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Obesity in pregnancy: Complications and maternal management

Patrick S Ramsey, MD, MSPH
Robert S Schenken, MD
Section Editors
Charles J Lockwood, MD, MHCM
F Xavier Pi-Sunyer, MD, MPH
Deputy Editor
Vanessa A Barss, MD, FACOG


Obese pregnant women are at increased risk for an array of maternal and perinatal complications, and the risks are amplified with increasing degrees of maternal obesity [1-4]. Among the adverse effects on the fetus are an increased risk of childhood and adult obesity [5,6]. Obstetric providers should be aware of these risks and modify patient care before pregnancy, during pregnancy, and postpartum to optimize maternal and offspring outcomes [7,8].

This topic will discuss issues related to obesity and pregnancy. Obesity in the nonpregnant population is reviewed separately. (See "Obesity in adults: Prevalence, screening, and evaluation" and "Obesity in adults: Health consequences" and "Obesity in adults: Overview of management".)


Adipose tissue is an active endocrine organ; when present in excess, it can have dysregulatory effects on metabolic, vascular, and particularly inflammatory pathways in many organ systems, and thereby affect obstetric outcomes [9]. For example, obesity-related insulin resistance and abnormalities in inflammatory pathways can affect placental growth and function [10], and have been linked to development of preeclampsia [11,12]. The observation that some obesity-related pregnancy complications increase with greater degrees of obesity support this hypothesis [13]. Maternal genotype may also play a role [14].

Epigenetic changes induced by fetal exposure to increased levels of glucose, insulin, lipids, and inflammatory cytokines may play a role in the long-term outcome of offspring. These in utero effects may result in permanent or transient changes in metabolic programming, leading to adverse health outcomes in adult life (fetal origins of adult disease theory [Barker hypothesis]) [15]. The potential programming effects of maternal overnutrition are difficult to study, however, because of the complex relationships between the maternal metabolic milieu and the developing fetus and the influence of postnatal factors, including lifestyle and environment [16].


Obesity is defined as body mass index (BMI) ≥30 kg/m2 (table 1) [8]. It is further stratified by class: class I (BMI 30.0 to 34.9 kg/m2), class II (BMI 35.0 to 39.9 kg/m2), and class III (BMI ≥40 kg/m2).

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Literature review current through: Nov 2017. | This topic last updated: Dec 04, 2017.
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