Seminars in Fetal & Neonatal Medicine
Volume 15, Issue 2 , Pages 70-76 , April 2010

Obesity in pregnancy: prevalence and metabolic consequences

  • Shahzya S. Huda

      Affiliations

    • Reproductive and Maternal Medicine, University of Glasgow, Queen Elizabeth Building, 10 Alexander Parade, Glasgow G31 2ER, UK
    • Corresponding Author InformationCorresponding author. Tel.: +44 141 211 2329; fax: +44 141 211 2012.
  • ,
  • Lauren E. Brodie

      Affiliations

    • Reproductive and Maternal Medicine, University of Glasgow, Queen Elizabeth Building, 10 Alexander Parade, Glasgow G31 2ER, UK
  • ,
  • Naveed Sattar

      Affiliations

    • BHF Glasgow Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow G12 8TA, UK

References 

  1. Confidential Enquiry into Maternal and Child Health . In:  Lewis G editors. Saving mother's lives. Reviewing maternal deaths to make motherhood safer – 2003–2005. London: CEMACH; 2007;
  2. World Health Organization . Fact sheet no. 311. Geneva: WHO; 2006;
  3. World Health Organization . Global database on body mass index. Geneva: WHO; 2009;
  4. Department of Health . Health survey for England 2002 – latest trends. London: DoH; 2003;
  5. Rasmussen KM, Yaktine AL. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press IOM (Institute of Medicine); 2009;
  6. Kanagalingam MG, Forouhi NG, Greer IA, Sattar N. Changes in booking body mass index over a decade: retrospective analysis from a Glasgow Maternity Hospital. Br J Obstet Gynaecol. 2005;112:1431–1433
  7. Usha Kiran TS, Hemmadi S, Bethel J, Evans J. Outcome of pregnancy in a woman with an increased body mass index. Br J Obstet Gynaecol. 2005;112:768–772
  8. Heslehurst N, Ells LJ, Simpson H, Batterham A, Wilkinson J, Summerbell CD. Trends in maternal obesity incidence rates, demographic predictors, and health inequalities in 36,821 women over a 15-year period. Br J Obstet Gynaecol. 2007;114:187–194
  9. Kim SY, Dietz PM, England L, Morrow B, Callaghan WM. Trends in pre-pregnancy obesity in nine states, 1993–2003. Obesity (Silver Spring). 2007;15:986–993
  10. Chu SY, Bachman DJ, Callaghan WM, et al. Association between obesity during pregnancy and increased use of health care. N Engl J Med. 2008;358:1444–1453
  11. Galtier-Dereure F, Boegner C, Bringer J. Obesity and pregnancy: complications and cost. Am J Clin Nutr. 2000;71(5 Suppl.):1242S–1248S
  12. Lean M, Gruer L, Alberti G, Sattar N. ABC of obesity. Obesity – can we turn the tide?. Br Med J. 2006;333(7581):1261–1264
  13. Vazquez G, Duval S, Jacobs DR, Silventoinen K. Comparison of body mass index, waist circumference, and waist/hip ratio in predicting incident diabetes: a meta-analysis. Epidemiol Rev. 2007;29:115–128
  14. Romero-Corral A, Montori VM, Somers VK, et al. Association of bodyweight with total mortality and with cardiovascular events in coronary artery disease: a systematic review of cohort studies. Lancet. 2006;368(9536):666–678
  15. Brown CD, Higgins M, Donato KA, et al. Body mass index and the prevalence of hypertension and dyslipidemia. Obes Res. 2000;8:605–619
  16. Wolk A, Gridley G, Svensson M, et al. A prospective study of obesity and cancer risk (Sweden). Cancer Causes Control. 2001;12:13–21
  17. Lievense AM, Bierma-Zeinstra SM, Verhagen AP, van Baar ME, Verhaar JA, Koes BW. Influence of obesity on the development of osteoarthritis of the hip: a systematic review. Rheumatology (Oxford). 2002;41:1155–1162
  18. Whitlock G, Lewington S, Sherliker P, et al. Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies. Lancet. 2009;373(9669):1083–1096
