Advertisement

Maternal Obesity and Pregnancy

  • Michael Conall Dennedy
  • Fidelma Dunne
Chapter

Abstract

We face a worldwide health crisis secondary to an increase in the population average for body mass index (BMI). This chapter presents a critical review of the published literature addressing the increasing prevalence of raised BMI in women of reproductive age. Raised maternal BMI presents significant risk for mother and child and has consistently been associated with adverse maternal and fetal/neonatal outcomes. The pathogeneses of BMI-related adverse obstetric and neonatal outcomes are multiple ranging from insulin resistance, to inflammation, to nutritional deficiency. Consensus statements now describe the current best-practice obstetric management of obesity during pregnancy. However, there is no clear guidance on the appropriate timing or BMI targets for weight management of this cohort.

Keywords

Gestational Diabetes Mellitus Weight Management Gestational Weight Gain Adverse Pregnancy Outcome Maternal Obesity 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. Amir LH, Donath S (2007) A systematic review of maternal obesity and breastfeeding intention, initiation and duration. BMC Pregnancy Childbirth 7:9PubMedCrossRefGoogle Scholar
  2. Ananth CV, Wen SW (2002) Trends in fetal growth among singleton gestations in the United States and Canada, 1985 through 1998. Semin Perinatol 26:260–267PubMedCrossRefGoogle Scholar
  3. Astrup A, Rossner S, Van Gaal L, Rissanen A, Niskanen L, AL Hakim M, Madsen J, Rasmussen MF, Lean ME (2009) Effects of liraglutide in the treatment of obesity: a randomised, double-blind, placebo-controlled study. Lancet 374:1606–1616PubMedCrossRefGoogle Scholar
  4. Bartha JL, Marin-Segura P, Gonzalez-Gonzalez NL, Wagner F, Aguilar-Diosdado M, Hervias-Vivancos B (2007) Ultrasound evaluation of visceral fat and metabolic risk factors during early pregnancy. Obesity (Silver Spring) 15:2233–2239CrossRefGoogle Scholar
  5. Bellamy L, Casas JP, Hingorani AD, Williams D (2009) Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis. Lancet 373:1773–1779PubMedCrossRefGoogle Scholar
  6. Bessesen DH (2008) Update on obesity. J Clin Endocrinol Metab 93:2027–2034PubMedCrossRefGoogle Scholar
  7. Bodnar LM, Catov JM, Roberts JM, Simhan HN (2007a) Prepregnancy obesity predicts poor vitamin D status in mothers and their neonates. J Nutr 137:2437–2442PubMedGoogle Scholar
  8. Bodnar LM, Simhan HN, Powers RW, Frank MP, Cooperstein E, Roberts JM (2007b) High prevalence of vitamin D insufficiency in black and white pregnant women residing in the northern United States and their neonates. J Nutr 137:447–452PubMedGoogle Scholar
  9. Catalano PM, Ehrenberg HM (2006) The short- and long-term implications of maternal obesity on the mother and her offspring. BJOG 113:1126–1133PubMedCrossRefGoogle Scholar
  10. Catalano PM, Tyzbir ED, Roman NM, Amini SB, Sims EA (1991a) Longitudinal changes in insulin release and insulin resistance in nonobese pregnant women. Am J Obstet Gynecol 165:1667–1672PubMedGoogle Scholar
  11. Catalano PM, Vargo KM, Bernstein IM, Amini SB (1991b) Incidence and risk factors associated with abnormal postpartum glucose tolerance in women with gestational diabetes. Am J Obstet Gynecol 165:914–919PubMedGoogle Scholar
  12. Catalano PM, Tyzbir ED, Wolfe RR, Roman NM, Amini SB, Sims EA (1992) Longitudinal changes in basal hepatic glucose production and suppression during insulin infusion in normal pregnant women. Am J Obstet Gynecol 167:913–919PubMedGoogle Scholar
  13. CEMACH (2006) Saving Mother’s lives: reviewing maternal deaths to make motherhood safer. 2003–2005. RCOG, LondonGoogle Scholar
