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Preventing Adverse Cardiovascular Outcomes in Pregnancy Complicated by Obesity

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Abstract

Purpose of Review

Obesity is a chronic disease that is becoming increasingly prevalent, and more individuals of reproductive age have obesity prior to becoming pregnant. Obesity in pregnancy is associated with short- and long-term adverse consequences for both the birthing person and their offspring which have been associated with increased long-term cardiovascular morbidity and mortality. The goal of this review is to discuss what is currently understood about the relationship between maternal obesity and adverse pregnancy outcomes (APOs), the association between APOs and future cardiovascular disease (CVD) risk, and what evidence-based interventions can be implemented to prevent adverse outcomes in this population.

Recent Findings

Maternal obesity has been associated with an increased risk of APOs such as gestational diabetes, hypertensive disorders of pregnancy, and preterm birth as well as an increased risk of future CVD, such as metabolic syndrome, chronic hypertension, coronary heart disease, and stroke. The impact of maternal obesity also extends beyond the pregnant individual to the offspring, increasing the risk of fetal, neonatal, and infant mortality, as well as of congenital malformations, prematurity, and long-term health problems such as insulin resistance and childhood obesity. Prevention guidelines are incorporating the increased risk of adverse outcomes from maternal obesity into formalized risk assessments to guide both prenatal and postpartum care. It is becoming evident that a multidisciplinary cardio-obstetrics team is an important part of providing comprehensive care for pregnant individuals with obesity and other cardiovascular risk factors, including preexisting CVD and a history of prior APOs. There remains a need for further studies to better understand the mechanisms underlying the relationship between maternal obesity and APOs, as well as the racial and ethnic disparities that have been noted in the prevalence of APOs and associated CVD risk and mortality.

Summary

There is increasing awareness that obesity in pregnancy is associated with various short- and long-term adverse maternal and offspring outcomes. There are multiple screening and prevention strategies that may be implemented before, during, and after pregnancy to prevent these adverse outcomes.

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Abbreviations

APO:

Adverse pregnancy outcome

CVD:

Cardiovascular disease

HDP:

Hypertensive disorders of pregnancy

GDM:

Gestational diabetes mellitus

PTB:

Preterm birth

RR:

Relative risk

HR:

Hazard ratio

OR:

Odds ratio

CI:

Confidence interval

BMI:

Body mass index

LGA:

Large for gestational age

T2DM:

Type 2 diabetes mellitus

CEs:

Cardiac events

GWG:

Gestational weight gain

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Funding

Dr. Sharma is supported by AHA 979462 and the Blumenthal Scholarship in Preventive Cardiology. Dr. Khan is supported by grants from NIH to her institution (R01HL161514; UG3HL163121).

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Authors and Affiliations

  1. Division of Cardiology, Johns Hopkins University School of Medicine, 559 Halstead, 600 N Wolfe Street, Baltimore, MD, 21287, USA

    Aarti M Purohit, Chigolum Pamela Oyeka, Marika Toscano, Shriddha Nayak, Roger S. Blumenthal & Garima Sharma

  2. Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Sadiya S. Khan

  3. Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Shari M. Lawson

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  1. Aarti M Purohit
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  2. Chigolum Pamela Oyeka
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Correspondence to Garima Sharma.

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Purohit, A.M., Oyeka, C.P., Khan, S.S. et al. Preventing Adverse Cardiovascular Outcomes in Pregnancy Complicated by Obesity. Curr Obstet Gynecol Rep 12, 129–137 (2023). https://doi.org/10.1007/s13669-023-00356-9

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