Pregnancy and obesity: practical implications

Clinical Review


Obesity is presently the most prevalent health threat in the western world, and its influence on general health is rapidly increasing. Obesity has also developed as a major and frequent risk factor for pregnancy complications. Complications often encountered in obese pregnant women are hypertensive disorders, gestational diabetes mellitus, caesarean section, and postpartum and postoperative infections. The incidence of pulmonary embolism and primary postpartum haemorrhage is most likely also increased. Anaesthetic complications are more frequent. Neonatal consequences of obesity include an increased rate of congenital anomalies, stillbirth, and macrosomia. This article focuses on practical implications of obesity in pregnancy and childbirth for the caregiver.


Pregnancy Obesity Overweight Pregnancy complications Labour complications 


  1. 1.
    Banegas JR, Lopez-Garcia E, Gutierrez-Fisac JL, Guallar-Castillon P, Rodriguez-Artalejo F (2003) A simple estimate of mortality attributable to excess weight in the European Union. Eur J Clin Nutr 57:201–208CrossRefPubMedGoogle Scholar
  2. 2.
    Matthews HB, Der Brucke MG (1938) Normal expectancy in the extreme obese pregnant woman. JAMA 110:554–559Google Scholar
  3. 3.
    Møller CE (1938) Course of pregnancy, labor and puerperium in overweight primiparas. Acta Obstet Gynecol Scand 18:226–236Google Scholar
  4. 4.
    Odell LD, Mengert WF (1945) The overweight obstetric patient. JAMA 128:87–90Google Scholar
  5. 5.
    Galtier-Dereure F, Boegner C, Bringer J (2000) Obesity and pregnancy: complications and cost. Am J Clin Nutr 71:1242S–1248SPubMedGoogle Scholar
  6. 6.
    Castro LC, Avina RL (2002) Maternal obesity and pregnancy outcomes. Curr Opin Obstet Gynecol 14:601–606CrossRefPubMedGoogle Scholar
  7. 7.
    Andreasen KR, Andersen ML, Schantz AL (2004) Obesity and pregnancy. Acta Obstet Gynecol Scand 83:1022–1029Google Scholar
  8. 8.
    International Obesity Task Force (1998) Managing the global epidemic of obesity: report of the WHO consultation on obesity. World Health Organization, Geneva, pp 1–279Google Scholar
  9. 9.
    Must A, Dallal GE, Dietz WH (1991) Reference data for obesity: 85th and 95th percentiles of body mass index (wt/ht2) and triceps skinfold thickness. Am J Clin Nutr 53:839–846PubMedGoogle Scholar
  10. 10.
    Deurenberg P, Yap M, Staveren WA (1998) Body mass index and percent body fat: a meta-analysis among different ethnic groups. Int J Obes 22:1164–1171CrossRefGoogle Scholar
  11. 11.
    Gurrici S, Hartriyanti Y, Hautvast JG, Deurenberg P (1998) Relationship between body fat and body mass index: differences between Indonesians and Dutch Caucasians. Eur J Clin Nutr 52:779–783CrossRefPubMedGoogle Scholar
  12. 12.
    Gallagher D, Visser M, Sepulveda D, Pierson RN, Harris T, Heymsfield SB (1996) How useful is body mass index for comparison of body fatness across age, sex, and ethnic groups? Am J Epidemiol 143:228–239PubMedGoogle Scholar
  13. 13.
    Deurenberg P, Andreoli A, Borg P, Kukkonen-Harjula K, de Lorenzo A, van Marken Lichtenbelt WD, Testolin G, Vigano R, Vollaard N (2001) The validity of predicted body fat percentage from body mass index and from impedance in samples of five European populations. Eur J Clin Nutr 55:973–979CrossRefPubMedGoogle Scholar
  14. 14.
    Kabiru W, Raynor BD (2004) Obstetric outcomes associated with increase in BMI category during pregnancy. Am J Obstet Gynecol 191:928–932CrossRefPubMedGoogle Scholar
  15. 15.
    Lindsay CA, Huston L, Amini SB, Catalano PM (1997) Longitudinal changes in the relationship between body mass index and percent body fat in pregnancy. Obstet Gynecol 89:377–382CrossRefPubMedGoogle Scholar
  16. 16.
    Ehrenberg HM, Huston-Presley L, Catalano PM (2003) The influence of obesity and gestational diabetes mellitus on accretion and the distribution of adipose tissue in pregnancy. Am J Obstet Gynecol 189:944–948CrossRefPubMedGoogle Scholar
  17. 17.
    Visscher TLS, Seidell JC (2004) Time trends (1993–1997) and seasonal variation in body mass index and waist circumference in the Netherlands. Int J Obes Relat Metab Disord 28:1309–1316Google Scholar
  18. 18.
    Sanin Aguirre LH, Reza-Lopez S, Levario-Carrillo M (2004) Relation between maternal body composition and birth weight. Biol Neonate 86:55–62CrossRefPubMedGoogle Scholar
  19. 19.
    Larciprete G, Valensise H, Vasapollo B, Altomare F, Sorge R, Casalino B, De Lorenzo A, Arduini D (2003) Body composition during normal pregnancy: reference ranges. Acta Diabetol 40(Suppl):S225—S232Google Scholar
  20. 20.
    Catalano PM, Roman-Drago NM, Amini SB, Sims EA (1998) Longitudinal changes in body composition and energy balance in lean women with normal and abnormal glucose tolerance during pregnancy. Am J Obstet Gynecol 179:156–165PubMedGoogle Scholar
  21. 21.
