Obesity, defined as a Body Mass Index >30, is a world-wide epidemic especially in the United States. Obesity is associated with many health concerns including high blood pressure and diabetes. When trying to conceive pre-pregnancy obesity is a major risk factor for both men and women. Obesity is also associated with infertility in both men and women and may be a factor in miscarriages and in the development of gestational diabetes and hypertension. Women with obesity during pregnancy are also more likely to develop problems in labor and more often need operative delivery. A recent study published in the European Journal of Cancer Prevention (2017 Mar;26(2):151-155) found that pre-pregnancy obesity is also a major risk factor for later development of both breast and ovarian cancer.
Life style modification remains the first line of therapy and includes calorie restriction and increased physical activity. Supervised medical therapy or bariatric surgery should also be considered. If bariatric surgery is performed, pregnancy should be postponed for a year so that metabolic stability can be affirmed. Unfortunately, many because of advancing age may not be able to afford the time to wait until ideal body weight is achieved. For those morbidly obese (BMI greater than or equal to 40 kg/m squared), the goal should be to achieve a BMI at least less than 35 kg/m squared.
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