  14. Challier JC, Basu S, Bintein T, Minium J, Hotmire K, Catalano PM, Hauguel-DE Mouzon S (2008) Obesity in pregnancy stimulates macrophage accumulation and inflammation in the placenta. Placenta 29:274–281PubMedCrossRefGoogle Scholar
  15. Chen A, Feresu SA, Fernandez C, Rogan WJ (2009) Maternal obesity and the risk of infant death in the United States. Epidemiology 20:74–81PubMedCrossRefGoogle Scholar
  16. Clapp JF III (2002) Maternal carbohydrate intake and pregnancy outcome. Proc Nutr Soc 61:45–50PubMedCrossRefGoogle Scholar
  17. Clapp JF III, Kim H, Burciu B, Schmidt S, Petry K, Lopez B (2002) Continuing regular exercise during pregnancy: effect of exercise volume on fetoplacental growth. Am J Obstet Gynecol 186:142–147PubMedCrossRefGoogle Scholar
  18. Cundy T, Gamble G, Townend K, Henley PG, Macpherson P, Roberts AB (2000) Perinatal mortality in type 2 diabetes mellitus. Diabet Med 17:33–39PubMedCrossRefGoogle Scholar
  19. Curat CA, Wegner V, Sengenès C, Miranville A, Tonus C, Busse R, Bouloumié A (2006) Macrophages in human visceral adipose tissue: increased accumulation in obesity and a source of resistin and visfatin. Diabetologia 49:744–747PubMedCrossRefGoogle Scholar
  20. Dempsey JC, Ashiny Z, Qiu CF, Miller RS, Sorensen TK, Williams MA (2005) Maternal pre-pregnancy overweight status and obesity as risk factors for cesarean delivery. J Matern Fetal Neonatal Med 17:179–185PubMedCrossRefGoogle Scholar
  21. Dennedy MC, Dunne F (2010) The maternal and fetal impacts of obesity and gestational diabetes on pregnancy outcome. Best Pract Res Clin Endocrinol Metab 24:573–589PubMedCrossRefGoogle Scholar
  22. Dennedy MC, Avalos G, O’Reilly M, O’Sullivan EP, Gaffney G, Dunne F. (2012) ATLANTIC-DIP: Raised maternal body mass index (BMI) adversely affects maternal and fetal outcomes in glucose tolerant women according to International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria. J Clin Endo Metabol. EPub Ahead of Print. http://jcem.endojournals.org/content/early/recent
  23. Despres JP, Moorjani S, Lupien PJ, Tremblay A, Nadeau A, Bouchard C (1990) Regional distribution of body fat, plasma lipoproteins, and cardiovascular disease. Arteriosclerosis 10:497–511PubMedCrossRefGoogle Scholar
  24. Dixon JB, O’Brien PE (2002) Health outcomes of severely obese type 2 diabetic subjects 1 year after laparoscopic adjustable gastric banding. Diabetes Care 25:358–363PubMedCrossRefGoogle Scholar
  25. Ehrenberg HM, Dierker L, Milluzzi C, Mercer BM (2002) Prevalence of maternal obesity in an urban center. Am J Obstet Gynecol 187:1189–1193PubMedCrossRefGoogle Scholar
  26. 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 189:944–948PubMedCrossRefGoogle Scholar
  27. Fabricatore AN, Wadden TA, Moore RH, Butryn ML, Gravallese EA, Erondu NE, Heymsfield SB, Nguyen AM (2009) Attrition from randomized controlled trials of pharmacological weight loss agents: a systematic review and analysis. Obes Rev 10:333–341PubMedCrossRefGoogle Scholar
  28. Fitzsimons KJ, Modder J (2010) Setting maternity care standards for women with obesity in pregnancy. Semin Fetal Neonatal Med 15:100–107PubMedCrossRefGoogle Scholar
  29. Flynn M (2007) Recommendations for a national policy on vitamin D supplementation for infants in Ireland. Food Safety Authority of Ireland, DublinGoogle Scholar
  30. Genc MR, Ford CE (2010) The clinical use of inflammatory markers during pregnancy. Curr Opin Obstet Gynecol 22:116–121PubMedCrossRefGoogle Scholar
  31. Guelinckx I, Devlieger R, Vansant G (2008) Reproductive outcome after bariatric surgery: a critical review. Hum Reprod Update 15:189–201CrossRefGoogle Scholar
