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E-grāmata: Obesity: A Ticking Time Bomb for Reproductive Health

Edited by (Consultant Obstetrician and Gynaecologist, Victoria Hospital, Kirkcaldy and Clinical Senior Lecturer, University of St. Andrews, UK), Edited by (Professor Emeritus, Division of Obstetrics and Gynaecology, St Georges University of London, London,)
  • Formāts: PDF+DRM
  • Izdošanas datums: 31-Dec-2012
  • Izdevniecība: Elsevier Science Publishing Co Inc
  • Valoda: eng
  • ISBN-13: 9780123914804
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Obesity: A Ticking Time Bomb for Reproductive HealthPalielināt
  • Formāts: PDF+DRM
  • Izdošanas datums: 31-Dec-2012
  • Izdevniecība: Elsevier Science Publishing Co Inc
  • Valoda: eng
  • ISBN-13: 9780123914804
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Obesity is a continuing issue around the world and in many contexts. The growing number of obese people is an increasing concern for those in the medical profession, and obesity can pose specific challenges in relation to fertility and pregnancy. Patients who are obese require specific considerations and knowledge. Bringing together experts from a variety of specialties to examine the issues and challenges of obesity, this book discusses how obesity affects fertility, reproduction, and pregnancy. Beginning with an exploration of the epidemiology of obesity, further chapters focus on specific issues related to obesity and both male and female reproduction, the complications of obesity during pregnancy and labour, and the long term effects of obesity. This is the most comprehensive resource to examine the topic of obesity and reproductive issues, making it invaluable for medical students, professionals, and researchers in public policy and medicine.

  • Comprehensive examination of fertility issues arising from male and female obesity
  • Clinical knowledge and expertise given to the subjects
  • In-depth examination through 47 chapters of a growing, but often overlooked, issue in fertility and pregnancy

Papildus informācija

Obesity poses specific risks in fertility and pregnancy, and this book provides specialist knowledge to consider and respond to the many issues encountered treating obese patients in reproductive issues
Foreword xxv
About the Editors xxvii
Contributors xxix
Section 1 Epidemiology
1(66)
1 Worldwide Epidemic of Obesity
3(10)
Rohana N. Haththotuwa
Chandrika N. Wijeyaratne
Upul Senarath
Introduction
3(1)
Definitions of Overweight and Obesity
4(1)
The Extent of the Problem
5(1)
Temporal Trends
6(1)
Factors Associated with Overweight and Obesity
7(1)
Disease Burden and Impact on Health and Economy
8(1)
International Response to the Epidemic
9(1)
Conclusions
9(1)
References
9(4)
2 Social and Ethnic Determinants of Obesity
13(10)
Chu Lim
Omar Thanoon
Introduction
13(1)
Ethnic Factors
13(2)
Social Factors
15(2)
Socio-economic Status
15(2)
Dietary Factors
17(1)
Conclusion
18(1)
References
18(5)
3 Genetic and Molecular Basis of Obesity
23(16)
Adnan Hasan
Tahir Mahmood
Introduction
23(1)
Hereditary Factors Influencing BMI
24(1)
Genetic---Molecular Interaction of Obesity
24(1)
Regulation of Energy Balance --- Molecular Basis
25(1)
Regulation of Food Energy Intake
25(1)
The Role of Hypothalamus
25(1)
The Role of Leptin
26(1)
Melanocortin Signalling Pathway
27(2)
Control of Energy Expenditure
29(3)
Adipogenesis
32(1)
Interactions Among Social, Environmental, Genetic and Behavioural Factors in Obesity
33(1)
Conclusion
34(1)
References
