OBESITY

Dr. Princess Aliza Lorezo

BMI or Quetelet index

NORMAL 18.5 to 24.9 kg /m2

OVERWEIGHT 25 to 29.9
OBESE >/= 30
CLASS 1 30 to 34.9
CLASS 2 35 to 39.9
CLASS 3 >/= 40
ADIPONECTIN
• Principal adipokine
• Enhances sensitivity
• Blocks hepatic release of glucose
• Has cardioprotective effects in circulating plasma
lipids
• Deficit-leads to DM, HTN, endothelial cell
activation, and CV disease
Adipocytokines in Pregnancy
• Leptin, resitin, TNF-alpha, IL-6: increased during
pregnancy
• Primary stimulant of insulin resistance
MEATBOLIC SYNDROME
Patients with 3 or more of the following:
Wasit circumference >88cm (34.7 in) in women
>102 cm ( 40.2 in) in men
Hypertriglyceridemia >/= 150 mg/dl
High-density lipoprotein <50mg/dL in women
<40 mg/dL in men
High blood pressure >/= 130/85 mmHg
High fasting glucose >/=110 mg/dL
NAFLD
• With obesity, excessive fat accumulates in
the liver  hepatic steatosis
• Steatosis + metabolic syndrome  NASH
and cirrhosis
• In pregnant women, overweight and obese
 high levels of LDL III  is a hallmark of
ectopic liver fat accumulation that is typical
of NAFLD
M/M associated with obesity

•Adipositas cordis – is caused by

HTN, hypervolemia,
dydlipidemia
•Abnormal LVF, HF, MI, stroke
PREGNANCY / OBESITY
• Difficulty in achieving pregnancy
• Early recurrent pregnancy loss
• Preterm delivery
• Myriad of increased obstetrical, medical, and
surgical complications
• Increased health-care utilization and costs
• Infants-increased M/M, obesity
Maternal Weight Gain And Energy
Requirement (p.177)
Maternal morbidity
• Increased rate of CS delivery
• Wound infections
• Difficult anesthesia
• Less likely to breastfeed
• Greater weight retention after delivery
• GDM
• Preeclampsia
• OCP failure
Perinatal M/M
• Unexplained fetal death
• Congenotal anomalies
• Macrosomia
• Obese wpmen beget obese children
ANTEPARTUM MANAGEMENT
• Weight reduction is not advisable during pregnancy
• Recommendation weight gain 11-20 lb
• Lifestyle intervention and physical activity
• Close prenatal surveillance
 Surgical and Anesthetic Concern
• ACOG recommendation to lower thromboembolic
complications:
• Graduated compression stockings
• Hydration
• Early mobilization after cesarean delivery
• ACOG recommendation for women wwho
undergone bariatric surgery:
• Vit B12 and D, FA, Calcium are given’Women with gastric
band should be monitored by the bariatric team during
pregnancy
• Special vigilance for signs of intestinal obstruction