    McCarthy EA, Strauss BJ, Walker SP, Permezel M (2004) Determination of maternal body composition in pregnancy and its relevance to perinatal outcomes. Obstet Gynecol Surv 59:731–742CrossRefPubMedGoogle Scholar
  22. 22.
    Yoshiike N, Seino F, Tajima S, Arai Y, Kawano M, Furuhata T, Inoue S (2002) Twenty-year changes in the prevalence of overweight in Japanese adults: the National Nutrition Survey 1976–1995. Obes Rev 3(3):183–190CrossRefPubMedGoogle Scholar
  23. 23.
    Zellner K, Jaeger U, Kromeyer-Hauschild K (2004) Height, weight and BMI of schoolchildren in Jena, Germany—is the secular trend levelling off? Econ Hum Biol 2:281–294CrossRefPubMedGoogle Scholar
  24. 24.
    Mayer J (1957) Correlation between metabolism and feeding behavior and multiple etiology of obesity. Bull NY Acad Med 33:744–761Google Scholar
  25. 25.
    Marti A, Moreno-Aliaga MJ, Hebebrand J, Martinez JA (2004) Genes, lifestyles and obesity. Int J Obes Relat Metab Disord 28(Suppl):S29–S36Google Scholar
  26. 26.
    Ellis L, Haman D (2004) Population increases in obesity appear to be partly due to genetics. J Biosoc Sci 36:547–559CrossRefPubMedGoogle Scholar
  27. 27.
    Pasquali R, Pelusi C, Genghini S, Cacciari M, Gambineri A (2003) Obesity and reproductive disorders in women. Hum Reprod Update 9:359–372CrossRefPubMedGoogle Scholar
  28. 28.
    Wang JX, Davies MJ, Norman RJ (2002) Obesity increases the risk of spontaneous abortion during infertility treatment. Obes Res 10:551–554PubMedGoogle Scholar
  29. 29.
    Bellver J, Rossal LP, Bosch E, Zuniga A, Corona JT, Melendez F, Gomez E, Simon C, Remohi J, Pellicer A (2003) Obesity and the risk of spontaneous abortion after oocyte donation. Fertil Steril 79:1136–1140CrossRefPubMedGoogle Scholar
  30. 30.
    Lashen H, Fear K, Sturdee DW (2004) Obesity is associated with increased risk of first trimester and recurrent miscarriage: matched case-control study. Hum Reprod 19:1644–1646CrossRefPubMedGoogle Scholar
  31. 31.
    Hamilton-Fairley D, Kiddy D, Watson H, Paterson C, Franks S (1992) Association of moderate obesity with a poor pregnancy outcome in women with polycystic ovary syndrome treated with low dose gonadotrophin. Br J Obstet Gynaecol 99:128–131PubMedGoogle Scholar
  32. 32.
    al-Ansary LA, Babay ZA (1994) Risk factors for spontaneous abortion: a preliminary study on Saudi women. J R Soc Health 114:188–193PubMedGoogle Scholar
  33. 33.
    Risch HA, Weiss NS, Clarke EA, Miller AB (1988) Risk factors for spontaneous abortion and its recurrence. Am J Epidemiol 128:420–430PubMedGoogle Scholar
  34. 34.
    Hendler I, Goldenberg RL, Mercer BM, Iams JD, Meis PJ, Moawad AH, MacPherson CA, Caritis SN, Miodovnik M, Menard KM, Thurnau GR, Sorokin Y (2005) The preterm prediction study: association between maternal body mass index and spontaneous and indicated preterm birth. Am J Obstet Gynecol 192:882–886CrossRefPubMedGoogle Scholar
  35. 35.
    Cnattingius S, Bergstrom R, Lipworth L, Kramer MS (1998) Prepregnancy weight and the risk of adverse pregnancy outcomes. N Engl J Med 338:147–152Google Scholar
  36. 36.
    Baeten JM, Bukusi EA, Lambe M (2001) Pregnancy complications and outcomes among overweight and obese nulliparous women. Am J Public Health 91:436–440PubMedGoogle Scholar
  37. 37.
    Sebire NJ, Jolly M, Harris JP, Wadsworth J, Joffe M, Beard RW, Regan L, Robinson S (2001) Maternal obesity and pregnancy outcome: a study of 287,213 pregnancies in London. Int J Obes Relat Metab Disord 25:1175–1182Google Scholar
  38. 38.
    Bianco AT, Smilen SW, Davis Y, Lopez S, Lapinski R, Lockwood CJ (1998) Pregnancy outcome and weight gain recommendations for the morbidly obese woman. Obstet Gynecol 91:97–102CrossRefPubMedGoogle Scholar
  39. 39.
    Weiss JL, Malone FD, Emig D, Ball RH, Nyberg DA, Comstock CH, Saade G, Eddleman K, Carter SM, Craigo SD, Carr SR, D’Alton ME; FASTER Research Consortium (2004) Obesity, obstetric complications and cesarean delivery rate—a population-based screening study. Am J Obstet Gynecol 190:1091–1097Google Scholar
  40. 40.
    Kumari AS (2001) Pregnancy outcome in women with morbid obesity. Int J Gynaecol Obstet 73:101–107CrossRefPubMedGoogle Scholar
  41. 41.
