Fetal and infant outcomes in obese pregnant women

Ruth Bell; Peter W. G. Tennant; Judith Rankin

doi:10.1017/CBO9780511782466.007

6 - Fetal and infant outcomes in obese pregnant women

from Section 2 - Pregnancy outcome

Published online by Cambridge University Press: 05 August 2012

Ruth Bell ,

Peter W. G. Tennant and

Judith Rankin

Edited by

Matthew W. Gillman and

Lucilla Poston

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Matthew W. Gillman: Affiliation:
Harvard Medical School
Lucilla Poston: Affiliation:
King's College London

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Summary

Introduction

Fetal loss, stillbirth, infant death, and major structural congenital anomaly are among the most serious adverse outcomes that have been associated with maternal obesity. This chapter summarizes the available epidemiological evidence, and discusses potential explanations and public health implications.

Maternal obesity and the risk of fetal and infant death

Fetal death and maternal obesity

Fetal death is the delivery of a fetus or infant that shows no signs of life. Fetal deaths are categorized as stillbirths or miscarriages on the basis of gestational age at delivery. A stillbirth is the delivery of a baby at a gestational age beyond the accepted threshold for viability that shows no signs of life, and a miscarriage is a fetal loss at an earlier gestational age. h e gestational age threshold dei ning stillbirth varies between countries, from 20 weeks in the United States [1], 24 weeks in the UK [2], and 28 weeks in other parts of Europe [3].

Around 1 in 200 births in developed countries ends in a stillbirth [4, 5], with limited evidence of improvement in recent years [1, 2]. Known maternal risk factors for stillbirth include advanced age, nulliparity, ethnic background, maternal diabetes, hypertension, obesity, and smoking [ 6– 8]. h e majority of stillbirths, around 85%, occur before the onset of labor (antepartum stillbirths) and the remainder occur during labor (intrapartum stillbirths) [2]. In epidemiological studies, a high proportion of stillbirths, 10% to 70% depending on cause of death classii cation, are described as “unexplained,” with no apparent underlying cause [5, 9]. While clinically many stillbirths occur unexpectedly in apparently uncomplicated pregnancies, if exhaustive post-mortem investigations are undertaken, an underlying cause can be identified in most cases [5]. However, in routine clinical practice, permission for autopsy is frequently either denied or not sought. The most frequent disorders include placental pathology, infection, umbilical cord abnormalities, congenital anomalies, and maternal medical disorders including diabetes and hypertension [9].

Keywords

BMI congenital anomaly fetal loss public health pregnancy maternal obesity neonatal mortality

Type: Chapter
Information: Maternal Obesity , pp. 56 - 69

DOI: https://doi.org/10.1017/CBO9780511782466.007 [Opens in a new window]

Publisher: Cambridge University Press

Print publication year: 2012

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6 - Fetal and infant outcomes in obese pregnant women

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