Title : Impact of obesity on obstetrical and gynecologic conditions
Abstract:
Obesity is a global epidemic resulting in multiple medical co-morbidities and excessive consumption of health care resources. It is a medical condition caused by lifestyle, diet, metabolic dysfunction, genetic and socioeconomic factors, whose prevalence has risen dramatically over the past 50 years. In the US, nearly half of women begin the pregnancy overweight or obese, and a similar percentage gain more weight in pregnancy than recommended. Pre-pregnancy weight and weight gain during pregnancy influence long-term weight gain and risk of obesity.
Epigenetic changes, caused by complex interactions between the fetus, the intrauterine environment of mothers experiencing increased inflammation predisposes the offspring to childhood obesity. Ninety percent of children with obesity or overweight at three years of age had obesity or overweight in adolescence.
Obesity is associated with higher prevalence of co-morbidities of pre-diabetes, Type 2 diabetes mellitus, hypertension, cardiovascular disease, and multiple malignancies. Non-gynecologic conditions which have been reported to be associated with obesity include venous thromboembolism, stroke, osteoarthritis, gout, hepatobiliary disease, cholelithiasis and cholecystitis, gastroesophageal reflux, obstructive sleep apnea, depression and possible dementia.
Obstetric conditions associated with obesity include pregnancy loss, gestational diabetes, preeclampsia, venous thromboembolism, induced labor, cesarean delivery, anesthetic complications and wound infections all occur more frequently. The fetus of a mother with obesity faces risk of congenital anomalies, prematurity, macrosomia, stillbirth and neonatal mortality, particularly with inter-pregnancy interval of less than 18 months.
Gynecologic conditions include menorrhagia, polycystic ovarian syndrome, infertility, endometriosis, leiomyomas, stress urinary incontinence, sexual dysfunction and cancer. Gynecologic cancers include breast, ovarian and uterine malignancies. All of the conditions are related to sex hormone imbalance and inflammatory response of the adipose tissue with the exception of pelvic organ prolapse, occurring as result of sustained increase in intraabdominal pressure.
Successful treatment requires holistic personalized approach. Behavioral modification and psychological intervention, medical therapy and bariatric surgery, all represent potentially effective options, requiring high degree of motivation by patients. The most important intervention, however, is primary prevention of obesity.
