Obesity and pregnancy: complications and cost

The prevalence of obesity is currently rising in developed countries, makin g pregravid overweight one of the most common high-risk obstetric situation s. Although the designs and populations of published studies vary widely, m ost authors agree that pregravid overweight increases maternal and fetal mo rbidity. Even moderate overweight is a risk factor for gestational diabetes and hypertensive disorders of pregnancy, and the risk is higher in subject s with overt obesity. Compared with normal weight, maternal overweight is r elated to a higher risk of cesarean deliveries and a higher incidence of an esthetic and postoperative complications in these deliveries. Low Apgar sco res, macrosomia, and neural tube defects are more frequent in infants of ob ese mothers than in infants of normal-weight mothers. The regional distribu tion of fat modulates the effects of weight on carbohydrate tolerance, hemo dynamic adaptation, and fetal size. Maternal obesity increases perinatal mo rtality. Longterm complications include worsening of maternal obesity and d evelopment of obesity in the infant. The average cost of hospital prenatal and postnatal care is higher for overweight mothers than for normal-weight mothers, and infants of overweight mothers require admission to neonatal in tensive care units more often than do infants of normal-weight mothers. Pre conception counseling, careful prenatal management, tight monitoring of wei ght gain, and long-term follow-up could minimize the social and economic co nsequences of pregnancies in overweight women.