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 Obesity may be as important (as) hypertension and diabetes as a
modifiable risk factor to improve birth outcomes, the study authors
wrote in the journal Obstetrics and Gynecology.
"As obstetricians, we have the unique responsibility of thinking
about multiple lives, such as the woman carrying the pregnancy and
the fetus developing in the womb," said study leader Dr. Brock
Polnaszek of Barnes-Jewish Hospital and Washington University in St.
Louis, Missouri, in an email to Reuters Health.
Polnaszek and colleagues studied 3,311 obese women and 3,147
non-obese women who had full-term vaginal deliveries. None of them
had diabetes or hypertension.
About nine percent of the babies of obese mothers had complications,
compared to about seven percent of infants born to non-obese women.
Specifically, the newborns of obese patients were more likely to
have signs and symptoms suggesting a dangerous form of infection
called sepsis. But while babies of obese mothers were more likely to
appear sick enough for sepsis to be a possibility, bacteria culture
tests showed actual sepsis rates didn't differ between the groups,
the authors note.
Also, while the rates of these problems were very low, the infants
of obese mothers were more likely to have brain damage caused by
insufficient oxygen and to need to have their body temperature
drastically reduced to protect the brain.
"Some risks, such as stillbirth, were attributed in the past to
diabetes but have been shown to be complications of pre-pregnancy
obesity instead," said Dr. Isaac Blickstein of Kaplan Medical Center
and Hadassah-Hebrew University School of Medicine in Jerusalem,
Israel. Blickstein, who wasn't involved with this study, researches
risks related to maternal obesity.
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"Obesity needs serious attention, maybe even more than gestational
diabetes receives," Blickstein said. "Doctors are happy to test
women and implement therapy for gestational diabetes, but they fail,
in general, to educate their patients."
Because obesity is an inflammatory disease, it can alter the fetal
environment, the study authors wrote. This could be exacerbated by
the additional effects of strained labor. In the current study,
obese women were more likely to be induced, have a prior cesarean
delivery, have a prolonged first stage of labor, and need oxytocin
during labor. Babies of obese mothers also had higher birth weight.
"As the epidemic of obesity continues, this identifies yet another
set of serious negative perinatal outcomes," said Dr. Jeffrey Gould,
who directs the Perinatal Epidemiology and Health Outcomes Research
Unit at Stanford University Medical Center in Palo Alto, California.
Gould, who wasn't involved with this study, told Reuters Health by
email, "This is a call to action, or rather, a call to two actions.
The first is to develop nationally effective strategies to reduce
the obesity epidemic. The second is for (obstetricians) to continue
to perfect their approaches to the perinatal care of all obese
women."
SOURCE: http://bit.ly/2x5NiqQ Obstetrics and Gynecology, online
August 17, 2018.
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