  32. Harman-Boehm I, Bluher M, Redel H, Sion-Vardy N, Ovadia S, Avinoach E, Shai I, Kloting N, Stumvoll M, Bashan N, Rudich A (2007) Macrophage infiltration into omental versus subcutaneous fat across different populations: effect of regional adiposity and the comorbidities of obesity. J Clin Endocrinol Metab 92:2240–2247PubMedCrossRefGoogle Scholar
  33. Hashimoto K, Wong WW, Thomas AJ, Uvena-Celebrezze J, Huston-Pressley L, Amini SB, Catalano PM (2002) Estimation of neonatal body composition: isotope dilution versus total-body electrical conductivity. Biol Neonate 81:170–175PubMedCrossRefGoogle Scholar
  34. Health, Institute Of (1990) Nutrition during pregnancy. Institute of Health, Washington DCGoogle Scholar
  35. Heslehurst N, Lang R, Rankin J, Wilkinson JR, Summerbell CD (2007) Obesity in pregnancy: a study of the impact of maternal obesity on NHS maternity services. BJOG 114:334–342PubMedCrossRefGoogle Scholar
  36. Heslehurst N, Simpson H, Ells LJ, Rankin J, Wilkinson J, Lang R, Brown TJ, Summerbell CD (2008) The impact of maternal BMI status on pregnancy outcomes with immediate short-term obstetric resource implications: a meta-analysis. Obes Rev 9:635–683PubMedCrossRefGoogle Scholar
  37. Hibbard JU, Gilbert S, Landon MB, Hauth JC, Leveno KJ, Spong CY, Varner MW, Caritis SN, Harper M, Wapner RJ, Sorokin Y, Miodovnik M, Carpenter M, Peaceman AM, O’Sullivan MJ, Sibai BM, Langer O, Thorp JM, Ramin SM, Mercer BM, Gabbe SG (2006) Trial of labor or repeat cesarean delivery in women with morbid obesity and previous cesarean delivery. Obstet Gynecol 108:125–133PubMedCrossRefGoogle Scholar
  38. Holick MF (2007) Vitamin D deficiency. N Engl J Med 357:266–281PubMedCrossRefGoogle Scholar
  39. Horvath K, Koch K, Jeitler K, Matyas E, Bender R, Bastian H, Lange S, Siebenhofer A (2010) Effects of treatment in women with gestational diabetes mellitus: systematic review and meta-analysis. BMJ 340:c1395–c1395PubMedCrossRefGoogle Scholar
  40. Huda SS, Brodie LE, Sattar N (2009) Obesity in pregnancy: prevalence and metabolic consequences. Seminars in Fetal and Neonatal Medicine, 1–7Google Scholar
  41. International Association of Diabetes and Pregnancy Study Groups (2010) International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care 33:676–682CrossRefGoogle Scholar
  42. Jacobsen AF, Skjeldestad FE, Sandset PM (2008) Ante- and postnatal risk factors of venous thrombosis: a hospital-based case-control study. J Thromb Haemost 6:905–912PubMedCrossRefGoogle Scholar
  43. Jarvie E, Ramsay JE (2010) Obstetric management of obesity in pregnancy. Seminars in Fetal and Neonatal Medicine, 1–6Google Scholar
  44. 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 189:239–244PubMedCrossRefGoogle Scholar
  45. Karelis A (2005) The metabolically healthy but obese individual presents a favorable inflammation profile. J Clin Endocrinol Metab 90:4145–4150PubMedCrossRefGoogle Scholar
  46. Karelis AD, Faraj M, Bastard JP, St-Pierre DH, Brochu M, Prud’Homme D, Rabasa-Lhoret R (2005) The metabolically healthy but obese individual presents a favorable inflammation profile. J Clin Endocrinol Metab 90:4145–4150PubMedCrossRefGoogle Scholar
  47. Kim C, Newton KM, Knopp RH (2002) Gestational diabetes and the incidence of type 2 diabetes: a systematic review. Diabetes Care 25:1862–1868PubMedCrossRefGoogle Scholar
  48. Kim SY, England LJ, Kendrick JS, Dietz PM, Callaghan WM (2009) The contribution of clinic-based interventions to reduce prenatal smoking prevalence among US women. Am J Public Health 99:893–898PubMedCrossRefGoogle Scholar
  49. Kinoshita T, Itoh M (2006) Longitudinal variance of fat mass deposition during pregnancy evaluated by ultrasonography: the ratio of visceral fat to subcutaneous fat in the abdomen. Gynecol Obstet Invest 61:115–118PubMedCrossRefGoogle Scholar
