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Abstract
<p class="first" id="d1012097e134">Obesity is the most common medical condition in
women of reproductive age. Obesity
during pregnancy has short term and long term adverse consequences for both mother
and child. Obesity causes problems with infertility, and in early gestation it causes
spontaneous pregnancy loss and congenital anomalies. Metabolically, obese women have
increased insulin resistance in early pregnancy, which becomes manifest clinically
in late gestation as glucose intolerance and fetal overgrowth. At term, the risk of
cesarean delivery and wound complications is increased. Postpartum, obese women have
an increased risk of venous thromboembolism, depression, and difficulty with breast
feeding. Because 50-60% of overweight or obese women gain more than recommended by
Institute of Medicine gestational weight guidelines, postpartum weight retention increases
future cardiometabolic risks and prepregnancy obesity in subsequent pregnancies. Neonates
of obese women have increased body fat at birth, which increases the risk of childhood
obesity. Although there is no unifying mechanism responsible for the adverse perinatal
outcomes associated with maternal obesity, on the basis of the available data, increased
prepregnancy maternal insulin resistance and accompanying hyperinsulinemia, inflammation,
and oxidative stress seem to contribute to early placental and fetal dysfunction.
We will review the pathophysiology underlying these data and try to shed light on
the specific underlying mechanisms.
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