    Schieve LA, Cogswell ME, Scanlon KS, Perry G, Ferre C, Blackmore-Prince C, Yu SM, Rosenberg D (2000) Prepregnancy body mass index and pregnancy weight gain: associations with preterm delivery. The NMIHS Collaborative Study Group. Obstet Gynecol 96:194–200CrossRefPubMedGoogle Scholar
  42. 42.
    Hedderson MM, Ferrara A, Sacks DA (2003) Gestational diabetes mellitus and lesser degrees of pregnancy hyperglycemia: association with increased risk of spontaneous preterm birth. Obstet Gynecol 102:850–856CrossRefPubMedGoogle Scholar
  43. 43.
    Cedergren MI (2004) Maternal morbid obesity and the risk of adverse pregnancy outcome. Obstet Gynecol 103:219–224PubMedGoogle Scholar
  44. 44.
    Gross T, Sokol RJ, King KC (1980) Obesity in pregnancy: risks and outcome. Obstet Gynecol 56:446–450PubMedGoogle Scholar
  45. 45.
    Vahratian A, Zhang J, Troendle JF, Savitz DA, Siega-Riz AM (2004) Maternal prepregnancy overweight and obesity and the pattern of labor progression in term nulliparous women. Obstet Gynecol 104:943–951PubMedGoogle Scholar
  46. 46.
    Bo S, Menato G, Gallo ML, Bardelli C, Lezo A, Signorile A, Gambino R, Cassader M, Massobrio M, Pagano G (2004) Mild gestational hyperglycemia, the metabolic syndrome and adverse neonatal outcomes. Acta Obstet Gynecol Scand 83:335–340Google Scholar
  47. 47.
    Kalkhoff RK, Kandaraki E, Morrow PG, Mitchell TH, Kelber S, Borkowf HI (1988) Relationship between neonatal birth weight and maternal plasma amino acid profiles in lean and obese nondiabetic women and in type I diabetic pregnant women. Metabolism 37:234–239CrossRefPubMedGoogle Scholar
  48. 48.
    Catalano PM, Kirwan JP, Haugel-de Mouzon S, King J (2003) Gestational diabetes and insulin resistance: role in short-term and long-term implications for mother and fetus. J Nutr 133(Suppl):1674S–1683SPubMedGoogle Scholar
  49. 49.
    Glazer NL, Hendrickson AF, Schellenbaum GD, Mueller BA (2004) Weight change and the risk of gestational diabetes in obese women. Epidemiology 15:733–737CrossRefPubMedGoogle Scholar
  50. 50.
    Abrams B, Parker J (1988) Overweight and pregnancy complications. Int J Obes 12:293–303PubMedGoogle Scholar
  51. 51.
    World Health Organization (1999) WHO Consultation: definition, diagnosis and classification of diabetes mellitus and its complications: report of a who consultation. Part 1: diagnosis and classification of diabetes mellitus. WHO/NCD/NCS/99.2, GenevaGoogle Scholar
  52. 52.
    Hidar S, Chaieb A, Baccouche S, Laradi S, Fkih M, Milled A, Khairi H (2001) Post-prandial plasma glucose test as screening tool for gestational diabetes: a prospective randomized trial. J Gynecol Obstet Biol Reprod (Paris) 30:344–347Google Scholar
  53. 53.
    Bhattacharya SM (2004) Fasting or two-hour postprandial plasma glucose levels in early months of pregnancy as screening tools for gestational diabetes mellitus developing in later months of pregnancy. J Obstet Gynaecol Res 30:333–336CrossRefPubMedGoogle Scholar
  54. 54.
    Perucchini D, Fischer U, Spinas GA, Huch R, Huch A, Lehmann R (1999) Using fasting plasma glucose concentrations to screen for gestational diabetes mellitus: prospective population based study. BMJ 319:812–815PubMedGoogle Scholar
  55. 55.
    Ostlund I, Haglund B, Hanson U (2004) Gestational diabetes and preeclampsia. Eur J Obstet Gynecol Reprod Biol 113:12–16CrossRefPubMedGoogle Scholar
  56. 56.
    van Hoorn J, Dekker G, Jeffries B (2002) Gestational diabetes versus obesity as risk factors for pregnancy-induced hypertensive disorders and fetal macrosomia. Aust NZ J Obstet Gynaecol 42:29–34CrossRefGoogle Scholar
  57. 57.
    Thadhani R, Stampfer MJ, Hunter DJ, Manson JE, Solomon CG, Curhan GC (1999) High body mass index and hypercholesterolemia: risk of hypertensive disorders of pregnancy. Obstet Gynecol 94:543–550CrossRefPubMedGoogle Scholar
  58. 58.
    O’Brien TE, Ray JG, Chan WS (2003) Maternal body mass index and the risk of preeclampsia: a systematic overview. Epidemiology 14:368–374CrossRefPubMedGoogle Scholar
  59. 59.
    de Man FH, Weverling-Rijnsburger AW, van der Laarse A, Smelt AH, Jukema JW, Blauw GJ (2000) Not acute but chronic hypertriglyceridemia is associated with impaired endothelium-dependent vasodilation: reversal after lipid-lowering therapy by atorvastatin. Arterioscler Thromb Vasc Biol 20:744–750PubMedGoogle Scholar
  60. 60.
    Martin JN Jr, May WL, Rinehart BK, Martin RW, Magann EF (2000) Increasing maternal weight: a risk factor for preeclampsia/eclampsia but apparently not for HELLP syndrome. South Med J 93:686–691PubMedGoogle Scholar
  61. 61.
