Available online 21 November 2022

Author links open overlay panelAbstract

With the increasing prevalence of obesity among women of reproductive age, the detrimental effects on maternal and neonatal health are increasing. The objective of this review is to summarise the evidence that comprehensive management of weight control in women of reproductive age has on maternal-fetal outcomes. First, the impact that obesity has on fertility and pregnancy is described and then the specific aspects of continued weight management in each of the stages (preconception, pregnancy and postpartum) during these years are outlined, not only to benefit women affected by obesity before pregnancy, but also to avoid and reverse weight gain during pregnancy that complicates future pregnancies.

Finally, the special planning and follow-up needs of women with a history of bariatric surgery are discussed in order to avoid nutritional deficiencies and/or surgical complications that endanger the mother or affect fetal development.

Resumen

Con el incremento de la prevalencia de la obesidad entre las mujeres en edad reproductiva están aumentando los efectos perjudiciales para la salud materna y neonatal. El objetivo de esta revisión es resumir la evidencia que el manejo integral del control ponderal de las mujeres en edad reproductiva tiene sobre los resultados materno-fetales. Primeramente, se describe el impacto que la obesidad tiene en la fertilidad y la gestación y a continuación se destacan los aspectos específicos del manejo continuado del peso en cada una de las etapas (preconcepción, embarazo y postparto) durante estos años, no sólo en las mujeres afectas de obesidad antes de la gestación, sino también para evitar y revertir la ganancia de peso durante el embarazo que complique las gestaciones futuras.

Finalmente, se discuten las necesidades especiales de planificación y seguimiento de las mujeres con antecedente de cirugía bariátrica para evitar deficiencias nutricionales y/o complicaciones quirúrgicas que pongan en peligro a la madre o puedan afectar el desarrollo fetal.

Introduction

Obesity in pregnancy is a currently a major challenge in obstetric care due to its prevalence, the adverse impact on both mother and foetus and the consequences for the health of present and future generations. This review describes the influence of obesity on reproductive health before and during pregnancy and postpartum. It also discusses the multidisciplinary management of obesity during a woman's reproductive period based on the Spanish- and English-language scientific literature on the subject published from 2010 to 2022.

In Spain, the prevalence of overweight and obesity in women of childbearing age (18–44) is 11.1%,1 with a similar rate of obesity reported in women during pregnancy.2 Obesity in this age group is not only important because of its prevalence, but also because it has a negative impact on the different reproductive stages: menstrual cycle and ovulation, achieving pregnancy spontaneously and through assisted reproductive techniques (ART) and in terms of maternal/foetal complications during the pregnancy.

Section snippetsImpact of obesity on fertility

The majority of men and women with obesity are fertile, although obesity increases the risk of infertility. A number of elements could explain the negative impact obesity has on fertility: ovulatory dysfunction, altered oocyte quality, endometrial dysfunction and affected male fertility. This section summarises the available evidence on the effects of obesity on female fertility.

Impact of obesity on assisted reproduction techniques

Apart from the effects of obesity on the quality of the oocyte, endometrium and sperm, obesity is associated with poorer outcomes in fertility treatments and in ART. First of all, women with obesity have a lower response to ovarian stimulation. In ovulation induction treatments, there is less likelihood of ovulation using clomifene citrate, they require higher doses of gonadotropins and a smaller number of follicles develop.3 In IVF cycles, ovarian stimulation takes longer and requires a higher

Obesity, polycystic ovary syndrome and reproduction

PCOS is the most common cause of infertility due to anovulation. Women with PCOS have a higher likelihood of obesity (prevalence ranging from 14% to 75% depending on the population studied), longitudinal weight gain and abdominal obesity compared to women without PCOS.12 Obesity and PCOS are two conditions with complex pathophysiologies and it is not clear which one of them acts as a cause or as a consequence of the other. Obesity exacerbates different reproductive and metabolic aspects of

Maternal-foetal complications in pregnancy in obese women

Obesity is associated with different short-term and long-term adverse consequences. Overweight or obese woman have an increased risk of spontaneous abortion and euploid abortion compared to patients with normal weight.3 The pregnancies of women with obesity are at increased risk of a different complications, including GD, hypertensive disease of pregnancy (gestational hypertension or preeclampsia), foetal malformations, prematurity, both spontaneous and induced by other complications, Caesarean

Preconception period

The preconception period is an ideal time to assess and manage conditions that may affect the health of the mother and foetus during the pregnancy, as they can have long-term implications for both.

Conclusions

The available evidence collected in this review supports the implementation of strategies for the prevention and integrated management of obesity in women of childbearing age, with the aim of improving their fertility, reducing pregnancy-related risks and benefiting the health of their offspring. Population-based information-providing activities, the design and development of preventive and therapeutic programmes and specific training for the different healthcare professionals involved in the

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