ESPE Yearbook of Paediatric Endocrinology

In Brief: The authors provide a comprehensive review of the health challenges of obesity in pregnancy, covering its epidemiology, associated risks for pregnancy, childbirth, fetus and offspring. They also discuss the evidence for lifestyle interventions during pregnancy and also the benefits and risks of bariatric surgery prior to conception.

Comment: Remarkably in the USA in 2020, only two out of every five pregnant women had a normal weight status – of the others just under half had overweight and just over half had obesity. Obesity has adverse effects on all maternal outcomes throughout the course of reproduction, from subfertility and miscarriage through to pregnancy, in particular gestational diabetes and hypertensive disorders of pregnancy but also depression and anxiety, on labour and childbirth, and even after birth on risks of postpartum haemorrhage, infection and likelihood of successful lactation. Risks for the fetus are also substantially raised – much of this can be explained by those maternal disorders of hyperglycemia, hypertension, preterm birth, and instrumental delivery. Risks for neural tube defects may reflect higher folic acid requirements by women with obesity. However, the full extent of the significantly elevated risks of stillbirth and congenital malformations associated with maternal obesity remains unexplained.

Of particular interest is the section of this review covering the benefits and risks of bariatric surgery in the mother before conception. Notably, data are lacking on the effectiveness and safety of new GLP1 and GIPR receptor agonists during pregnancy as this group is deliberately excluded from such trials due to lack of knowledge about potential teratogenicity. Therefore bariatric surgery will likely continue to be increasingly used. It has been shown to restore ovulation and improve fertility, and reduce risks of gestational diabetes, hypertensive disorders and the associated newborn complications. However, there is a risk of surgical complications and also micronutrient deficiencies in the mother, which impact adversely on fetal development. Therefore the American College of Obstetrics and Gynaecology recommends that women delay pregnancy for at least 12 to 18 months after surgery or until they achieve a stable post-surgery weight.