    Pickering TG, Hall JE, Appel LJ, Falkner BE, Graves J, Hill MN, Jones DW, Kurtz T, Sheps SG, Roccella EJ (2005) Subcommittee of Professional and Public Education of the American Heart Association Council on High Blood Pressure Research. Recommendations for blood pressure measurement in humans and experimental animals: Part 1: blood pressure measurement in humans: a statement for professionals from the Subcommittee of Professional and Public Education of the American Heart Association Council on High Blood Pressure Research. Hypertension 45:142–61PubMedGoogle Scholar
  62. 62.
    Marks LA, Groch A (2000) Optimizing cuff width for noninvasive measurement of blood pressure. Blood Press Monit 5:153–158PubMedGoogle Scholar
  63. 63.
    Oliveira SM, Arcuri EA, Santos JL (2002) Cuff width influence on blood pressure measurement during the pregnant-puerperal cycle. J Adv Nurs 38:180–189CrossRefPubMedGoogle Scholar
  64. 64.
    Singer AJ, Kahn SR, Thode HC, Hollander JE (1999) Comparison of forearm and upper arm blood pressures. Prehosp Emerg Care 3:123–126PubMedGoogle Scholar
  65. 65.
    Emerick DR (2002) An evaluation of non-invasive blood pressure (NIBP) monitoring on the wrist: comparison with upper arm NIBP measurement. Anaesth Intensive Care 30:43–47PubMedGoogle Scholar
  66. 66.
    Altunkan S, Yildiz S, Azer S (2002) Wrist blood-pressure measuring devices: a comparative study of accuracy with a standard auscultatory method using a mercury manometer. Blood Press Monit 7:281–284CrossRefPubMedGoogle Scholar
  67. 67.
    Block FE, Schulte GT (1996) Ankle blood pressure measurement, an acceptable alternative to arm measurements. Int J Clin Monit Comput 13:167–171CrossRefPubMedGoogle Scholar
  68. 68.
    Wilkes JM, DiPalma JA (2004) Brachial blood pressure monitoring versus ankle monitoring during colonoscopy. South Med J 97:939–941CrossRefPubMedGoogle Scholar
  69. 69.
    Abir F, Bell R (2004) Assessment and management of the obese patient. Crit Care Med 32(Suppl):S87–S91CrossRefPubMedGoogle Scholar
  70. 70.
    Luke B, Hediger ML, Scholl TO (1996) Point of diminishing returns: when does gestational weight gain cease benefiting birthweight and begin adding to maternal obesity? J Matern Fetal Med 5:168–173CrossRefPubMedGoogle Scholar
  71. 71.
    Jensen DM, Damm P, Sorensen B, Molsted-Pedersen L, Westergaard JG, Ovesen P, Beck-Nielsen H (2003) Pregnancy outcome and prepregnancy body mass index in 2459 glucose-tolerant Danish women. Am J Obstet Gynecol 189:239–244CrossRefPubMedGoogle Scholar
  72. 72.
    Edwards LE, Hellerstedt WL, Alton IR, Story M, Himes JH (1996) Pregnancy complications and birth outcomes in obese and normal-weight women: effects of gestational weight change. Obstet Gynecol 87:389–394CrossRefPubMedGoogle Scholar
  73. 73.
    Shepard MJ, Hellenbrand KG, Bracken MB (1986) Proportional weight gain and complications of pregnancy, labor, and delivery in healthy women of normal prepregnant stature. Am J Obstet Gynecol 155:947–954PubMedGoogle Scholar
  74. 74.
    Institute of Medicine (1990) Nutrition during pregnancy: part I, weight gain. National Academy Press, Washington, DCGoogle Scholar
  75. 75.
    Schieve LA, Cogswell ME, Scanlon KS (1998) An empiric evaluation of the Institute of Medicine’s pregnancy weight gain guidelines by race. Obstet Gynecol 91:878–884CrossRefPubMedGoogle Scholar
  76. 76.
    Olson CM, Strawderman MS, Reed RG (2004) Efficacy of an intervention to prevent excessive gestational weight gain. Am J Obstet Gynecol 191:530–536CrossRefPubMedGoogle Scholar
  77. 77.
    Polley BA, Wing RR, Sims CJ (2002) Randomized controlled trial to prevent excessive weight gain in pregnant women. Int J Obes Relat Metab Disord 26:1494–1502CrossRefPubMedGoogle Scholar
  78. 78.
    Kramer MS (2000) Energy/protein restriction for high weight-for-height or weight gain during pregnancy. Cochrane Database Syst Rev CD000080Google Scholar
  79. 79.
    Ehrenberg HM, Mercer BM, Catalano PM (2004) The influence of obesity and diabetes on the prevalence of macrosomia. Am J Obstet Gynecol 191:964–968CrossRefPubMedGoogle Scholar
  80. 80.
    Schaefer-Graf UM, Heuer R, Kilavuz O, Pandura A, Henrich W, Vetter K (2002) Maternal obesity not maternal glucose values correlates best with high rates of fetal macrosomia in pregnancies complicated by gestational diabetes. J Perinat Med 30:313–321CrossRefPubMedGoogle Scholar
  81. 81.
    Farrell T, Holmes R, Stone P (2002) The effect of body mass index on three methods of fetal weight estimation. BJOG 109:651–657PubMedGoogle Scholar
  82. 82.
    Field NT, Piper JM, Langer O (1995) The effect of maternal obesity on the accuracy of fetal weight estimation. Obstet Gynecol 86:102–107CrossRefPubMedGoogle Scholar
  83. 83.