  50. Koupil I, Toivanen P (2008) Social and early-life determinants of overweight and obesity in 18-year-old Swedish men. Int J Obes (Lond) 32:73–81CrossRefGoogle Scholar
  51. Laitinen J, Power C, Jarvelin MR (2001) Family social class, maternal body mass index, childhood body mass index, and age at menarche as predictors of adult obesity. Am J Clin Nutr 74:287–294PubMedGoogle Scholar
  52. Landon MB, Spong CY, Thom E, Carpenter MW, Ramin SM, Casey B, Wapner RJ, Varner MW, Rouse DJ, Thorp JM Jr, Sciscione A, Catalano P, Harper M, Saade G, Lain KY, Sorokin Y, Peaceman AM, Tolosa JE, Anderson GB (2009) A multicenter, randomized trial of treatment for mild gestational diabetes. N Engl J Med 361:1339–1348PubMedCrossRefGoogle Scholar
  53. Lapillonne A (2010) Vitamin D deficiency during pregnancy may impair maternal and fetal outcomes. Med Hypotheses 74:71–75PubMedCrossRefGoogle Scholar
  54. Larsen TB, Sorensen HT, Gislum M, Johnsen SP (2007) Maternal smoking, obesity, and risk of venous thromboembolism during pregnancy and the puerperium: a population-based nested case-control study. Thromb Res 120:505–509PubMedCrossRefGoogle Scholar
  55. Lauenborg J, Hansen T, Jensen DM, Vestergaard H, Molsted-Pedersen L, Hornnes P, Locht H, Pedersen O, Damm P (2004) Increasing incidence of diabetes after gestational diabetes: a long-term follow-up in a Danish population. Diabetes Care 27:1194–1199PubMedCrossRefGoogle Scholar
  56. Lederman SA, Paxton A, Heymsfield SB, Wang J, Thornton J, Pierson RN Jr (1997) Body fat and water changes during pregnancy in women with different body weight and weight gain. Obstet Gynecol 90:483–488PubMedCrossRefGoogle Scholar
  57. Lumley J, Watson L, Watson M, Bower C (2001) Periconceptional supplementation with folate and/or multivitamins for preventing neural tube defects. Cochrane Database Syst Rev 3:CD001056PubMedGoogle Scholar
  58. McIntyre HD, Chang AM, Callaway LK, Cowley DM, Dyer AR, Radaelli T, Farrell KA, Huston-Presley L, Amini SB, Kirwan JP, Catalano PM (2010) Hormonal and metabolic factors associated with variations in insulin sensitivity in human pregnancy. Diabetes Care 33:356–360PubMedCrossRefGoogle Scholar
  59. Mestan K, Yu Y, Matoba N, Cerda S, Demmin B, Pearson C, Ortiz K, Wang X (2010) Placental inflammatory response is associated with poor neonatal growth: preterm birth cohort study. Pediatrics 125:e891–e898PubMedCrossRefGoogle Scholar
  60. Metzger BE, Lowe LP, Dyer AR, Trimble ER, Chaovarindr U, Coustan DR, Hadden DR, McCance DR, Hod M, McIntyre HD, Oats JJ, Persson B, Rogers MS, Sacks DA (2008) Hyperglycemia and adverse pregnancy outcomes. N Engl J Med 358:1991–2002PubMedCrossRefGoogle Scholar
  61. Modder J, Fitzsimons KJ (2010) CMACE/RCOG joint guideline: management of women with obesity in pregnancy, 1st edn. Centre for Maternal and Child Enquiries (CMACE); Royal College of Obstetricians and Gynaecologists (RCOG), LondonGoogle Scholar
  62. Mojtabai R (2004) Body mass index and serum folate in childbearing age women. Eur J Epidemiol 19:1029–1036PubMedCrossRefGoogle Scholar
  63. Mok E, Multon C, Piguel L, Barroso E, Goua V, Christin P, Perez MJ, Hankard R (2008) Decreased full breastfeeding, altered practices, perceptions, and infant weight change of prepregnant obese women: a need for extra support. Pediatrics 121:e1319–e1324PubMedCrossRefGoogle Scholar
  64. Morgan KMH, Watson D, Perry I, Barry M, Shelley E, Harrington J, Molcho M, Layte, RTN, Van Lente E, Ward M, Lutomski J, Conroy R, Brugha R (2008) In Children HA (Ed) SLAN: survey of lifestyle attitudes and nutrition in Ireland. Main Report. The Stationery Office, DublinGoogle Scholar