  19. Halberg N, Wernstedt-Asterholm I, Scherer PE. The adipocyte as an endocrine cell. Endocrinol Metab Clin North Am. 2008;37:753–768x–xi
  20. Avram MM, Avram AS, James WD. Subcutaneous fat in normal and diseased states. 3. Adipogenesis: from stem cell to fat cell. J Am Acad Dermatol. 2007;56:472–492
  21. de Ferranti S, Mozaffarian D. The perfect storm: obesity, adipocyte dysfunction, and metabolic consequences. Clin Chem. 2008;54:945–955
  22. Boden G. Fatty acid-induced inflammation and insulin resistance in skeletal muscle and liver. Curr Diab Rep. 2006;6:177–181
  23. Boden G. Role of fatty acids in the pathogenesis of insulin resistance and NIDDM. Diabetes. 1997;46:3–10
  24. Lupi R, Dotta F, Marselli L, et al. Prolonged exposure to free fatty acids has cytostatic and pro-apoptotic effects on human pancreatic islets: evidence that beta-cell death is caspase mediated, partially dependent on ceramide pathway, and Bcl-2 regulated. Diabetes. 2002;51:1437–1442
  25. Hotamisligil GS. Inflammation and metabolic disorders. Nature. 2006;444(7121):860–867
  26. Hotamisligil GS, Erbay E. Nutrient sensing and inflammation in metabolic diseases. Nat Rev Immunol. 2008;8:923–934
  27. Hirosumi J, Tuncman G, Chang L, et al. A central role for JNK in obesity and insulin resistance. Nature. 2002;420(6913):333–336
  28. Tuncman G, Hirosumi J, Solinas G, Chang L, Karin M, Hotamisligil GS. Functional in vivo interactions between JNK1 and JNK2 isoforms in obesity and insulin resistance. Proc Natl Acad Sci USA. 2006;103:10741–10746
  29. Ozcan U, Cao Q, Yilmaz E, et al. Endoplasmic reticulum stress links obesity, insulin action, and type 2 diabetes. Science. 2004;306(5695):457–461
  30. Bays HE. ‘Sick fat,’ metabolic disease, and atherosclerosis. Am J Med. 2009;122(1 Suppl.):S26–S37
  31. Shah A, Mehta N, Reilly MP. Adipose inflammation, insulin resistance, and cardiovascular disease. JPEN J Parenter Enteral Nutr. 2008;32:638–644
  32. Drolet R, Richard C, Sniderman AD, et al. Hypertrophy and hyperplasia of abdominal adipose tissues in women. Int J Obes (Lond). 2008;32:283–291
  33. Fox CS, Massaro JM, Hoffmann U, et al. Abdominal visceral and subcutaneous adipose tissue compartments: association with metabolic risk factors in the Framingham Heart Study. Circulation. 2007;116:39–48
  34. Sniderman AD, Bhopal R, Prabhakaran D, Sarrafzadegan N, Tchernof A. Why might South Asians be so susceptible to central obesity and its atherogenic consequences? The adipose tissue overflow hypothesis. Int J Epidemiol. 2007;36:220–225
  35. Brown TT, Xu X, John M, et al. Fat distribution and longitudinal anthropometric changes in HIV-infected men with and without clinical evidence of lipodystrophy and HIV-uninfected controls: a substudy of the Multicenter AIDS Cohort Study. AIDS Res Ther. 2009;6:8
  36. Chaston TB, Dixon JB. Factors associated with percent change in visceral versus subcutaneous abdominal fat during weight loss: findings from a systematic review. Int J Obes (Lond). 2008;32:619–628
  37. Lederman SA, Paxton A, Heymsfield SB, Wang J, Thornton J, Pierson RN. Body fat and water changes during pregnancy in women with different body weight and weight gain. Obstet Gynecol. 1997;90(4 Pt 1):483–488
  38. Lawrence M, Coward WA, Lawrence F, Cole TJ, Whitehead RG. Fat gain during pregnancy in rural African women: the effect of season and dietary status. Am J Clin Nutr. 1987;45:1442–1450
  39. Goldberg GR, Prentice AM, Coward WA, et al. Longitudinal assessment of energy expenditure in pregnancy by the doubly labeled water method. Am J Clin Nutr. 1993;57:494–505
