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Management of pregnancy in women with history of weight loss surgery

31.1 Introduction The proportion of the female population either overweight or obese has increased significantly in recent years and pregnancy in this group of women is associated with significant health problems. Pregnancy in obese women is associated with increased risk of metabolic syndrome, including impaired glucose tolerance and raised blood pressure. Of late, more and more young women are seeking bariatric surgery (BS) where nonsurgical methods…

Weight management during pregnancy

30.1 Introduction The antenatal period can be a difficult time for pregnant obese patients to manage their weight. There is often the misconception that a pregnant person needs to “eat for two” and a patient may need educating that a healthy, balanced diet should be maintained. The weight gained while pregnant can be attributed to the foetus, placenta, amniotic fluid, and maternal adipose deposits, along with…

Infections during pregnancy

Many infections in pregnancy have little effect on maternal health, and may result in minimal or no maternal symptoms unless the mother is immunocompromised. Acute maternal infection can have significant consequences on the mother right through pregnancy because of immunological adjustments. However certain infections are known to be teratogenic to the developing foetus, and this damage is determined by the gestational age at exposure to infection.…

Management of pregnancy in elderly obese women

Pregnancy in elderly obese women poses increased maternal and foetal risks; The World Health Organization classifies obesity into: class I BMI (Body mass index) 30.0–34.9 class II 35.0–39.9 class III 40 or greater There has been an increase in prevalence of obesity worldwide. Prevalence of obesity is around 30% in the United States, increasing to near 60% when both obese and overweight (BMI 25.0–29.9) are combined.…

Antenatal care for obese women

26.1 Introduction Obesity poses an increased risk for women before, during, and after pregnancy. Traditionally obesity is calculated using weight and height and is classified by the WHO (World Health Organization) into class I BMI (Body Mass Index) 30.0–34.9, class II 35.0–39.9, and class III 40 or greater Obesity is a worldwide pandemic but the prevalence is not uniform across different regions and countries. 26.2 According…

Ultrasound scanning in early pregnancy and foetal abnormality screening in obese women

25.1 Introduction The prevalence of obesity is on the rise and is a major health concern in pregnancy. It is associated with comorbidities posing risks to the health of both the mother and her unborn foetus. Planned optimum antenatal care commencing from the early weeks of pregnancy can help to identify and mitigate many of these risks, such that adverse outcomes can be avoided. In this…

Early pregnancy and obesity

Obesity has become a major health problem worldwide and it’s an independent risk factor for adverse pregnancy outcome. The World Health Organization classifies obesity into class I BMI (body mass index) 30.0–34.9, class II 35.0–39.9, and class III 40 or greater. The prevalence of obesity in the general population in the UK has increased markedly since the early 1990s. The prevalence of obesity in pregnancy has…

Weight optimisation strategies in pregnant obese women

Roughly one in five pregnant women are obese and this number is increasing. High maternal weight gain in pregnancy is associated with adverse maternal and foetal outcomes. These risks are increased in mothers who are already obese at booking. Strategies aiming to optimise maternal weight during pregnancy have been shown to be effective in reducing gestational weight gain and improving maternal health outcomes. 23.1 Guidelines on…

Pathological basis of effects of obesity on pregnancy outcome

21.1 Introduction 1. Obesity has reached epidemic proportions globally and nearly tripled worldwide between 1975 and 2016. 2. According to the World Health Organisation (WHO) in 2016, more than 1.9 billion adults aged 18 years and older were overweight, and of those over 650 million adults were obese. 3. Overall approximately 13% of world’s adult population (11% of men and 15% of women) was obese in…

Intraoperative care during gynaecology surgery

20.1 Introduction Obesity is associated with various conditions, including diabetes mellitus, hypertension, hypercholesterolemia, heart disease, asthma, and arthritis. All these conditions contribute to increased morbidity and mortality in gynaecology surgery. Obese women with metabolic syndrome (specifically hypertension and diabetes) who underwent general, vascular, and orthopaedic surgery are at increased risk of perioperative morbidity and mortality compared with normal-weight patients. Based on the data, the American College…

Menopause and hormone replacement therapy

19.1 Introduction Menopause is an inevitable component of ageing and encompasses the loss of ovarian reproductive function, either occurring spontaneously or secondary to other conditions. This has a significant influence in women’s quality of life and the likelihood of healthy ageing: 1. Temporal changes in health and quality of life (vasomotor symptoms (VMS), sleep disturbance, and depression). 2. Longer term changes in several health outcomes (urogenital…

Female obesity and osteoporosis

18.1 Introduction 1. Obesity and osteoporosis are two important problems affecting global health with a high impact on both mortality and morbidity. 2. Both have multifactorial aetiologies, including genetic and environmental components, with potential interactions between them. 3. Obesity is a condition of excessive body fat due to an imbalance when energy intake exceeds energy expenditure over a prolonged period. a. In healthy adults, body weight…

Obesity and breast cancer

17.1 Epidemiology 1. Breast cancer (BC) is the most prevalent female cancer, responsible for 15% of all cancer deaths in women worldwide. 2. 33% of BCs in post menopause are due to obesity. 3. Linear association between obesity and overall risk of BC in menopause has been reported with a hazard ratio of 1.05 (99% Confidence interval, CI 103–1.07), for each body mass index 5 kg/m…

Obesity and cancer

16.1 Overview 1. Cancer development is stimulated by genetic components, environmental exposures, and lifestyle exposures; all impact the cellular microenvironment and initiate carcinogenesis. 2. Links between obesity and cancer have been documented for hormonally influenced cancers such as endometrial and breast cancer, and links to broader cancers are emerging. 3. Changes to systemic and microenvironment from obesity and hypernutrition not only cause significant risk for carcinogenesis…

Obesity and clinical psychosomatic women’s health

15.1 Introduction 1. The concept “clinical psychosomatic” brings together and emphasises the connection between mind and body as being relevant to clinical medicine when evaluating diseases that affect both physical and mental health concomitantly. 2. It accounts for the fact that the body and mind are not disparate entities. Rather, they are anatomically and physiologically linked via the neuroendocrine system, with their interplay influencing the maintenance…

Obesity and pelvic organ prolapse

13.1 Introduction 1. Pelvic Organ Prolapse (POP) prevalence rates range from 10% in younger women and up to 50% in postmenopausal women. 2. Nearly 1 in 10 women will undergo surgical correction for POP in their lifetime. 3. This can be defined as descend into the vaginal space prolapse of >1 intrapelvic organ (uterus, bladder, rectum, and the urethra), presumably due to deficiencies in the pelvic…

Obesity, incontinence, and pelvic floor dysfunction

12.1 Urinary incontinence 12.1.1 Introduction 1. Urinary incontinence (UI) is a common disorder that affects approximately 25% of the general population according to large epidemiological studies. 2. Several factors have been implicated in UI, including parity, operative vaginal delivery, length of labour, obesity, chronic cough, depression, anxiety, poor health status, lower urinary tract symptoms, previous hysterectomy, and smoking. 3. UI is a cause of significant morbidity…