  65. Moses RG, Luebcke M, Davis WS, Coleman KJ, Tapsell LC, Petocz P, Brand-Miller JC (2006) Effect of a low-glycemic-index diet during pregnancy on obstetric outcomes. Am J Clin Nutr 84:807–812PubMedGoogle Scholar
  66. Nelson SM, Matthews P, Poston L (2009) Maternal metabolism and obesity: modifiable determinants of pregnancy outcome. Hum Reprod Update 16:255–275PubMedCrossRefGoogle Scholar
  67. Norman J (2011) EMPOWaR. Efficacy of metformin in pregnant obese women: a randomised controlled trial. http://www.eme.ac.uk/projectfiles/0824609protocol.pdf. Accessed 18 October, 2011
  68. O’Brien TE, Ray JG, Chan WS (2003) Maternal body mass index and the risk of preeclampsia: a systematic overview. Epidemiology 14:368–374PubMedGoogle Scholar
  69. Ogden CL, Carroll MD, Curtin LR, Lamb MM, Flegal KM (2010) Prevalence of high body mass index in US children and adolescents, 2007–2008. JAMA 303:242–249PubMedCrossRefGoogle Scholar
  70. WHO (2006) Fact Sheet no. 311. WHO, GenevaGoogle Scholar
  71. O’Reilly MW, Avalos G, Dennedy MC, O’Sullivan EP, Dunne F. (2011) Atlantic DIP: high prevalence of abnormal glucose tolerance post partum is reduced by breast-feeding in women with prior gestational diabetes mellitus. Eur J Endocrinol 165:953–959Google Scholar
  72. Owens LA, O’Sullivan EP, Kirwan B, Avalos G, Gaffney G, Dunne F (2010) ATLANTIC DIP: the impact of obesity on pregnancy outcome in glucose-tolerant women. Diabetes Care 33:577–579PubMedCrossRefGoogle Scholar
  73. Pedersen J (1972) Diabetes and pregnancy: blood sugar of newborn infants. Copenhagen, CopenhagenGoogle Scholar
  74. Pevzner L, Powers BL, Rayburn WF, Rumney P, Wing DA (2009) Effects of maternal obesity on duration and outcomes of prostaglandin cervical ripening and labor induction. Obstet Gynecol 114:1315–1321PubMedCrossRefGoogle Scholar
  75. Pirkola J, Pouta A, Bloigu A, Hartikainen AL, Laitinen J, Jarvelin MR, Vaarasmaki M (2010) Risks of overweight and abdominal obesity at age 16 years associated with prenatal exposures to maternal prepregnancy overweight and gestational diabetes mellitus. Diabetes Care 33:1115–1121PubMedCrossRefGoogle Scholar
  76. Pitkin RM (1976) Nutritional support in obstetrics and gynecology. Clin Obstet Gynecol 19:489–513PubMedCrossRefGoogle Scholar
  77. Ramsay JE, Ferrell WR, Crawford L, Wallace AM, Greer IA, Sattar N (2002) Maternal obesity is associated with dysregulation of metabolic, vascular, and inflammatory pathways. J Clin Endocrinol Metab 87:4231–4237PubMedCrossRefGoogle Scholar
  78. Reilly JJ, Armstrong J, Dorosty AR, Emmett PM, Ness A, Rogers I, Steer C, Sherriff A (2005) Early life risk factors for obesity in childhood: cohort study. BMJ 330:1357PubMedCrossRefGoogle Scholar
  79. Rowan JA, Hague WM, Gao W, Battin MR, Moore MP (2008) Metformin versus insulin for the treatment of gestational diabetes. N Engl J Med 358:2003–2015PubMedCrossRefGoogle Scholar
  80. Saravanakumar K, Rao SG, Cooper GM (2006) The challenges of obesity and obstetric anaesthesia. Curr Opin Obstet Gynecol 18:631–635PubMedCrossRefGoogle Scholar
  81. Schenk S, Saberi M, Olefsky JM (2008) Insulin sensitivity: modulation by nutrients and inflammation. J Clin Invest 118:2992–3002PubMedCrossRefGoogle Scholar
  82. 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 25:1175–1182PubMedCrossRefGoogle Scholar
  83. Shah M, Simha V, Garg A (2006) Review: long-term impact of bariatric surgery on body weight, comorbidities, and nutritional status. J Clin Endocrinol Metab 91:4223–4231PubMedCrossRefGoogle Scholar
  84. Shi H, Kokoeva MV, Inouye K, Tzameli I, Yin H, Flier JS (2006) TLR4 links innate immunity and fatty acid-induced insulin resistance. J Clin Invest 116:3015–3025PubMedCrossRefGoogle Scholar
