OBESITY IN OBSTETRICS AND GYNECOLOGY

In some countries, the incidence of obesity doubles every 10 years. Fo r the obstetrician-gynecologist, there are many different situations w here the patient's excess body weight calls for an adapted diagnostic and therapeutic approach. Obesity does not in itself appear to be a fa ctor lowering fertility. However obesity-induced hormone disorders cou ld contribute, in certain cases, to biological imbalance and thus favo r the development of ovulation dysfunction. Pregnancy in obese women s hould be managed as a high risk pregnancy. The incidence of gestationa l diabetes and hypertension is increased. Macrosomatia is frequent. Th ere is a 2- to 3-fold increase in the rate of cesarean sections with m ore complications. Fetal morbidity does not appear to be changed when maternal weight gain is limited. With obesity, then is an increased ri sk for boast and endometrial cancer due, for most authors, to elevated levels of circulating estrogens resulting from aromatization of male sex steroids in adipose tissue and decreased levels of sex hormone-bin ding globulin. Anesthesia and surgery in obese patients can be problem atic and special care must be taken to prevent further morbidity. Lapa roscopic surgery is possible under certain conditions, although its ro le remains to be determined. Prescription of hormone replacement must take into consideration several parameters which determine its usefuln ess and surveillance. Obesity is not a contraindication for hormone re placement therapy but is frequently a non-indication. (C) 1998 Elsevie r Science Ireland Ltd.