    Froen JF, Arnestad M, Frey K, Vege A, Saugstad OD, Stray-Pedersen B (2001) Risk factors for sudden intrauterine unexplained death: epidemiologic characteristics of singleton cases in Oslo, Norway, 1986–1995. Am J Obstet Gynecol 184:694–702CrossRefPubMedGoogle Scholar
  84. 84.
    Little RE, Weinberg CR (1993) Risk factors for antepartum and intrapartum stillbirth. Am J Epidemiol 137:1177–1189PubMedGoogle Scholar
  85. 85.
    Stephansson O, Dickman PW, Johansson A, Cnattingius S (2001) Maternal weight, pregnancy weight gain, and the risk of antepartum stillbirth. Am J Obstet Gynecol 184:463–469CrossRefPubMedGoogle Scholar
  86. 86.
    Waller DK, Mills JL, Simpson JL, Cunningham GC, Conley MR, Lassman MR, Rhoads GG (1994) Are obese women at higher risk for producing malformed offspring? Am J Obstet Gynecol 170:541–548PubMedGoogle Scholar
  87. 87.
    Queisser-Luft A, Kieninger-Baum D, Menger H, Stolz G, Schlaefer K, Merz E (1998) Does maternal obesity increase the risk of fetal abnormalities? Analysis of 20,248 newborn infants of the Mainz Birth Register for detecting congenital abnormalities. Ultraschall Med 19:40–44Google Scholar
  88. 88.
    Watkins ML, Rasmussen SA, Honein MA, Botto LD, Moore CA (2003) Maternal obesity and risk for birth defects. Pediatrics 111:1152–1158PubMedGoogle Scholar
  89. 89.
    Werler MM, Louik C, Shapiro S, Mitchell AA (1996) Prepregnant weight in relation to risk of neural tube defects. JAMA 275:1089–1092CrossRefPubMedGoogle Scholar
  90. 90.
    Ray JG, Wyatt PR, Vermeulen MJ, Meier C, Cole DE (2005) Greater maternal weight and the ongoing risk of neural tube defects after folic acid flour fortification. Obstet Gynecol 105:261–265PubMedGoogle Scholar
  91. 91.
    Shaw GM, Quach T, Nelson V, Carmichael SL, Schaffer DM, Selvin S, Yang W (2003) Neural tube defects associated with maternal periconceptional dietary intake of simple sugars and glycemic index. Am J Clin Nutr 78:972–978PubMedGoogle Scholar
  92. 92.
    Carmichael SL, Shaw GM, Neri E, Schaffer DM, Selvin S (2002) Physical activity and risk of neural tube defects. Matern Child Health J 6:151–157CrossRefPubMedGoogle Scholar
  93. 93.
    Watkins ML, Botto LD (2001) Maternal prepregnancy weight and congenital heart defects in offspring. Epidemiology 12:439–446CrossRefPubMedGoogle Scholar
  94. 94.
    Prentice A, Goldberg G (1996) Maternal obesity increases congenital malformations. Nutr Rev 54:146–150PubMedGoogle Scholar
  95. 95.
    Reddy UM, Branum AM, Klebanoff MA (2005) Relationship of maternal body mass index and height to twinning. Obstet Gynecol 105:593–597PubMedGoogle Scholar
  96. 96.
    Wolfe HM, Sokol RJ, Martier SM, Zador IE (1990) Maternal obesity: a potential source of error in sonographic prenatal diagnosis. Obstet Gynecol 76:339–342PubMedGoogle Scholar
  97. 97.
    Catanzarite V, Quirk JG (1990) Second-trimester ultrasonography: determinants of visualization of fetal anatomic structures. Am J Obstet Gynecol 163:1191–1195PubMedGoogle Scholar
  98. 98.
    Schwarzler P, Senat MV, Holden D, Bernard JP, Masroor T, Ville Y (1999) Feasibility of the second-trimester fetal ultrasound examination in an unselected population at 18, 20 or 22 weeks of pregnancy: a randomized trial. Ultrasound Obstet Gynecol 14:92–97CrossRefPubMedGoogle Scholar
  99. 99.
    Hendler I, Blackwell SC, Treadwell MC, Bujold E, Sokol RJ, Sorokin Y (2004) Does advanced ultrasound equipment improve the adequacy of ultrasound visualization of fetal cardiac structures in the obese gravid woman? Am J Obstet Gynecol 190:1616–1619CrossRefPubMedGoogle Scholar
  100. 100.
    Paladini D, Vassallo M, Tartaglione A, Lapadula C, Martinelli P (2004) The role of tissue harmonic imaging in foetal echocardiography. Ultrasound Obstet Gynecol 23:159–16CrossRefPubMedGoogle Scholar
  101. 101.
    Hendler I, Blackwell SC, Bujold E, Treadwell MC, Wolfe HM, Sokol RJ, Sorokin Y (2004) The impact of maternal obesity on midtrimester sonographic visualization of fetal cardiac and craniospinal structures. Int J Obes Relat Metab Disord 28:1607–1611Google Scholar
  102. 102.
    Reichler A, Sherer DM, Divon MY (1997) Transvaginal sonographic imaging of early second-trimester fetal anatomy assisted by uterine fundal pressure. Obstet Gynecol 89:949–952CrossRefPubMedGoogle Scholar
  103. 103.
