Maternal Obesity: Resources for Providers and Patients

Abstract

Maternal obesity is a significant health problem that may negatively affect the health and birth outcomes of neonates. This resource guide is intended to support the healthcare provider in the management of patients with maternal obesity by supplying references for evidence-based information and strategies to assist in addressing this issue. Additional resources for patients with maternal obesity are also included.

Introduction

According to the World Health Organization (WHO), maternal obesity is an increasing trend that affects approximately 32% of adult women in the United States.¹ The Centers for Disease Control and Prevention (CDC) reports that approximately one in five women of childbearing age are obese prior to becoming pregnant.^2,3 It has been estimated that healthcare costs related to overweight and obesity in the United States may become 16–18% of the total healthcare costs by the year 2030.⁴ In addition, maternal obesity is associated with an increased rate of caesarean sections, stillbirths, and neonatal deaths.^5–7 Research also suggests an association between maternal obesity and congenital anomalies in the neonate.^8,9 Later in life, children and adolescents born to obese mothers are more likely to become overweight and obese,¹⁰ and there is a correlation with the development of type 2 diabetes mellitus in the offspring of such women.¹¹ Likewise, women who are obese when they become pregnant are more likely to develop gestational diabetes mellitus during their pregnancies.¹²

On account of the increasing prevalence of maternal obesity and the seriousness of such preventable health and birth outcomes, it is essential for healthcare providers to be knowledgeable in the prevention and management of this condition. The purpose of this resource guide is to assist healthcare providers in developing and reviewing the current evidence for maternal obesity management, as well as to provide useful patient resources that may be beneficial for managing obesity during pregnancy.

Materials and Methods

A literature review was conducted using three electronic databases (PubMed, CINAHL, and Evidence-Based Medicine Reviews) for the initial search. Keywords and Medical Subject Headings (MeSH terms) utilized were as follows: maternal obesity management, obesity in pregnancy, pregnancy and weight management, maternal obesity interventions, prenatal obesity management, prenatal nutrition, and pregnancy dietary recommendations. The search was limited to peer-reviewed resources from 2007 to present.

Bibliographic Findings

The following is a list of references designed to assist healthcare providers in the care of the maternally obese patient. Included are studies and clinical reviews on maternal obesity management, counseling, and other interventions. Several resources on the dietary recommendations for nutrition and exercise during pregnancy have also been included, as this is a critical component in the care of the maternally obese. Although it is not an exhaustive list, these references were selected because they provide critical information for understanding the challenges in maternal obesity management, as well as recommendations for management of obesity in gravid women. The references have been divided into the following topics: overviews of maternal obesity management, resources that discuss specific interventions for maternal obesity including surgical interventions, nutrition-specific recommendations for managing maternal obesity, and additional research and references that specifically focus on optimization of outcomes and effectiveness of interventions.

Overviews of maternal obesity management

Birdsall KM, Vyas S, Khazaezadeh N, Oteng-Ntim E. Maternal obesity: a review of interventions. Int J Clin Pract 2009;63:494–507.

Catalano PM. Management of obesity in pregnancy. Obstet Gynecol 2007;109:419–433.

Cockcroft E, Marsden PJ. Extreme obesity in pregnancy – prevalence and management. Arch Dis Child Fetal Neonatal Ed 2011;96:Fa120.

Davies GA, Maxwell C, McLeod L, Gagnon R, Basso M, Bos H, et al. Obesity in pregnancy. J Obstet Gynaecol Can 2010;32:165–173.

Davies GA, Maxwell C, McLeod L, Gagnon R, Basso M, Bos H, et al. SOGC clinical practice guidelines: obesity in pregnancy. Int J Gynaecol Obstet 2010;110:167–173.

Dixit A, Girling JC. Obesity and pregnancy. J Obstet Gynaecol 2008;28:14–23.

Fitzsimons KJ, Modder J. Setting maternity care standards for women with obesity in pregnancy. Semin Fetal Neonatal Med 2010;15:100–107.

Gunatilake RP, Perlow JH. Obesity and pregnancy: clinical management of the obese gravida. AJOG 2011;106–119.

Herring SJ, Platek DN, Elliott P, Riley LE, Stuebe AM, Oken E. Addressing obesity in pregnancy: what do obstetric providers recommend? J Womens Health 2010;19:65–70.

Jarvie E, Ramsay JE. Obstetric management of obesity in pregnancy. Semin Fetal Neonatal Med 2010;15:83–88.

Jevitt C. Pregnancy complicated by obesity: midwifery management. J Midwifery Womens Health 2009;54:445–451.

Power ML, Cogswell ME, Schulklin J. US obstetrician-gynaecologist's prevention and management of obesity in pregnancy. J Obstet Gynaecol 2009;29:373–377.

