime impact of disability and morbidity

    • Increased risk for

      • ■

        cardiovascular disease, including coronary heart disease, stroke, heart failure, atrial fibrillation, and venous thromboembolism;

      • ■

        diabetes mellitus type 2;

      • ■

        dementia in middle-aged adults;

      • ■

        gastrointestinal diseases such as gastroesophageal reflux, gallstones, and nonalcoholic fatty liver disease.

  • With obesity in pregnancy, associated complications include increased risks for pregnancy-induced hypertension, antepartum venous thromboembolism, labour induction, caesarean delivery, and wound infection, and foetal and neonatal mortality.

  • Increasing body mass index (BMI) associated with increased risk of many cancers including colon, breast, corpus uteri, and kidney and leukaemia.

  • Additional complications of obesity may include

    • increased risk of

      • ■

        chronic kidney disease;

      • ■

        kidney stones;

      • ■

        hot flashes;

      • ■

        obstructive sleep apnoea.

    • lower specificity of screening mammography;

    • lower efficacy of oral contraceptives;

    • orthopaedic issues such as increased risk for low back pain, lumbar disc degeneration, total hip replacement, and knee osteoarthritis;

    • dyspnoea and adult-onset asthma.

44.2

Complications of weight stigma

  • ‘Weight stigma’ defined as social devaluation/denigration of individuals due to excess body weight and may lead to negative attitudes, stereotyping, prejudice, and discrimination; weight bias (of patient themselves (internalised), other individuals patient interacts with, and healthcare provider) may be

    • explicit – overt, consciously held negative attitudes that can be measured by self-report

    • implicit – automatic negative attributions and stereotypes existing without conscious awareness

  • Reported complications/associations of weight stigma include

    • increased obesity and weight gain over time

    • increased risk of transitioning from overweight to obesity

    • depressive symptoms

    • higher anxiety levels

    • low self-esteem

    • social isolation

    • perceived stress

    • substance use

    • unhealthy eating and weight-control behaviours, such as binge eating or emotional overeating

    • paradoxically increased food intake (regardless of BMI)

    • lower levels of physical activity and higher exercise avoidance

    • increased sedentary behaviour

  • Reported possible effects of obesity stigma in healthcare setting include

    • avoidance of clinical care, such as age-appropriate cancer screening

    • reduced adherence to prescribed treatment or self-care

    • lower frequency of achieving weight loss goals.

44.3

Outcomes of obesity and its effects on future pregnancies

44.3.1

Maternal outcomes

  • Pregestational BMI > 30 kg/m 2 may be associated with increased risk for cardiovascular hospitalisations after pregnancy.

  • Obesity during pregnancy may be associated with increased risk of premature death and cardiovascular disease.

  • Excessive gestational weight gain during pregnancy in obese women is associated with increased risk of weight retention at 1-year postpartum.

44.3.2

Foetal/neonatal outcomes

  • Increasing BMI is associated with increased foetal and neonatal mortality with higher risk of foetal death, stillbirth, and neonatal, perinatal, and infant death.

  • Prepregnancy maternal BMI >25 kg/m 2 associated with increased birth weight for gestational age and infant adiposity.

  • Maternal overweight and obesity is associated with small increased risk for congenital anomalies and birth defects.

44.3.3

Outcomes in childhood for children born to obese mothers

Children born to obese women have higher risk of

  • metabolic syndrome and childhood obesity

  • development of autism spectrum disorders

  • respiratory hospitalisation during childhood in offspring

  • type 1 diabetes in offspring of parents without diabetes

  • development of affective disorders in offspring

  • adverse mental and motor development assessed at 2 years of age in preterm offspring

  • developmental delay in offspring among children.

44.3.4

Outcomes in adulthood being born to obese mothers

  • Maternal overweight and obesity is associated with increased risk of premature death in adult offspring.

  • Maternal gestational weight gain exceeding recommended guidelines may be associated with overweight or obesity in daughters during middle age.

44.4

General postpartum management

44.4.1

Management

  • Routine postpartum care as discussed before in the immediate postpartum period.

44.4.2

You're Reading a Preview

Become a Clinical Tree membership for Full access and enjoy Unlimited articles

Become membership

If you are a member. Log in here