    Rosenberg JC, Guzman ER, Vintzileos AM, Knuppel RA (1995) Transumbilical placement of the vaginal probe in obese pregnant women. Obstet Gynecol 85:132–134CrossRefPubMedGoogle Scholar
  104. 104.
    McCoy MC, Watson WJ, Chescheir NC, Zerfas S (1996) Transumbilical use of the endovaginal probe. Am J Perinatol 13:395–397PubMedGoogle Scholar
  105. 105.
    Nuthalapaty FS, Rouse DJ, Owen J (2004) The association of maternal weight with cesarean risk, labor duration, and cervical dilation rate during labor induction. Obstet Gynecol 103:452–456PubMedGoogle Scholar
  106. 106.
    Jensen H, Agger AO, Rasmussen KL (1999) The influence of prepregnancy body mass index on labor complications. Acta Obstet Gynecol Scand 78:799–802Google Scholar
  107. 107.
    Buhimschi CS, Buhimschi IA, Malinow AM, Weiner CP (2004) Intrauterine pressure during the second stage of labor in obese women. Obstet Gynecol 103:225–230PubMedGoogle Scholar
  108. 108.
    Cottrill HM, Barton JR, O’Brien JM, Rhea DL, Milligan DA (2004) Factors influencing maternal perception of uterine contractions. Am J Obstet Gynecol 190:1455–1457Google Scholar
  109. 109.
    Hope P, Breslin S, Lamont L, Lucas A, Martin D, Moore I, Pearson J, Saunders D, Settatree R (1998) Fatal shoulder dystocia: a review of 56 cases reported to the Confidential Enquiry into Stillbirths and Deaths in Infancy. Br J Obstet Gynaecol 105:1256–1261PubMedGoogle Scholar
  110. 110.
    Nocon JJ, McKenzie DK, Thomas LJ, Hansell RS (1993) Shoulder dystocia: an analysis of risks and obstetric maneuvers. Am J Obstet Gynecol 168:1732–1737PubMedGoogle Scholar
  111. 111.
    Robinson H, Tkatch S, Mayes DC, Bott N, Okun N (2003) Is maternal obesity a predictor of shoulder dystocia? Obstet Gynecol 101:24–27CrossRefPubMedGoogle Scholar
  112. 112.
    Gonen R, Spiegel D, Abend M (1996) Is macrosomia predictable, and are shoulder dystocia and birth trauma preventable? Obstet Gynecol 88:526–529CrossRefPubMedGoogle Scholar
  113. 113.
    Chen G, Uryasev S, Young TK (2004) On prediction of the cesarean delivery risk in a large private practice. Am J Obstet Gynecol 191:617–625CrossRefGoogle Scholar
  114. 114.
    Ehrenberg HM, Durnwald CP, Catalano P, Mercer BM (2004) The influence of obesity and diabetes on the risk of cesarean delivery. Am J Obstet Gynecol 191:969–974CrossRefPubMedGoogle Scholar
  115. 115.
    Crane SS, Wojtowycz MA, Dye TD, Aubry RH, Artal R (1997) Association between pre-pregnancy obesity and the risk of cesarean delivery. Obstet Gynecol 89:213–216CrossRefPubMedGoogle Scholar
  116. 116.
    Brost BC, Goldenberg RL, Mercer BM, Iams JD, Meis PJ, Moawad AH, Newman RB, Miodovnik M, Caritis SN, Thurnau GR, Bottoms SF, Das A, McNellis D (1997) The preterm prediction study: association of cesarean delivery with increases in maternal weight and body mass index. Am J Obstet Gynecol 177:333–337PubMedGoogle Scholar
  117. 117.
    Witter FR, Caulfield LE, Stoltzfus RJ (1995) Influence of maternal anthropometric status and birth weight on the risk of cesarean delivery. Obstet Gynecol 85:947–951CrossRefPubMedGoogle Scholar
  118. 118.
    Brill Y, Windrim R (2003) Vaginal birth after Caesarean section: review of antenatal predictors of success. J Obstet Gynaecol Can 25:275–286PubMedGoogle Scholar
  119. 119.
    Carroll CS Sr, Magann EF, Chauhan SP, Klauser CK, Morrison JC (2003) Vaginal birth after cesarean section versus elective repeat cesarean delivery: weight-based outcomes. Am J Obstet Gynecol 188:1516–1520CrossRefPubMedGoogle Scholar
  120. 120.
    Durnwald CP, Ehrenberg HM, Mercer BM (2004) The impact of maternal obesity and weight gain on vaginal birth after cesarean section success. Am J Obstet Gynecol 191:954–957CrossRefPubMedGoogle Scholar
  121. 121.
    Shalev E, Battino S, Giladi Y, Edelstein S (1993) External cephalic version at term using tocolysis. Acta Obstet Gynecol Scand 72:455–457Google Scholar
  122. 122.
    Chervenak FA, Berkowitz RL (1983) Successful external cephalic version in a massively obese patient. Obstet Gynecol 62(Suppl):8s–9sPubMedGoogle Scholar
  123. 123.
    Solum T (1980) A comparison of the three methods for external cardiography. Acta Obstet Gynecol Scand 59:123–126PubMedGoogle Scholar
  124. 124.
    Rayburn WF, Motley ME, Zuspan FP (1982) Conditions affecting nonstress test results. Obstet Gynecol 59:490–493PubMedGoogle Scholar
  125. 125.
    Poots S, Logmans A, Duvekot JJ, Steegers EA (2004) Morbid obesity: a risk factor for obstetric complications. Ned Tijdschr Geneeskd 148:2253–2256PubMedGoogle Scholar
  126. 126.
