Skip to main content Accessibility help
Hostname: page-component-544b6db54f-lmg95 Total loading time: 0.331 Render date: 2021-10-24T15:37:27.774Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "metricsAbstractViews": false, "figures": true, "newCiteModal": false, "newCitedByModal": true, "newEcommerce": true, "newUsageEvents": true }

4 - Maternal outcomes in obese pregnancies

from Section 2 - Pregnancy outcome

Published online by Cambridge University Press:  05 August 2012

Matthew W. Gillman
Harvard Medical School
Lucilla Poston
King's College London
Get access



The effect of obesity in pregnancy is wide ranging with potentially serious impacts on both the mother and the child. This chapter summarizes the current state of knowledge of the relationship between obesity and adverse maternal outcome, including effects on the health of the pregnant mother as well as complications at the time of delivery. We examine how obesity influences the risk of maternal death, gestational diabetes, hypertensive diseases of pregnancy, and infection. In regard to delivery we summarize evidence for effects on induction of labor, cesarean section (CS), postpartum hemorrhage, and other serious complications. This chapter draws together a considerable body of evidence to show that risks of adverse obstetric outcome may be doubled or even trebled in an obese woman compared to a woman with a healthy body mass index (BMI). The final section of the chapter looks at the impact of maternal obesity at a population, rather than an individual, level. We highlight the proportion of adverse obstetric outcome that is explained by obesity in the population and estimate that approximately one fifth of obstetric morbidity in developed countries could be avoided if maternal obesity was eliminated.

What is obesity in pregnancy?

Measurement and definition of obesity

Obesity is defined as “an accumulation of excess body fat to such an extent that may impair health” [1]. Total body fat can be measured by direct methods such as dual energy X-ray absorptiometry (DEXA) and magnetic resonance imaging (MRI) [2]. Both are expensive, cumbersome, and impractical to perform in most circumstances. Moreover, DEXA has the added radiation risk [3]. Hence obesity is usually measured using indirect methods such as BMI, based on anthropometry. Body mass index is an expression of body weight-for-height using the formula weight (in kilograms) divided by height (in meters) squared (kg/m2). Obesity in adults is defined by the World Health Organization (WHO), the US Institute of Medicine (IOM), and the UK National Institute for Health and Clinical Excellence (NICE) as BMI ≥30kg/m2. Table 1.1 of Chapter 1 describes the different classifications of obesity in common usage.

Maternal Obesity , pp. 35 - 44
Publisher: Cambridge University Press
Print publication year: 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)