  40. Okereke NC, Huston-Presley L, Amini SB, Kalhan S, Catalano PM. Longitudinal changes in energy expenditure and body composition in obese women with normal and impaired glucose tolerance. Am J Physiol Endocrinol Metab. 2004;287:E472–E479
  41. Kopp-Hoolihan LE, van Loan MD, Wong WW, King JC. Fat mass deposition during pregnancy using a four-component model. J Appl Physiol. 1999;87:196–202
  42. Pipe NG, Smith T, Halliday D, Edmonds CJ, Williams C, Coltart TM. Changes in fat, fat-free mass and body water in human normal pregnancy. Br J Obstet Gynaecol. 1979;86:929–940
  43. Sohlstrom A, Wahlund LO, Forsum E. Total body fat and its distribution during human reproduction as assessed by magnetic resonance imaging. Basic Life Sci. 1993;60:181–184
  44. Ehrenberg HM, Huston-Presley L, Catalano PM. The influence of obesity and gestational diabetes mellitus on accretion and the distribution of adipose tissue in pregnancy. Am J Obstet Gynecol. 2003;189:944–948
  45. Kinoshita T, Itoh M. 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. 2006;61:115–118
  46. Einstein FH, Fishman S, Muzumdar RH, Yang XM, Atzmon G, Barzilai N. Accretion of visceral fat and hepatic insulin resistance in pregnant rats. Am J Physiol Endocrinol Metab. 2008;294:E451–E455
  47. Zhang S, Folsom AR, Flack JM, Liu K. Body fat distribution before pregnancy and gestational diabetes: findings from coronary artery risk development in young adults (CARDIA) study. Br Med J. 1995;311:1139–1140
  48. Ijuin H, Douchi T, Nakamura S, Oki T, Yamamoto S, Nagata Y. Possible association of body-fat distribution with preeclampsia. J Obstet Gynaecol Res. 1997;23:45–49
  49. Sattar N, Clark P, Holmes A, Lean ME, Walker I, Greer IA. Antenatal waist circumference and hypertension risk. Obstet Gynecol. 2001;97:268–271
  50. Bartha JL, Marin-Segura P, Gonzalez-Gonzalez NL, Wagner F, Aguilar-Diosdado M, Hervias-Vivancos B. Ultrasound evaluation of visceral fat and metabolic risk factors during early pregnancy. Obesity (Silver Spring). 2007;15:2233–2239
  51. Villamor E, Cnattingius S. Interpregnancy weight change and risk of adverse pregnancy outcomes: a population-based study. Lancet. 2006;368(9542):1164–1170
  52. Merzouk H, Meghelli-Bouchenak M, Loukidi B, Prost J, Belleville J. Impaired serum lipids and lipoproteins in fetal macrosomia related to maternal obesity. Biol Neonate. 2000;77:17–24
  53. Ramsay JE, Ferrell WR, Crawford L, Wallace AM, Greer IA, Sattar N. Maternal obesity is associated with dysregulation of metabolic, vascular, and inflammatory pathways. J Clin Endocrinol Metab. 2002;87:4231–4237
  54. Sattar N, Tan CE, Han TS, et al. Associations of indices of adiposity with atherogenic lipoprotein subfractions. Int J Obes Relat Metab Disord. 1998;22:432–439
  55. Stewart FM, Freeman DJ, Ramsay JE, Greer IA, Caslake M, Ferrell WR. Longitudinal assessment of maternal endothelial function and markers of inflammation and placental function throughout pregnancy in lean and obese mothers. J Clin Endocrinol Metab. 2007;92:969–975
  56. van der Steeg JW, Steures P, Eijkemans MJ, et al. Obesity affects spontaneous pregnancy chances in subfertile, ovulatory women. Hum Reprod. 2008;23:324–328
  57. Hammoud AO, Gibson M, Peterson CM, Meikle AW, Carrell DT. Impact of male obesity on infertility: a critical review of the current literature. Fertil Steril. 2008;90:897–904
  58. Metwally M, Ong KJ, Ledger WL, Li TC. Does high body mass index increase the risk of miscarriage after spontaneous and assisted conception? A meta-analysis of the evidence. Fertil Steril. 2008;90:714–726