34(5)
4 The Psychological Basis of Obesity
39(14)
Gyongyi Kokonyei
Alexander Baldacchino
Robert Urban
Zsolt Demetrovics
Introduction
39(1)
Eating Behaviour
40(2)
Early Attachment and Trauma
42(1)
Emotion Regulation
42(1)
Personality Traits
43(1)
Depression and Anxiety
43(1)
Cognitive Factors
44(1)
Summary
45(1)
Acknowledgements
46(1)
References
46(7)
5 Obesity in Adolescence
53(14)
Gail Busby
Mourad W. Seif
Introduction
53(1)
Prevalence of Childhood Obesity: A Global Perspective
53(1)
Obesity and the Pubertal Transition
54(1)
Factors Affecting Childhood and Adolescent Obesity
55(1)
Adolescent Obesity --- Adverse Outcomes
56(1)
General
56(1)
Psychological Effects
57(1)
The Metabolic Syndrome
57(1)
Polycystic Ovarian Syndrome in Adolescence
57(2)
Obstetric Outcomes in Obese Adolescents
59(1)
The Impact of Childhood and Adolescent Obesity on Adult Health
59(1)
Management Principles
60(1)
Prevention
60(1)
Lifestyle Interventions
60(1)
Drugs
61(1)
Surgery
61(1)
Management of PCOS in Adolescence
61(1)
Combined Oral Contraceptive Pills
61(1)
Insulin Sensitisers
62(1)
Conclusion
62(1)
References
63(4)
Section 2 Obesity and Reproduction
67(72)
6 Obesity and Contraception
69(22)
Sujeetha Damodaran
Krishnan Swaminathan
Introduction
69(1)
Risks of Obesity in Pregnancy
69(1)
Classification of Obesity Based on Body Mass Index
70(1)
Potential Concerns with Obesity and Contraception
71(1)
Obesity and Contraceptive Efficacy
71(10)
Evidence (or Lack of) for Contraceptive Efficacy in Overweight or Obese Women
71(1)
Mechanisms by Which Obesity Could Affect Contraceptive Efficacy
72(1)
Contraceptives and Weight Gain: Myth or Truth?
73(2)
Safety of Hormonal Contraceptives in Obese Women
75(1)
Obesity, Contraception and Cardiovascular Disease
75(1)
Obesity, Contraception and VTE
76(1)
Obesity, Contraception and Cancer
76(1)
Contraceptive Issues After Bariatric Surgery
77(1)
IUCDs in Obese Women
78(1)
Sterilisation Procedures in Obese Women
79(1)
What Do the Guidelines Say?
79(2)
Conclusion
81(1)
References
81(10)
7 Sexual Health and Obesity
91(8)
Sharon Cameron
Introduction
91(1)
Obesity and Sexual Behaviour
91(2)
Obesity and Sexual Dysfunction
93(1)
Obesity and Sexual Health Outcomes
94(1)
Conclusion
95(1)
References
96(3)
8 Obesity in PCOS and Infertility
99(18)
Ioannis E. Messinis
Christina I. Messini
Konstantinos Dafopoulos
Introduction
99(1)
Obesity and Infertility --- Possible Mechanisms
100(4)
Hyperandrogenism
100(1)
Hypersecretion of LH
100(1)
Hyperinsulinaemia
101(1)
Adipokines
101(3)
Impact of Obesity on Infertility Treatment
104(5)
Diet and Life-style Changes
104(1)
Clomiphene Citrate
105(1)
Aromatase Inhibitors
106(1)
Low-Dose FSH
107(1)
Laparoscopic Ovarian Drilling
108(1)
Insulin Sensitisers
108(1)
In Vitro Fertilisation
109(1)
References
109(8)
9 Obesity and Recurrent Miscarriage
117(10)
Harish Malappa Bhandari
Siobhan Quenby
Introduction
117(1)
Obesity and Miscarriage
118(1)
Obesity and Recurrent Miscarriage
118(1)
Metabolic Effects of Obesity on Ovary
119(1)
Polycystic Ovarian Syndrome
119(1)
Ovarian Dysfunction
120(1)
Endometrial Changes in Obesity
120(2)
Luteal-phase Deficiency
121(1)
Leukaemia Inhibitory Factor
121(1)
Leptin
121(1)
Endometrial Proteins
122(1)
Management
122(1)
Role of Weight Reduction
122(1)
Role of Insulin-Sensitising Agents
122(1)
Conclusion
123(1)
References
123(4)
10 Obesity and Assisted Reproduction
127(12)
Mark Hamilton
Abha Maheshwari
Introduction
127(1)
Prevalence of Obesity in the Assisted Reproduction Sector
127(1)
Evidence of Reduced Fertility in Obese Women
