Instituto Valenciano de Infertilidad (IVI)
Title: Obesity and pregnancy complications
Daniela Galliano received her M.D. from the University of Turin (Italy). After being a specialist in the Department of Obstetrics and Gynecology at the University of Granada (Spain), she completed her Ph.D. in the same faculty. She currently works in Reproductive Medicine at IVI (Instituto Valenciano de Infertilidad), in Barcelona, Spain. She specializes in endocrinology, infertility, IVF and hysteroscopy surgery. Her publications include articles in scientific magazines and several book chapters. She is a member of the European Society of Human Reproduction and Embryology (ESHRE), and other national and international societies.
Maternal obesity has been associated with obstetrical in the three trimesters of pregnancy and neonatal complications. Miscarriage rates and unexplained stillbirth are higher among obese women who have conceived naturally or through assisted reproduction techniques. Obesity increases the risk of pregnancy-induced hypertension and preeclampsia, pre-gestational diabetes and gestational diabetes mellitus, childhood obesity, and type 2 diabetes mellitus. Maternal obesity makes preterm labor, operative vaginal delivery and cesarean section more likely in both primigravid and multigravid women, and negatively affects the outcome of vaginal birth after cesarean. The rate of cervical dilation in both nulliparous and multiparous women declines as maternal BMI rises, which shows that obese women are at a higher risk of experiencing dysfunctional labor. Moreover, obese pregnant women are also more likely to present intraoperative and postoperative complications (including postpartum hemorrhage), anesthetic complications (failed intubation at the time of general endotracheal anesthesia), postoperative wound infection and dehiscence, thromboembolism and endomyometritis in the puerperium. Obesity is associated with 18% of obstetric causes of maternal mortality and 80% of anesthesia-related deaths. Female obesity is also related to adverse fetal/neonatal outcome, such as macrosomia (defined as a birth weight 44.000 g or 495th percentile of gestational age), which increases by 2-3-fold, shoulder dystocia, fetal distress, hypoglycemia, jaundice, stillbirth and congenital malformations, including heart, great vessels, ventral wall and intestine defects, hydrocephaly, omphalocele and neural tube defects.