World Health Organization Obesity: Preventing and Managing the Global Epidemic 2000
Despres, J P Lemieux, I Prud’homme, D. Treatment of obesity: need to focus on high risk abdominally obese patients BMJ 2001 322 716 Google Scholar
Han, T S Sattar, N Lean, M. ABC of obesity. Assessment of obesity and its clinical implications BMJ 2006 333 695 Google Scholar
Kopelman, P. Obesity as a medical problem Nature 2000 404 635 Google Scholar
CMACE/RCOG CMACE/RCOG Joint Guideline. Management of Women with Obesity in Pregnancy 2010
Rasmussen, K M Catalano, P M Yaktine, A L New guidelines for weight gain during pregnancy: what obstetrician/gynecologists should know Curr Opin Obstet Gynecol 2009 21 521 Google Scholar
Rasmussen, KM Abrams, B Bodnar, LM Recommendations for weight gain during pregnancy in the context of the obesity epidemic Obstet Gynecol 2010 116 1191 Google Scholar
Cantwell, R Clutton-Brock, T Cooper, G Saving Mothers’ Lives: reviewing maternal deaths to make motherhood safer: 2006–2008. The Eighth Report of the Confidential Enquiries into Maternal Deaths in the United Kingdom BJOG 2011 118 1 Google Scholar
California Department of Public Health The California Pregnancy-associated Mortality Review. Report from 2002 and 2003 Maternal Death Reviews 2011
Heslehurst, N Rankin, J Wilkinson, J R A nationally representative study of maternal obesity in England, UK: trends in incidence and demographic inequalities in 619323 births, 1989–2007 Int J Obes (Lond) 2010 34 420 Google Scholar
World Health Organization Global Database on Body Mass Index: an Interactive Surveillance Tool for Monitoring Nutrition Transition 2011
Campbell, O M Graham, W J Lancet Maternal Survival Series steering group Strategies for reducing maternal mortality: getting on with what works Lancet 2006 368 1284 Google Scholar
Waugh, N Royle, P Clar, C Screening for hyperglycaemia in pregnancy: a rapid update for the National Screening Committee Health Technol Assess 2010 14 1 Google Scholar
Sebire, N J Jolly, M Harris, J P Maternal obesity and pregnancy outcome: a study of 287,213 pregnancies in London Int J Obes Relat Metab Disord 2001 25 1175 Google Scholar
Torloni, M R Betrán, A P Horta, B L Prepregnancy BMI and the risk of gestational diabetes: a systematic review of the literature with meta-analysis Obes Rev 2009 10 194 Google Scholar
Chu, S Y Callaghan, W M Kim, S Y Maternal obesity and risk of gestational diabetes mellitus Diabetes Care 2007 30 2070 Google Scholar
Yogev, Y Catalano, P M Pregnancy and obesity Obstet Gynecol Clin North Am 2009 36 285 Google Scholar
National Institute for Health and Clinical Excellence (NICE) Diabetes in Pregnancy. Management of Diabetes and its Complications from Pre-conception to the Postnatal Period 2008
World Health Organization Definition, Diagnosis and Classification of Diabetes Mellitus and its Complications. Report of a WHO Consultation. Part 1: Diagnosis and Classification of Diabetes Mellitus 1999
Metzger, B E Lowe, L P Dyer, A R Hyperglycemia and adverse pregnancy outcomes N Engl J Med 2008 3358 1991 Google Scholar
Crowther, C A Hiller, J E Moss, J R Effect of treatment of gestational diabetes mellitus on pregnancy outcomes N Engl J Med 2005 352 2477 Google Scholar
Gillman, M W Oakey, H Baghurst, P A Effect of treatment of gestational diabetes mellitus on obesity in the next generation Diabetes Care 2010 33 964 Google Scholar
Yu, C K Teoh, T G Robinson, S. Obesity in pregnancy BJOG 2006 113 1117 Google Scholar
Bellamy, L Casas, J P Hingorani, A D Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis Lancet 2009 373 1773 Google Scholar
Poston, L. Developmental programming and diabetes – the human experience and insight from animal models Best Pract Res Clin Endocrinol Metab 2010 24 541 Google Scholar
Poston, L Harthoorn, L F Van Der Beek, E M Obesity in pregnancy: implications for the mother and lifelong health of the child. A consensus statement Pediatr Res 2011 69 175 Google Scholar
Milne, F Redman, C Walker, J Assessing the onset of pre-eclampsia in the hospital day unit: summary of the pre-eclampsia guideline (PRECOG II) BMJ 2009 339 b3129 Google Scholar
National Institute for Health and Clinical Excellence Hypertension in Pregnancy. The Management of Hypertensive Disorders During Pregnancy
O’Brien, T E Ray, J G Chan, W S Maternal body mass index and the risk of preeclampsia: a systematic overview Epidemiology 2003 14 368 Google Scholar
Cedergren, M I Maternal morbid obesity and the risk of adverse pregnancy outcome Obstet Gynecol 2004 103 219 Google Scholar
Walsh, S W Obesity: a risk factor for preeclampsia Trends Endocrinol Metab 2007 18 365 Google Scholar
Bhattacharya, S Campbell, D M Liston, W A Effect of body mass index on pregnancy outcomes in nulliparous women delivering singleton babies BMC Public Health 2007 7 168 Google Scholar
Bhattacharya, S. Higher BMI in pregnant women associated with a greater likelihood of pre-eclampsia, caesarian delivery and higher offspring birth weight and body fat Evid Based Med 2010 15 152 Google Scholar
Rajasingam, D Seed, P T Briley, A L A prospective study of pregnancy outcome and biomarkers of oxidative stress in nulliparous obese women Am J Obstet Gynecol 2009 200 395e1 Google Scholar
Finucane, M M Stevens, G A Cowan, M J National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9.1 million participants Lancet 2011 377 557 Google Scholar
Bellamy, L Casas, J P Hingorani, A D Pre-eclampsia and risk of cardiovascular disease and cancer in later life: systematic review and meta-analysis BMJ 2007 335 974 Google Scholar
Bourjeily, G Paidas, M Khalil, H Pulmonary embolism in pregnancy Lancet 2010 375 500 Google Scholar
Drife, J. Thromboembolism Br Med Bull 2003 67 177 Google Scholar
Larsen, T B Sorensen, H T Gislum, M Maternal smoking, obesity, and risk of venous thromboembolism during pregnancy and the puerperium: a population-based nested case-control study Thromb Res 2007 120 505 Google Scholar
Knight, M. Antenatal pulmonary embolism: risk factors, management and outcomes BJOG 2008 115 453 Google Scholar
Lippi, G Franchini, M. Pathogenesis of venous thromboembolism: when the cup runneth over Semin Thromb Hemost 2008 34 747 Google Scholar
Heslehurst, N Simpson, H Ells, L J The impact of maternal BMI status on pregnancy outcomes with immediate short-term obstetric resource implications: a meta-analysis Obes Rev 2008 9 635 Google Scholar
Zhang, J Bricker, L Wray, S Poor uterine contractility in obese women BJOG 2007 114 343 Google Scholar
Nuthalapaty, F S Rouse, D J The impact of obesity on obstetrical practice and outcome Clin Obstet Gynecol 2004 47 898 Google Scholar
Sheiner, E Levy, A Menes, T S Maternal obesity as an independent risk factor for caesarean delivery Paediatr Perinat Epidemiol 2004 18 196 Google Scholar
Usha Kiran, T S Hemmadi, S Bethel, J Outcome of pregnancy in a woman with an increased body mass index BJOG 2005 112 768 Google Scholar
Poobalan, A S Aucott, L S Gurung, T Obesity as an independent risk factor for elective and emergency caesarean delivery in nulliparous women – systematic review and meta-analysis of cohort studies Obes Rev 2009 10 28 Google Scholar
Heslehurst, N Lang, R Rankin, J Obesity in pregnancy: a study of the impact of maternal obesity on NHS maternity services BJOG 2007 114 334 Google Scholar
Heslehurst, N Moore, H Rankin, J How can maternity services be developed to effectively address maternal obesity? A qualitative study Midwifery 2011 27 e170 Google Scholar
Cited by

Send book to Kindle

To send this book to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle.

Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats

Send book to Dropbox

To send content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about sending content to Dropbox.

Available formats

Send book to Google Drive

To send content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about sending content to Google Drive.

Available formats