128(1)
Cycle Effects
128(1)
Specific Issues Relating to Art
129(1)
Effects on the Oocyte
129(1)
Effects on Embryos
129(1)
Effects on the Endometrium
130(1)
Rationale for the Use of Assisted Reproduction
130(1)
Practical Management of Obese Women Undertaking Art
130(2)
Patient Selection
130(1)
Stimulation Regimes
131(1)
Monitoring of Stimulation
131(1)
Clinical Procedures
132(1)
Egg Collection
132(1)
Embryo Transfer
132(1)
hCG Trigger
132(1)
Luteal Support
132(1)
Effect of Obesity on the Results of Art
132(2)
Pregnancy Rate
132(1)
Miscarriage Rate
133(1)
Live-Birth Rate
133(1)
Safety Issues for Mothers and Offspring
134(1)
Ethical Issues Relevant to Access to Services
135(1)
Conclusion
136(1)
References
136(3)
Section 3 Obesity and Male Reproduction
139(52)
11 Obesity and Sexual Dysfunction
141(22)
Darius A. Paduch
Alexander Bolyakov
Laurent Vaucher
Physiology of Sexual Function
141(6)
Sexual Dysfunction and Obesity-Related Co-morbidities
147(3)
Hypercholesterolaemia
147(2)
Hypertension
149(1)
Peripheral Vascular Disease
149(1)
Coronary Artery Disease
149(1)
Diabetes Mellitus
150(1)
Evaluation
150(2)
Treatment
152(5)
Weight Management
153(1)
Pharmacological Therapy
153(4)
Summary
157(1)
References
157(6)
12 Male Obesity --- Impact on Semen Quality
163(16)
Vanessa J. Kay
Sarah Martins da Silva
Background
163(1)
Impact on Semen Quality
164(5)
Sperm Concentration and Count
164(2)
Sperm Motility
166(1)
Sperm Morphology
167(1)
Combined Semen Parameters
167(1)
Sperm DNA Damage
167(2)
Aetiological Theories
169(3)
Endocrine Theory
169(2)
Genetic Theory
171(1)
Sexual Dysfunction Theory
171(1)
Testicular Hyperthermia Theory
171(1)
Reactive Oxygen Species Theory
171(1)
Treatment
172(1)
Conclusions
173(1)
References
173(6)
13 Obesity, Bariatric Surgery and Male Reproductive Function
179(12)
Jyothis George
Richard Anderson
Introduction
179(1)
Bariatric Surgical Techniques
180(1)
Gastric Banding
180(1)
Gastric Bypass
180(1)
Biliopancreatic Diversion
180(1)
Sleeve Gastrectomy
181(1)
Future Directions
181(1)
Pathophysiology of the Hypothalamic---Pituitary---Gonadal Axis in Obesity
181(5)
Obesity and Leydig Cell Function
181(3)
Obesity and Spermatogenesis
184(1)
Obesity and Sertoli Cell Function
185(1)
Obesity and Erectile Function
185(1)
Summary and Practical Considerations
186(1)
References
186(5)
Section 4 Pregnancy and Obesity
191(78)
14 Maternal Obesity and Developmental Priming of Risk of Later Disease
193(20)
R.C.W. Ma
Peter D. Gluckman
Mark A. Hanson
Introduction
193(1)
Epidemiological Observations on Maternal Obesity, Macrosomia and Neonatal Adiposity
194(1)
Maternal Obesity and Childhood Obesity
195(1)
Maternal Pregnancy Weight Gain and Childhood Obesity
196(1)
Maternal Diabetes, GDM and Glucose Effects
196(1)
Relationship Between Maternal Hyperglycaemia and Neonatal Adiposity
197(1)
Maternal Hyperglycaemia and Childhood Obesity
198(1)
GDM and Cardiometabolic Diseases in the Offspring
198(1)
Maternal Insulin Resistance, Hyperinsulinaemia and Foetal Growth
199(1)
Glucose Metabolism and Foetal Growth
200(1)
Maternal Lipid Supply and Foetal Growth
201(1)
Effects on Vascular Function
201(1)
Animal Models Using Maternal Obesity
202(1)
Neurohormonal Changes
203(1)
Placenta, Foetal Priming and Foetal Development
203(1)
Epigenetics as the Unifying Mechanism in Foetal Priming of NCD Risk
204(1)
Implications for Public Health Intervention
204(2)
Acknowledgements
206(1)
References
206(7)
15 Foetal Ultrasound in Obese Pregnancy
213(10)
Jennifer M. Walsh