Shaikh H, Robinson S, Teoh TG. Management of maternal obesity prior to and during pregnancy. Semin Fetal Neonatal Med 2010;15:77–82.

Sugiyama T, Watanabe H, Takimoto H, Fukuoka H, Yoshiike N, Sagawa N. Management of obesity in pregnancy. Curr Womens Health Rev 2009;5:220–224.

Specific interventions for maternal obesity

Grundy MA, Woodcock S, Attwood SE. The surgical management of obesity in young women: consideration of the mother's and baby's health before, during, and after pregnancy. Surg Endosc 2008;22:2107–2116.

Lee CY, Koren G. Maternal obesity: effects on pregnancy and the role of pre-conception counselling. J Obstet Gynaecol 2010;30:101–106.

Nutrition-specific recommendations for maternal obesity

Kaiser LL, Allen L. Position of the American Dietetic Association: nutrition and lifestyle for healthy pregnancy outcomes. J Amer Diet Assoc 2008;108:553–561.

Lammi-Keefe CJ, Couch SC, Philipson EH (eds). Handbook of Nutrition and Pregnancy. Totowa, NJ: Humana Press, 2008.

Siega-Riz AM. Position of the American Dietetic Association and the American Society for Nutrition: obesity, reproduction, and pregnancy outcomes. J Amer Diet Assoc 2009;109:918–927.

Additional research and optimization of outcomes

Galtier F, Raingeard I, Renard E, Boulot P, Bringer J. Optimizing the outcome of pregnancy in obese women: from pregestational to long-term management. Diabetes Metab 2008;34:19–25.

Guelinckx I, Devlieger R, Beckers K, Vansant G. Maternal obesity: pregnancy complications, gestational weight gain and nutrition. Obes Rev 2008;9:140–150.

Heslehurst N, Moore H, Rankin J, Ells LJ, Wilkinson JR, Summberbell CD, et al. How can maternity services be developed to effectively address maternal obesity? A qualitative study. Midwifery 2011;27:e170–e177.

Oteng-Ntim E, Pheasant H, Khazaezadeh N, Mohidden A, Bewley S, Wong J, et al. Developing a community-based maternal obesity intervention: a qualitative study of service providers' views. BJOG 2010;13:1651–1655.

Thangaratinam S, Jolly K. Obesity in pregnancy: a review of reviews on the effectiveness of interventions. BJOG 2010;117:1309–1312.

Wax JR. Risks and management of obesity in pregnancy: current controversies. Curr Opin Obstet Gynecol 2009;21:117–123.

Patient Resources

In addition to the bibliographic findings, there are also several organizations and online resources that may be beneficial for maternally obese patients. The Internet is becoming a widely used source of health information for gravid women,^13–15 and healthcare providers are in a unique position to refer patients to websites that have credible and reliable information.¹⁶ Internet websites that may benefit maternally obese patients have been listed below with a brief description of the content and purpose of the resources.

Centers for Disease Control and Prevention (CDC)

A resource index is available at www.cdc.gov/obesity/resources/index.html, which includes obesity prevention guidelines, fact sheets, brochures for obese patients, community guides, and links to state-based obesity prevention programs.

Obesity Society

A consumer-based website filled with resources for obese consumers is available at www.obesity.org/resources-for/consumer.htm, designed to promote the attainment and maintenance of a healthy weight for the general public.

Shape Up America!

Shape Up America! is a non-profit organization that has been established to provide the public with obesity awareness and strategies for effective weight management (www.shapeup.org).

American College of Obstetricians and Gynecology (ACOG)

A patient education resource with frequently asked questions regarding nutrition during pregnancy is available on the ACOG website, and such education is an important component of maternal obesity management (www.acog.org/publications/faq/faq001.cfm).

American Dietetic Association

Resources for healthy eating are available at www.eatright.org in order to help consumers reach their educational goals for nutrition and weight management through proper dietary choices.

Obesity Resource Center

Available at www.obesityresource.com, the Obesity Resource Center was designed as a portal to connect consumers with health professionals, classes, and other weight management resources for tackling the problem of obesity.

United States Department of Agriculture – MyPlate

This United States governmental site is purposed to educate Americans about healthy dietary choices to promote nutrition and healthy weight management, which is an essential component of weight loss for obese patients. Content specifically for nutrition in pregnancy is available at www.choosemyplate.gov/mypyramidmoms/index.html.

Conclusion

Maternal obesity is a significant health problem in the United States with negative effects on maternal and neonatal health, as well as healthcare economics. Healthcare providers are in a unique position to assist in the prevention and management of this condition. The resources provided are intended to support healthcare providers in this challenging time.

Footnotes

Disclosure Statement

No competing financial interests exist.

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