  59. Thum MY, El-Sheikhah A, Faris R, et al. The influence of body mass index to in-vitro fertilisation treatment outcome, risk of miscarriage and pregnancy outcome. J Obstet Gynaecol. 2007;27:699–702
  60. Tian L, Shen H, Lu Q, Norman RJ, Wang J. Insulin resistance increases the risk of spontaneous abortion after assisted reproduction technology treatment. J Clin Endocrinol Metab. 2007;92:1430–1433
  61. Dashe JS, McIntire DD, Twickler DM. Effect of maternal obesity on the ultrasound detection of anomalous fetuses. Obstet Gynecol. 2009;113:1001–1007
  62. Anderson JL, Waller DK, Canfield MA, Shaw GM, Watkins ML, Werler MM. Maternal obesity, gestational diabetes, and central nervous system birth defects. Epidemiology. 2005;16:87–92
  63. Werler MM, Louik C, Shapiro S, Mitchell AA. Prepregnant weight in relation to risk of neural tube defects. J Am Med Assoc. 1996;275:1089–1092
  64. Ray JG, Wyatt PR, Vermeulen MJ, Meier C, Cole DE. Greater maternal weight and the ongoing risk of neural tube defects after folic acid flour fortification. Obstet Gynecol. 2005;105:261–265
  65. O'Brien TE, Ray JG, Chan WS. Maternal body mass index and the risk of preeclampsia: a systematic overview. Epidemiology. 2003;14:368–374
  66. Redman CW, Sargent IL. Latest advances in understanding preeclampsia. Science. 2005;308(5728):1592–1594
  67. Redman CW, Sargent IL. Placental stress and pre-eclampsia: a revised view. Placenta. 2009;30(Suppl. A):S38–S42
  68. Ramsay JE, Simms RJ, Ferrell WR, et al. Enhancement of endothelial function by pregnancy: inadequate response in women with type 1 diabetes. Diabetes Care. 2003;26:475–479
  69. Bellamy L, Casas JP, Hingorani AD, Williams DJ. Pre-eclampsia and risk of cardiovascular disease and cancer in later life: systematic review and meta-analysis. Br Med J. 2007;335(7627):974
  70. Catalano PM, Tyzbir ED, Wolfe RR, et al. Carbohydrate metabolism during pregnancy in control subjects and women with gestational diabetes. Am J Physiol. 1993;264(1 Pt 1):E60–E67
  71. Catalano PM, Huston L, Amini SB, Kalhan SC. Longitudinal changes in glucose metabolism during pregnancy in obese women with normal glucose tolerance and gestational diabetes mellitus. Am J Obstet Gynecol. 1999;180:903–916
  72. Catalano PM, Tyzbir ED, Roman NM, Amini SB, Sims EA. Longitudinal changes in insulin release and insulin resistance in nonobese pregnant women. Am J bstet Gynecol. 1991;165(6 Pt 1):1667–1672
  73. Catalano PM, Tyzbir ED, Wolfe RR, Roman NM, Amini SB, Sims EA. Longitudinal changes in basal hepatic glucose production and suppression during insulin infusion in normal pregnant women. Am J Obstet Gynecol. 1992;167(4 Pt 1):913–919
  74. Homko CJ, Sivan E, Reece EA, Boden G. Fuel metabolism during pregnancy. Semin Reprod Endocrinol. 1999;17:119–125
  75. Mills JL, Jovanovic L, Knopp R, et al. Physiological reduction in fasting plasma glucose concentration in the first trimester of normal pregnancy: the diabetes in early pregnancy study. Metabolism. 1998;47:1140–1144
  76. Sivan E, Chen X, Homko CJ, Reece EA, Boden G. Longitudinal study of carbohydrate metabolism in healthy obese pregnant women. Diabetes Care. 1997;20:1470–1475
  77. Chu SY, Callaghan WM, Kim SY, et al. Maternal obesity and risk of gestational diabetes mellitus. Diabetes Care. 2007;30:2070–2076
  78. Catalano PM, Nizielski SE, Shao J, Preston L, Qiao L, Friedman JE. Downregulated IRS-1 and PPARgamma in obese women with gestational diabetes: relationship to FFA during pregnancy. Am J Physiol Endocrinol Metab. 2002;282:E522–E533