Fionnuala M. McAuliffe
Introduction
213(1)
Excess Foetal Risks Associated with Obesity
213(2)
Congenital Anomalies
213(1)
Stillbirths
214(1)
Intrauterine Growth Restriction
214(1)
Macrosomia
215(1)
Ultrasound Assessment in Obesity
215(3)
First Trimester Ultrasound
215(1)
Second Trimester Ultrasound
216(1)
Foetal Growth Assessment
217(1)
Conclusion
218(1)
References
219(4)
16 Obesity and Prolonged Pregnancy
223(6)
Mani Malarselvi
Siobhan Quenby
Introduction
223(1)
Prolonged Pregnancy
223(3)
Epidemiology
223(1)
Mechanisms
224(1)
Management
225(1)
Conclusion
226(1)
References
226(3)
17 Obesity and Venous Thromboembolism
229(18)
Joanne Ellison
Andrew Thomson
Introduction
229(1)
Epidemiology, Prevalence and Trends
229(3)
Maternal Mortality
229(2)
Maternal Morbidity
231(1)
Obesity and Pregnant Women
232(1)
Possible Underlying Mechanisms
232(1)
Prevention of VTE in Obese Women During Pregnancy
233(8)
Recognition and Assessment of Risk
233(2)
Thromboprophylaxis
235(3)
Thromboprophylactic Agents
238(3)
Investigation and Diagnosis of VTE in the Obese Pregnant Woman
241(1)
Treatment of VTE in the Obese Pregnant Woman
242(1)
Conclusion
242(1)
References
242(5)
18 Obesity and pre-eclampsia
247(12)
Fiona Broughton-Pipkin
Pamela Loughna
Definitions
247(1)
Blood Pressure Measurement
247(1)
Urine Testing
248(1)
Changing Incidence of Obesity
248(1)
Does Obesity Predispose to Pre-Eclampsia?
249(2)
Adipokines
251(2)
Is `Pre-Eclampsia' in the Obese Pregnant Women Really Underlying Chronic (Essential) Hypertension?
253(3)
Final Considerations
256(1)
References
256(3)
19 Obesity, Insulin Resistance and Placental Dysfunction - Foetal Growth
259(10)
Anjum Doshan
Justin C. Konje
Introduction
259(2)
Obesity and the Endocrine Environment
261(1)
Placenta and Insulin Resistance
261(1)
Placental Size
262(1)
Placental Transporter System
262(2)
Placenta and Inflammatory Response
264(1)
Prothrombotic State
264(1)
Diabetes and the Placenta
264(1)
The Intrauterine Growth-Restricted Foetus
265(1)
Conclusions
266(1)
References
266(3)
Section 5 Obesity and Gestational Diabetes
269(46)
20 Screening for Gestational Diabetes
271(10)
Peter Hornnes
Jeannet Lauenborg
Introduction
271(1)
Overweight as a Risk Factor for GDM
271(1)
Pathophysiology
272(1)
Diagnosis of GDM
273(2)
Treatment of GDM
275(1)
Implications Related to GDM
276(1)
References
277(4)
21 Obesity and Metabolic Disorders During Pregnancy and Pregnancy Outcome
281(8)
Gerard H.A. Visser
Yariv Yogev
Introduction
281(1)
Obesity and Gestational Diabetes
281(2)
Impact of Obesity and/or Diabetes During Pregnancy on the Offspring
283(1)
Interventions
284(1)
Conclusions
285(1)
References
285(4)
22 Obesity, Polycystic Ovary and Impaired Reproductive Outcome
289(10)
Jyoti Balani
Stephen Hyer
Marion Wagner
Hassan Shehata
Introduction
289(1)
Obesity and Reproductive Health
290(1)
Pathogenic Mechanisms
290(1)
Polycystic Ovary Syndrome
291(1)
Obesity in Pregnancy
292(1)
Gestational Weight Gain in Obese Women
293(1)
Guidelines for Management for Obese Women of Reproductive Age
294(1)
Management of Obesity in Pregnancy
294(2)
Dietary Approaches
294(1)
Physical Activity
295(1)
Behavioural Interventions
295(1)
Pharmacological Interventions
295(1)
Bariatric Surgery
296(1)
References
296(3)
23 Pregnancy and Metabolic Syndrome of Obesity
299(16)
Shahzya S. Huda
Scott M. Nelson
Introduction
299(1)
Lipid Metabolism and Fat Deposition in Lean Pregnancy
299(2)
Lipid Metabolism and Fat Deposition in Obese Women
301(2)
Glucose Metabolism in Lean and Obese Pregnancy
303(1)