    Skrablin S, Banovic V, Kuvacic I (2004) Morbid maternal obesity and pregnancy. Int J Gynaecol Obstet 85:40–41CrossRefPubMedGoogle Scholar
  127. 127.
    Wilkinson C, Enkin MW (2000) Lateral tilt for caesarean section. Cochrane Database Syst Rev CD000120Google Scholar
  128. 128.
    Wall PD, Deucy EE, Glantz JC, Pressman EK (2003) Vertical skin incisions and wound complications in the obese parturient. Obstet Gynecol 102:952–956CrossRefPubMedGoogle Scholar
  129. 129.
    Vermillion ST, Lamoutte C, Soper DE, Verdeja A (2000) Wound infection after cesarean: effect of subcutaneous tissue thickness. Obstet Gynecol 95:923–926CrossRefPubMedGoogle Scholar
  130. 130.
    Houston MC, Raynor BD (2000) Postoperative morbidity in the morbidly obese parturient woman: supraumbilical and low transverse abdominal approaches. Am J Obstet Gynecol 182:1033–1035CrossRefPubMedGoogle Scholar
  131. 131.
    Chelmow D, Rodriguez EJ, Sabatini MM (2004) Suture closure of subcutaneous fat and wound disruption after cesarean delivery: a meta-analysis. Obstet Gynecol 103:974–980PubMedGoogle Scholar
  132. 132.
    Allaire AD, Fisch J, McMahon MJ (2000) Subcutaneous drain vs. suture in obese women undergoing cesarean delivery. A prospective, randomized trial. J Reprod Med 45:327–331PubMedGoogle Scholar
  133. 133.
    Endler GC (1990) The risk of anesthesia in obese parturients. J Perinatol 10:175–179PubMedGoogle Scholar
  134. 134.
    Hood DD, Dewan DM (1993) Anesthetic and obstetric outcome in morbidly obese parturients. Anesthesiology 79:1210–1218PubMedGoogle Scholar
  135. 135.
    Ranta P, Jouppila P, Spalding M, Jouppila R (1995) The effect of maternal obesity on labour and labour pain. Anaesthesia 50:322–326PubMedGoogle Scholar
  136. 136.
    Brunette DD (2004) Resuscitation of the morbidly obese patient. Am J Emerg Med 22:40–47CrossRefPubMedGoogle Scholar
  137. 137.
    Brettingham M (2004) Depression and obesity are major causes of maternal death in Britain. BMJ 329:1205CrossRefGoogle Scholar
  138. 138.
    Perlow JH, Morgan MA (1994) Massive maternal obesity and perioperative cesarean morbidity. Am J Obstet Gynecol 170:560–565PubMedGoogle Scholar
  139. 139.
    Myles TD, Gooch J, Santolaya J (2002) Obesity as an independent risk factor for infectious morbidity in patients who undergo cesarean delivery. Obstet Gynecol 100:959–964CrossRefPubMedGoogle Scholar
  140. 140.
    Tran TS, Jamulitrat S, Chongsuvivatwong V, Geater A (2000) Risk factors for postcesarean surgical site infection. Obstet Gynecol 95:367–371CrossRefPubMedGoogle Scholar
  141. 141.
    Bodnar LM, Siega-Riz AM, Cogswell ME (2004) High prepregnancy BMI increases the risk of postpartum anemia. Obes Res 12:941–948PubMedGoogle Scholar
  142. 142.
    Frederiksen SG, Hedenbro JL, Norgren L (2003) Enoxaparin effect depends on body-weight and current doses may be inadequate in obese patients. Br J Surg 90:547–548Google Scholar
  143. 143.
    Hull RD, Pineo GF, Stein PD, Mah AF, MacIsaac SM, Dahl OE, Ghali WA, Butcher MS, Brant RF, Bergqvist D, Hamulyak K, Francis CW, Marder VJ, Raskob GE (2001) Timing of initial administration of low-molecular-weight heparin prophylaxis against deep vein thrombosis in patients following elective hip arthroplasty: a systematic review. Arch Intern Med 161:1952–1960CrossRefPubMedGoogle Scholar
  144. 144.
    Agnelli G (2004) Prevention of venous thromboembolism in surgical patients. Circulation 110(Suppl):IV4–IV12CrossRefPubMedGoogle Scholar
  145. 145.
    Leizorovicz A, Mismetti P (2004) Preventing venous thromboembolism in medical patients. Circulation 110(Suppl):IV13–IV19PubMedGoogle Scholar
  146. 146.
    Schytt E, Lindmark G, Waldenstrom U (2004) Symptoms of stress incontinence 1 year after childbirth: prevalence and predictors in a national Swedish sample. Acta Obstet Gynecol Scand 83:928–936Google Scholar
  147. 147.
    Greene GW, Smiciklas-Wright H, Scholl TO, Karp RJ (1988) Postpartum weight change: how much of the weight gained in pregnancy will be lost after delivery? Obstet Gynecol 71:701–707PubMedGoogle Scholar
  148. 148.
    Lederman SA, Pierson RN Jr, Wang J, Paxton A, Thornton J, Wendel J, Heymsfield SB (1993) Body composition measurements during pregnancy. Basic Life Sci 60:193–195PubMedGoogle Scholar
  149. 149.