  79. Friedman JE, Kirwan JP, Jing M, Presley L, Catalano PM. Increased skeletal muscle tumor necrosis factor-alpha and impaired insulin signaling persist in obese women with gestational diabetes mellitus 1 year postpartum. Diabetes. 2008;57:606–613
  80. Winzer C, Wagner O, Festa A, et al. Plasma adiponectin, insulin sensitivity, and subclinical inflammation in women with prior gestational diabetes mellitus. Diabetes Care. 2004;27:1721–1727
  81. Worda C, Leipold H, Gruber C, Kautzky-Willer A, Knofler M, Bancher-Todesca D. Decreased plasma adiponectin concentrations in women with gestational diabetes mellitus. Am J Obstet Gynecol. 2004;191:2120–2124
  82. Mazaki-Tovi S, Romero R, Vaisbuch E, et al. Maternal serum adiponectin multimers in gestational diabetes. J Perinat Med. 2009 Jun 17;[Epub ahead of print]
  83. Metzger BE, Lowe LP, Dyer AR, et al. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med. 2008;358:1991–2002
  84. Ben-Haroush A, Yogev Y, Hod M. Epidemiology of gestational diabetes mellitus and its association with Type 2 diabetes. Diabet Med. 2004;21:103–113
  85. Alessi MC, Juhan-Vague I. Metabolic syndrome, haemostasis and thrombosis. Thromb Haemost. 2008;99:995–1000
  86. Chunilal SD, Bates SM. Venous thromboembolism in pregnancy: diagnosis, management and prevention. Thromb Haemost. 2009;101:428–438
  87. Heslehurst N, Simpson H, Ells LJ, et al. The impact of maternal BMI status on pregnancy outcomes with immediate short-term obstetric resource implications: a meta-analysis. Obes Rev. 2008;9:635–683
  88. Whitaker RC. Predicting preschooler obesity at birth: the role of maternal obesity in early pregnancy. Pediatrics. 2004;114:e29–e36
  89. Koupil I, Toivanen P. Social and early-life determinants of overweight and obesity in 18-year-old Swedish men. Int J Obes (Lond). 2008;32:73–81
  90. Forsen T, Eriksson JG, Tuomilehto J, Teramo K, Osmond C, Barker DJ. Mother's weight in pregnancy and coronary heart disease in a cohort of Finnish men: follow up study. Br Med J. 1997;315(7112):837–840
  91. Avon Longitudinal Study of Parents and Children. Details available at: http://www.bristol.ac.uk/alspac/
  92. Asbee SM, Jenkins TR, Butler JR, White J, Elliot M, Rutledge A. Preventing excessive weight gain during pregnancy through dietary and lifestyle counseling: a randomized controlled trial. Obstet Gynecol. 2009;113(2 Pt 1):305–312
  93. Wolff S, Legarth J, Vangsgaard K, Toubro S, Astrup A. A randomized trial of the effects of dietary counseling on gestational weight gain and glucose metabolism in obese pregnant women. Int J Obes (Lond). 2008;32:495–501
  94. Claesson IM, Sydsjo G, Brynhildsen J, et al. Weight gain restriction for obese pregnant women: a case–control intervention study. Br J Obstet Gynaecol. 2008;115:44–50
  95. Kinnunen TI, Pasanen M, Aittasalo M, et al. Preventing excessive weight gain during pregnancy – a controlled trial in primary health care. Eur J Clin Nutr. 2007;61:884–891
  96. Olson CM, Strawderman MS, Reed RG. Efficacy of an intervention to prevent excessive gestational weight gain. Am J Obstet Gynecol. 2004;191:530–536
  97. Polley BA, Wing RR, Sims CJ. Randomized controlled trial to prevent excessive weight gain in pregnant women. Int J Obes Relat Metab Disord. 2002;26:1494–1502
  98. Stothard KJ, Tennant PW, Bell R, Rankin J. Maternal overweight and obesity and the risk of congenital anomalies: a systematic review and meta-analysis. J Am Med Assoc. 2009;301:636–650

    * The most important references are indicated with an asterisks.

PII: S1744-165X(09)00098-5

doi: 10.1016/j.siny.2009.09.006

Seminars in Fetal & Neonatal Medicine
Volume 15, Issue 2 , Pages 70-76 , April 2010