Adiposity, Obesity and IR: Potential Mechanisms
304(1)
Amino Acid Metabolism in Lean and Obese Pregnancy
305(1)
Pre-eclampsia, Obesity and Metabolic Syndrome of Pregnancy
305(1)
Intervention Strategies in Maternal Obesity and Effects on Metabolism
306(2)
Conclusion
308(1)
References
308(7)
Section 6 Obesity and Labour
315(106)
24 Induction of Labour in Obese Women
317(8)
Carolyn Chiswick
Fiona C. Denison
Background
317(1)
Indications for Induction of Labour
317(3)
Post-Dates Pregnancy
318(1)
Hypertensive Disorders of Pregnancy
319(1)
Diabetes
319(1)
Induction of Labour for Foetal Macrosomia
319(1)
Stillbirth
319(1)
`Soft' Indications for Induction of Labour
320(1)
Women with a Previous Caesarean Section
320(1)
Assessment Prior to Induction of Labour
320(1)
Methods of Inducing Labour
321(1)
Foetal Weil-Being
321(1)
Summary
322(1)
References
322(3)
25 Challenges of Intrapartum Care in Obese Women
325(18)
Lindsay Edwards
Boon H. Lim
Introduction
325(1)
Preterm and Post-term Pregnancy
325(1)
Induction of Labour
326(1)
Place of Delivery
326(1)
Equipments Required
327(1)
Labour and Intrapartum Monitoring
328(2)
Labour Dystocia
330(1)
Caesarean Section in the Obese Woman
331(4)
Macrosomia and Shoulder dystocia
335(1)
Post-partum Care
335(1)
Perinatal Morbidity
336(1)
Risks in Subsequent Pregnancy
336(1)
Conclusion
337(1)
References
337(6)
26 The Role of the Midwife During Pregnancy, Labour and Post-partum
343(14)
Yana Richens
Debbie M. Smith
Tina Lavender
The Role of the Midwife in Pregnancy
343(3)
Background
343(2)
Weighing Women
345(1)
Maternity Care Pathways
346(1)
Specialist Clinics for Women with a BMI ≥ 30 kg/m2
346(5)
Advice on Weight Management
347(2)
Diabetes
349(1)
Folic Acid Intake
349(1)
Abdominal Palpation
349(1)
Blood Pressure
350(1)
Venous Thromboembolism
350(1)
The Role of the Midwife in Labour
351(1)
The Role of the Midwife in the Post-partum Period
351(1)
Conclusion
352(1)
References
352(5)
27 Anaesthetic Issues During Labour
357(14)
Alistair Milne
Alistair Lee
Introduction
357(11)
The Cardiovascular System
357(1)
The Respiratory System
358(1)
The Gastrointestinal System
359(1)
The Endocrine System
359(1)
Anaesthetic Considerations
359(2)
The Anaesthetic Clinic
361(1)
The Labour Ward
362(1)
The Operating Theatre
363(4)
The Post-Operative Period
367(1)
Conclusion
368(1)
References
368(3)
28 Maternal Obesity and the Risk of Stillbirth
371(12)
Mairead Black
Siladitya Bhattacharya
Background
371(1)
Epidemiology
372(1)
Pathophysiology
373(1)
Direct Risk Factors
373(3)
Gestational Diabetes
373(1)
Hypertensive Disorders
374(1)
Vascular Pathology and Placental Dysfunction
374(1)
Metabolic Syndrome
375(1)
Previous Obstetric History
375(1)
Foetal Abnormalities
375(1)
Sleep Disorders
375(1)
Failed Antenatal Screening
376(1)
Post-maturity
376(1)
Indirect Risk Factors
376(2)
Age
376(1)
Parity
376(1)
Social Class and Dietary Habits
377(1)
Ethnicity
377(1)
Obesity as an Independent Risk Factor
377(1)
Management
378(2)
Prevention
378(2)
Public Health Implication
380(1)
References
380(3)
29 Obesity, Diabetes, Placental Pathology and Foetal Malformations
383(14)
Margaret J. Evans
Introduction
383(2)
Obesity, Diabetes and the Umbilical Cord Coiling
385(3)
Obesity, Diabetes and the Placenta
388(2)
Obesity and Other Placental Changes
390(1)
Obesity, Diabetes and Foetal Pathology
390(4)
Conclusion
394(1)
References
394(3)
30 Post-Natal Care for the Recently Delivered Obese Women
397(24)
Debra Bick
Sarah Beake
Introduction
397(2)
Background
399(2)
For the Woman
400(1)
For the Baby
400(1)
