Obesity, O

1
Obesity, OG and Risk

• Diana Hamilton-Fairley
• Consultant Obstetrician and Gynaecologist
• Guys and St. Thomas NHS Foundation Trust

2
Aims

• Obesity is a public health issue
• Impact of obesity on womens health
• Weight loss does make a difference
• Clinicians have a powerful role to play

3
Health Risks
Which of these is the greatest risk to health?
Being Overweight
4
Risk

• The possibility of suffering harm or loss
  danger.
• A factor, thing, element, or course involving
  uncertain danger
• The danger or probability of loss to an insurer.
• One considered with respect to the possibility of
  loss a poor risk.

5
The Epidemic

• Child obesity has doubled in a decade
• 21 increased risk of cancer in girls
• Double the risk of dying before 50

6
Reproductive Years Obesity, Hirsutism and
Menstruation
PCOS
Plt0.01
Plt0.01

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Implications

• Anovulation
• Menorrhagia
• Endometrial Hyperplasia
• Anaemia
• Hirsutism / Acne
• Psychological impact

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Obesity and Ovulation induction
Plt0.02
NS
Plt0.01
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Obesity and Miscarriage

• Risk of miscarriage before a live birth in 13,123
  consecutive pregnancies

BMI
1
19-25
1.42
25-29
gt29
2.06
10
Reproductive Years Pregnancy - Gestational
Diabetes

• 96 801 Nulliparous women
• Prepregnancy weight

BMI
1
19-25 (71.7)
2.4
25-29.9 (18.2)
gt30 (10.1)
5.2
Baeton et al.2001 Am J Pub Health 91436 - 439
11
Pre-eclampsia and Eclampsia
BMI
19-25
1
25-29.9
2.0
gt30
3.3
Baeton et al.2001 Am J Pub Health 91436 - 439
12
Delivery at lt32 weeks
BMI
1
19-25
1.3
25-29.9
gt30
1.5
Baeton et al.2001 Am J Pub Health 91436 - 439
13
Caesarean Delivery
BMI
1
19-25
1.8
25-29.9
gt30
2.7
Baeton et al.2001 Am J Pub Health 91436 - 439
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Other increased risks in pregnancy

• Congenital abnormality 3 fold
• Thromboembolism 12 fold
• Failed Trial of Labour 87 vs 20-40

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Shoulder Dystocia and neonatal injury

• BMI gt 30kg/m2
• Second stage gt20 mins
• Birthweight gt 4.5kg

Mehta et al. 2006 J Perinatology 2685-8
16
Infant Death
BMI
1
19-25
1.5
25-29.9
gt30
2.0
Baeton et al.2001 Am J Pub Health 91436 - 439
17
Mean maternal glucose concentrations and infant
mortality
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Obese Parents

• Increase the risk of obese children
• Increased risk of early onset Type 2 DM
• Increased risk of metabolic syndrome
• Glucose intolerance, raised VLDL, Decreased HDL,
  Hypertension, Increased risk for cardiovascular
  disease
• Increased risk of cancer
• Increased risk of dying before children reach
  adulthood

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Disease for which Obesity is a risk factor
Disease Risk Risk in PCOS
Diabetes 3.8 5 fold
Cardiovascular disease 2.1 Stroke gt IHD 0.7 (NS)
Hypertension 5.6
Endometrial Cancer 3 10 fold Depends
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Risk factors in endometrial cancer
Risk Fold risk
Obesity 3 - 10
Nulliparity 2
Late Menopause 2.4
bloody menopause 4
Diabetes 2.8
Hypertension 1.5
Unopposed E2 9.5
Complex Hyperplasia 29
21
Risk of Surgery

• Obesity increases your risk of needing a
  Hysterectomy
• Infection 15.3 vs 11.3 (plt0.01)
• Bleeding no difference
• Increased duration of surgery
• Increased LOS
• Manual Handling
• Surgical difficulty

22
Weight loss
Is it worth the effort?
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Obesity and PCOS

• Does weight loss treat symptoms?

Yes
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Does weight loss improve outcome

• In pregnancy reduces
• Congenital abnormality
• Miscarriage
• GDM, macrosomia
• Pre-eclampsia
• Prematurity
• Caesarean section
• Postpartum
• Type 2 DM
• Hypertension
• Cancer (Endometrial)

25
Treatment algorithm for obesity
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What is our role?

• Young fit women - INFORMATION
• Actively treat obesity in gynaecology and
  subfertility clinics
• Pre-conception obesity clinics
• Pregnancy advice on weight gain
• Postpartum follow-up and support

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Obesity is a Public Health Issue

• We all have a role to play in reducing the risks