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Maternal Obesity & Pregnancy Outcomes 319

tropins & have an increased miscarriage rate. Even iology. It is this metabolic function of the adipose tis-
5% weight loss iproves fertility outcomes. It is shown sue that causes the pathology associated with obesity.
than 5% weight loss leads to 56% regular cycles,48%
spontaneous ovulation,32% spontaneous pregnancy
&25 % live birth rates. Enzymes & Hormones Produced by Adipose
Tissue
Enzyme / Hor- Function Changes with
mone OBESITY
Aromatase Converts androgens to No change
estrogens with obesity
17- hydrox- Converts estrone to es- No change
ysteroid tradiol & androstendione
hydrogenase to testosterone
5-reductase Inactivates cortisol No change
11- hydrox- Converts cortisone to Activity is
ysteroid cortisol increased in
dehydrogenase obese women
type 1
Pregnancy Leptin Affects food intake, Circulating
leptin levels
timing of puberty, bone
Pregnancy perse is reported as one of the factor for development, and im- are increased
the development of obesity.Excess Pre pregnancy mune function in obese
weight ,weight gain during pregnancy and retention women
of weight after delivery have detrimental effects on TNFα Represses genes in- Expression
both mother & Baby. The Pregnancy complications volved in the uptake and of TNF is in-
include. storage of nonesterfied creased in the
fatty acids and glucose adipose tissue
Early Pregnancy of obese
women
Spontaneous Miscarriage, Recurrent Miscarriages,
Congenital Anomalies – NTD, CHD, Spinabifida, Om- GDM
phalocele
Gestational Diabetes Mellitus (GDM) is the most com-
mon complication of pregnancy in Obese women.
Late Pregnancy The prevalence of GDM Varies from 1 to 20 % and
Gestational HTN, PreEclampsia, Eclampsia ,Gesta- is rising worldwide in line with increasing trends of
tional Diabetes, Preterm birth / PROM, IUGR, IUFD Maternal obesity and Type-2 DM. The incidence of
GDM rises disproportionately with increasing obesity.
Peripartum Based on the meta analysis of the literature ,the risk
Higher rate of C-Sections ,PPH, Anaesthesia com- of developing GDM is about two ,four and eight times
plications, Wound infection/breakdown ,Postpartum higher among overweight, obese and severely obese
Endometritis , Postpartum thrombosis,Difficulty in women respectively compared with normal-weight
Breast Feeding pregnant women. Pregnancy is a state of insulin
resistance triggered by the pregnancy hormones &
Fetus/Neonate adipokines secreted from the placenta such as TNF
α,Placental lactogen, placental growth hormone,
Fetal Macrosomia , Shoulder dystocia , Childhood cortisol and progesterone which reverses at delivery.
Obesity
The insulin resistance is compensated by increased.
Insulin secretion from pancreatic beta cell in normal
Pathophysiology of Obesity in Pregnancy pregnancy.GDM develops when the mother does not
Adipose tissue is a storehouse of energy. It provides secrete enough insulin to meet the metabolic stress
structural support & the fat serves as a cushion from of insulin resistance .As GDM and Obesity share
trauma. Adipose tissue also functions as an endocrine many of the same health consequences,obese wom-
organ, the non fat cell of the adipose tissue produce ens & their off spring are at a greater risk of adverse
enzymes & hormones which influence the body phys- outcomes.

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