Centre for Maternal and Child Enquiries
400(1)
Implications of Obesity for Planning of Post-Natal Care
401(1)
Post-Natal Morbidity
401(5)
Pre-Eclampsia
401(1)
Thromboembolism
402(1)
Infection
403(1)
Cardiac Disease
404(1)
Post-partum Haemorrhage
405(1)
Severe Maternal Morbidity as an Indicator of Quality of Maternity Care
406(1)
Planning Post-Natal Care
406(1)
Current Guidance to Inform the Content and Timing of Post-Natal Care
407(9)
Physical Observations and Examinations
408(1)
Severe Morbidity
408(1)
Commonly Experienced Morbidity
409(1)
Care Following Caesarean Section
410(1)
Diabetes
411(1)
Infant Feeding
412(1)
Weight Management Post-Birth
413(1)
Implications for Health Service Resource Use
414(1)
Implications for Safety of Maternity Care
414(1)
The Importance of Women's Views
415(1)
References
416(5)
Section 7 Interventions to Improve Care of Women During Pregnancy
421(80)
31 Anti-Obesity Drugs for Obese Women Planning Pregnancy
423(8)
Hang Wun Raymond Li
Chin Peng Lee
Karen Siu Ling Lam
Pak Chung Ho
Introduction
423(1)
Classification of Anti-Obesity Drugs
423(1)
Drugs for Weight Reduction in Reproductive-Age Women: Pharmacology and Clinical Efficacy
424(3)
Orlistat (Xenical®)
424(1)
Sibutramine
425(1)
Rimonabant
426(1)
Metformin (Glucophage®)
426(1)
Phentermine and Diethylpropion
427(1)
Pharmacological Anti-Obesity Treatment in Women Contemplating Pregnancy
427(2)
Indications of Pharmacological Treatment: A Review of Evidence
427(1)
Safety Data in Pregnancy
428(1)
Timing of Intervention
428(1)
Concluding Remarks
429(1)
References
429(2)
32 Anti-Obesity Surgery for Women Planning Pregnancy?
431(22)
Kavita Deonarine
Dilip Dan
Surujpal Teelucksingh
Introduction and Background
431(1)
The Global Obesity Epidemic
431(1)
Obesity and Reproductive Function
432(1)
The Effects of Obesity on Pregnancy
432(2)
Bariatric Surgery: Overview and Indications
434(1)
The Surgical Options
435(6)
Laparoscopic Adjustable Gastric Band
436(1)
Sleeve Gastrectomy
437(1)
Bilio-Pancreatic Diversion
438(2)
Roux en Y Gastric Bypass
440(1)
Pre-Operative Assessment for Bariatric Surgery
441(2)
Special Considerations in a Post-Bariatric Patient
443(1)
Nutrient Replacement
443(1)
Anaemia
443(1)
Gastrointestinal Problems in Pregnancy
443(1)
Role of Bariatric Surgery to Treat Obesity-Related Female Reproductive Abnormalities
444(3)
United States AHRQ
445(1)
Royal College of Obstetrics and Gynaecologists Scientific Advisory Committee Opinion Paper 17
445(2)
American College of Obstetrics and Gynecologists
447(1)
Conclusion
447(1)
References
448(5)
33 Evidence-Based Approach to the Management of Obese Pregnant Women
453(10)
Shakila Thangaratinam
Khalid S. Khan
Background
453(1)
Pre-Pregnancy Weight Management
454(1)
Weight Management Interventions in Pregnancy
454(4)
Recommended Weight Gain in Pregnancy
454(1)
Effects of Interventions on Maternal and Foetal Weight
455(1)
Diet-Based Intervention
455(1)
Physical Activity-Based Intervention
456(1)
Mixed Approach Intervention
456(1)
Safety of Weight Management Interventions and Weight Loss in Pregnancy
457(1)
Women's Views on Weight Management Interventions in Pregnancy
457(1)
Health Professionals' Views on Weight Management Interventions
458(1)
Nutritional Supplementation for Obese Women in Pregnancy
458(1)
Prophylaxis for Pre-Eclampsia and Thromboembolism
459(1)
Screening for Gestational Diabetes
459(1)
Public Health Measures on Obesity
459(1)
Recommendations for Clinical Practice
460(1)
Recommendations for Research
460(1)
References
461(2)