  85. Shields BM, Knight BA, Powell RJ, Hattersley AT, Wright DE (2006) Assessing newborn body composition using principal components analysis: differences in the determinants of fat and skeletal size. BMC Pediatr 6:24PubMedCrossRefGoogle Scholar
  86. Signori C, Zalesin KC, Franklin B, Miller WL, Mccullough PA (2010) Effect of gastric bypass on vitamin D and secondary hyperparathyroidism. Obes Surg 20:949–952PubMedCrossRefGoogle Scholar
  87. Sjostrom L, Lindroos AK, Peltonen M, Torgerson J, Bouchard C, Carlsson B, Dahlgren S, Larsson B, Narbro K, Sjostrom CD, Sullivan M, Wedel H (2004) Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med 351:2683–2693PubMedCrossRefGoogle Scholar
  88. Sjostrom L, Narbro K, Sjostrom CD, Karason K, Larsson B, Wedel H, Lystig T, Sullivan M, Bouchard C, Carlsson B, Bengtsson C, Dahlgren S, Gummesson A, Jacobson P, Karlsson J, Lindroos AK, Lonroth H, Naslund I, Olbers T, Stenlof K, Torgerson J, Agren G, Carlsson LM (2007) Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med 357:741–752PubMedCrossRefGoogle Scholar
  89. Sjostrom L, Gummesson A, Sjostrom CD, Narbro K, Peltonen M, Wedel H, Bengtsson C, Bouchard C, Carlsson B, Dahlgren S, Jacobson P, Karason K, Karlsson J, Larsson B, Lindroos AK, Lonroth H, Naslund I, Olbers T, Stenlof K, Torgerson J, Carlsson LM (2009) Effects of bariatric surgery on cancer incidence in obese patients in Sweden (Swedish Obese Subjects Study): a prospective, controlled intervention trial. Lancet Oncol 10:653–662PubMedCrossRefGoogle Scholar
  90. Stothard KJ, Tennant PW, Bell R, Rankin J (2009) Maternal overweight and obesity and the risk of congenital anomalies: a systematic review and meta-analysis. JAMA 301:636–650PubMedCrossRefGoogle Scholar
  91. Taggart NR, Holliday RM, Billewicz WZ, Hytten FE, Thomson AM (1967) Changes in skinfolds during pregnancy. Br J Nutr 21:439–451PubMedCrossRefGoogle Scholar
  92. Valentino MA, Lin JE, Waldman SA (2010) Central and peripheral molecular targets for antiobesity pharmacotherapy. Clin Pharmacol Ther 87:652–662PubMedCrossRefGoogle Scholar
  93. Villamor E, Cnattingius S (2006) Interpregnancy weight change and risk of adverse pregnancy outcomes: a population-based study. Lancet 368:1164–1170PubMedCrossRefGoogle Scholar
  94. Weisberg SP, Hunter D, Huber R, Lemieux J, Slaymaker S, Vaddi K, Charo I, Leibel RL, Ferrante A (2006) CCR2 modulates inflammatory and metabolic effects of high-fat feeding. J Clin Invest 116:115–124PubMedCrossRefGoogle Scholar
  95. 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 (2004) Obesity, obstetric complications and cesarean delivery rate–a population-based screening study. Am J Obstet Gynecol 190:1091–1097PubMedCrossRefGoogle Scholar
  96. WHO (2009) Global database on body mass index. WHO, GenevaGoogle Scholar
  97. Zaninotto P, Wardle H, Stamatakis E, Mindell J, Head J (2006) Forecasting obesity to 2010. http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_073033.pdf. Accessed 18 October, 2011.
  98. Zeyda M, Farmer D, Todoric J, Aszmann O, Speiser M, Györi G, Zlabinger GJ, Stulnig TM (2007) Human adipose tissue macrophages are of an anti-inflammatory phenotype but capable of excessive pro-inflammatory mediator production. Int J Obes Relat Metab Disord 31:1420–1428CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  1. 1.Department of Endocrinology and Diabetes Mellitus, c/o Department of Medicine, Clinical Sciences InstituteNational University of Ireland, GalwayGalwayIreland
  2. 2.Department of Medicine, Clinical Sciences InstituteNational University of Ireland, GalwayGalwayIreland

Personalised recommendations