    Soltani H, Fraser RB (2000) A longitudinal study of maternal anthropometric changes in normal weight, overweight and obese women during pregnancy and postpartum. Br J Nutr 84:95–101PubMedGoogle Scholar
  150. 150.
    Linne Y, Rossner S (2003) Interrelationships between weight development and weight retention in subsequent pregnancies: the SPAWN study. Acta Obstet Gynecol Scand 82:318–325Google Scholar
  151. 151.
    Rasmussen KM, Kjolhede CL (2004) Prepregnant overweight and obesity diminish the prolactin response to suckling in the first week postpartum. Pediatrics 113:e465–e471CrossRefPubMedGoogle Scholar
  152. 152.
    McCrory MA (2001) Does dieting during lactation put infant growth at risk? Nutr Rev 59:18–21PubMedGoogle Scholar
  153. 153.
    Ogden CL, Fryar CD, Carroll MD, Flegal KM (2004) Mean body weight, height, and body mass index, United States 1960–2002. Adv Data 347:1–17PubMedGoogle Scholar
  154. 154.
    National Institutes of Health (1998) Clinical guidelines on the identification, evaluation and treatment of overweight and obesity in adults: the evidence report. National Institutes of Health, US Department of Health and Human Services, Bethesda, MDGoogle Scholar
  155. 155.
    Kadioglu M, Ulku C, Yaris F, Kesim M, Kalyoncu NI, Yaris E (2004) Sibutramine use in pregnancy: report of two cases. Birth Defects Res A Clin Mol Teratol 70:545–546CrossRefPubMedGoogle Scholar
  156. 156.
    Einarson A, Bonari L, Sarkar M, McKenna K, Koren G (2004) Exposure to sibutramine during pregnancy: a case series. Eur J Obstet Gynecol Reprod Biol 116:112CrossRefPubMedGoogle Scholar
  157. 157.
    Gastrointestinal surgery for severe obesity: National Institutes of Health Consensus Development Conference Statement (1992) Am J Clin Nutr 55:615S–619SGoogle Scholar
  158. 158.
    Colquitt J, Clegg A, Sidhu M, Royle P (2003) Surgery for morbid obesity. Cochrane Database Syst Rev CD003641Google Scholar
  159. 159.
    Martin LF, Finigan KM, Nolan TE (2000) Pregnancy after adjustable gastric banding. Obstet Gynecol 95:927–930PubMedGoogle Scholar
  160. 160.
    Ramirez MM, Turrentine MA (1995) Gastrointestinal hemorrhage during pregnancy in a patient with a history of vertical-banded gastroplasty. Am J Obstet Gynecol 173:1630–1631CrossRefPubMedGoogle Scholar
  161. 161.
    Moore KA, Ouyang DW, Whang EE (2004) Maternal and fetal deaths after gastric bypass surgery for morbid obesity. N Engl J Med 351:721–722Google Scholar
  162. 162.
    Printen KJ, Scott D (1982) Pregnancy following gastric bypass for the treatment of morbid obesity. Am Surg 48:363–365PubMedGoogle Scholar
  163. 163.
    Wittgrove AC, Jester L, Wittgrove P, Clark GW (1998) Pregnancy following gastric bypass for morbid obesity. Obes Surg 8:461–464PubMedGoogle Scholar
  164. 164.
    Richards DS, Miller DK, Goodman GN (1987) Pregnancy after gastric bypass for morbid obesity. J Reprod Med 32:172–176PubMedGoogle Scholar
  165. 165.
    Dixon JB, Dixon ME, O’Brien PE (2001) Pregnancy after Lap-Band surgery: management of the band to achieve healthy weight outcomes. Obes Surg 12:59–65CrossRefGoogle Scholar
  166. 166.
    Sheiner E, Levy A, Silverberg D, Menes TS, Levy I, Katz M, Mazor M (2004) Pregnancy after bariatric surgery is not associated with adverse perinatal outcome. Am J Obstet Gynecol 190:1335–1340CrossRefPubMedGoogle Scholar
  167. 167.
    Gerrits EG, Ceulemans R, van Hee R, Hendrickx L, Totte E (2003) Contraceptive treatment after biliopancreatic diversion needs consensus. Obes Surg 13:378–382CrossRefPubMedGoogle Scholar
  168. 168.
    Holt VL, Scholes D, Wicklund KG, Cushing-Haugen KL, Daling JR (2005) Body mass index, weight, and oral contraceptive failure risk. Obstet Gynecol 105:46–52PubMedGoogle Scholar
  169. 169.
    Bilenka B, Ben-Shlomo I, Cozacov C, Gold CH, Zohar S (1995) Fertility, miscarriage and pregnancy after vertical banded gastroplasty operation for morbid obesity. Acta Obstet Gynecol Scand 74:42–44Google Scholar
  170. 170.
    Marceau P, Kaufman D, Biron S, Hould FS, Lebel S, Marceau S, Kral JG (2004) Outcome of pregnancies after biliopancreatic diversion. Obes Surg 14:318–324PubMedGoogle Scholar
  171. 171.
    Deitel M, Stone E, Kassam HA, Wilk EJ, Sutherland DJ (1988) Gynecologic-obstetric changes after loss of massive excess weight following bariatric surgery. J Am Coll Nutr 7:147–153PubMedGoogle Scholar

Copyright information

© European Board and College of Obstetrics and Gynaecology 2005

Authors and Affiliations

  1. 1.Division of Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynaecology, Erasmus MCUniversity Medical Centre RotterdamRotterdamThe Netherlands

Personalised recommendations