34 Multimodal Framework for Reducing Obesity-Related Maternal Morbidity and Mortality
463(20)
Leroy C. Edozien
Introduction
463(1)
Obesity in Women of Reproductive Age
464(1)
Obesity-Related Maternal Mortality
465(1)
Obesity-Related Maternal Morbidity
465(1)
The Concept of a Multimodal Framework
466(3)
Primary Prevention of Obesity-Related Maternal Mortality and Morbidity
469(1)
Secondary Prevention of Obesity-Related Maternal Mortality and Morbidity
470(4)
Dedicated Clinic
470(1)
The Booking Visit and Follow-Up Arrangements
471(1)
Anaesthetic Consultation
471(1)
Facilities
471(1)
Staff
472(1)
Weight Control in Pregnancy
472(1)
Intrapartum Care
473(1)
Caesarean Section
473(1)
Thromboembolism Prophylaxis
474(1)
Breastfeeding
474(1)
Post-Natal Care
474(1)
Tertiary Prevention of Obesity-Related Maternal Mortality and Morbidity
474(2)
Dealing with Co-Morbidities
474(1)
Vaginal Birth After Caesarean Section
475(1)
Pregnancy After Bariatric Surgery
475(1)
Conclusion
476(1)
References
476(7)
35 Developing Standards of Care for Obese Women During Pregnancy
483(18)
David Churchill
Gemma Forbes
Tahir Mahmood
Introduction
483(1)
What Is a Standard in Health Care?
483(1)
How to Develop Standards
484(1)
What Measures Should be Used When Defining Standards of Care?
484(1)
The Obesity Epidemic
485(1)
Pre-Pregnancy Care
486(1)
Early Pregnancy Care
487(1)
Dietary Advice
487(1)
Aspects of Care During Pregnancy
488(7)
Maintaining and Monitoring Maternal Well-Being
489(1)
Blood Pressure Measurement
489(1)
Obesity and Gestational Diabetes
489(1)
Foetal Anomaly Screening and the Assessment of Foetal Growth
490(1)
Thromboembolic Disease
491(1)
Prophylaxis and Treatment
492(1)
Planning for Labour and Delivery
493(1)
Care During Labour and Delivery
493(2)
Team Management on Delivery Suite
495(1)
Post-Natal Care
495(1)
Organisation
496(1)
Organisational Requirements
496(1)
References
497(4)
Section 8 Long-Term Impact of Obesity
501(82)
36 Maternal Obesity - The Road to Diabetes and Cardiovascular Risk
503(12)
Ioannidis Ioannis
Grigoropoulou Pinelopi
Introduction
503(2)
Impact of Maternal Obesity on Offspring Obesity, Diabetes and Cardiovascular Disease Risk - Evidence from Experimental Studies
504(1)
The Link Between Maternal Obesity and Offspring Obesity, Diabetes and Cardiovascular Risk -- Hypotheses and Possible Mechanisms
505(6)
The Developmental Overnutrition Hypothesis
505(1)
Predictive Adaptive Response Hypothesis
506(1)
Maternal Obesity, Inflammation and Foetal Skeletal Muscle Development
506(2)
Epigenetics
508(1)
Leptin Central Processes Regulating Food Intake in Offspring
508(1)
Maternal Obesity and Glucose Metabolism in Mother and Offspring
509(1)
Maternal Obesity and Programming of Blood Pressure and Vascular Function
510(1)
Conclusions
511(1)
References
511(4)
37 Obesity and Female Malignancies
515(10)
Mohamed K. Mehasseb
Mahmood I. Shafi
Introduction
515(1)
Epidemiology
515(3)
Obesity and Endometrial Carcinoma
515(2)
Obesity and Breast Cancer
517(1)
Obesity and Ovarian Cancer
518(1)
Obesity and Cervical Cancer
518(1)
Mechanisms Relating Obesity to Female Malignancies Risks
518(1)
Effect of Obesity on Management of Female Malignancies
519(2)
Future Directions
521(1)
References
521(4)
38 Obesity and Menstrual Disorders
525(12)
Hilary O.D. Critchley
W. Colin Duncan
Savita Brito-Mutunayagam
Rebecca M. Reynolds
Obesity: The Problem
525(1)
Obesity and Abnormal Uterine Bleeding
526(1)
Polyps
526(1)
Malignancy and Hyperplasia
527(1)
Ovulatory Dysfunction
527(1)
The Endometrium
528(2)
Polycystic Ovary Syndrome
530(1)
Obesity in the Absence of PCOS
530(1)
Summary
531(1)
Acknowledgements
531(1)
References
532(5)
39 Developing HRT Prescribing in Obese Women
537(20)
Kate Maclaran
Nick Panay
Introduction
537(3)
Effect of Menopause on Metabolic Factors
540(1)
Managing Menopausal Symptoms in Obese Women
540(10)
Hormone Replacement Therapy
540(1)
Shared Effects of HRT and Obesity
541(7)
Prescribing HRT in Obese Women
548(2)
Alternatives to HRT
550(1)
Conclusion
550(1)
References
550(7)
40 Incontinence and Prolapse in the Obese Woman
557(14)
Douglas G. Tincello
Introduction
557(1)
Incidence and Prevalence
557(2)
Normal Bladder Function and Causes of Incontinence in Women
559(2)
Urodynamic Stress Incontinence
560(1)
Detrusor Overactivity
561(1)
Obesity and Urinary Incontinence
561(1)
Obesity and Faecal Incontinence
562(1)
Obesity and Prolapse
563(1)
Weight Loss and the Effects Upon Continence and Prolapse
563(1)
Continence and Prolapse Surgery in the Obese Woman
564(2)
Conclusion
566(1)
References
566(5)
41 Laparoscopic Surgery in Obese Women
571(12)
Christy Burden
Sanjay Vyas
Introduction
571(9)
Obesity
571(1)
Physiological Changes in the Obese Patient
572(1)
Benefits of Laparoscopic Surgery
572(1)
Laparoscopic Surgery and Obesity
573(1)
Morbid Obesity
574(1)
Alternatives
574(1)
Pre-Operative Preparation
575(1)
Anaesthesia in Obesity
576(1)
Patient Positioning
577(1)
Medication
578(1)
Laparoscopic Surgical Techniques
578(2)
Post-Operative
580(1)
Conclusion
580(1)
References
580(3)
Section 9 The Future Research and Health Service Planning
583
42 Obese Women and Quality of Life
585(12)
Rhona J. Mclnnes
Cindy M. Gray
Quality of Life
585(1)
Obesity and Quality of Life
585(1)
Physical Functioning
585(1)
Psychological Functioning
586(1)
Social Functioning
587(1)
Body Image
588(1)
Obesity and Quality of the Childbearing Experience
589(2)
Conclusion
591(1)
References
591(6)
43 Understanding Eating Behaviour and Lifestyle Issues in Women -- Implications for Obesity Development and Prevention
597(10)
Annie S. Anderson
Angela M. Craigie
Introduction
597(1)
Current Diet and Lifestyle Issues
597(2)
Socio-Cultural Influences on Eating and Lifestyle Behaviours
599(3)
Individual-level Influences
602(2)
Conclusion
604(1)
Acknowledgements
604(1)
References
604(3)
44 Planning for the Future: Maternity Services in 2035
607(16)
Amanda Jefferys
Tim Draycott
Tahir Mahmood
Planning for the Future: Maternity Services in 2035
607(1)
Projected Prevalence of Obesity in 2035
607(2)
Key Health Burdens of Obesity in Pregnancy
609(5)
Direct Health Burdens
609(5)
Indirect Health Burdens
614(1)
Current Model of Care
614(1)
Future Model of Care
614(5)
Pre-Conceptual Care
615(1)
Weight-Loss Strategies
615(1)
Antenatal Care
616(1)
Weight Management During Pregnancy
617(1)
Risk Management
617(1)
Previous Gastric Banding
617(1)
Intrapartum Care
617(1)
Post-Natal Care
618(1)
How Can We Deliver this Care?
619(1)
Predicted New Service Delivery Model
619(1)
Health Service Planning Assumptions and Inpatient Beds Requirements
619(1)
Research Needed to Inform Future Planning
620(1)
Summary
620(1)
References
620(3)
45 Providing Infertility Services for Obese Women
623(14)
Sarah McRobbie
Abha Maheshwari
Introduction
623(1)
What Is the Current Situation?
623(1)
Evidence for BMI Restriction to Fertility Services and Not Providing Service
624(1)
What Is the Need?
624(1)
What Are the Potential Barriers?
624(1)
Awareness of the Problem Both by Patients and Clinics
624(1)
Focusing on Short-Term Gain
625(1)
Limited Advice
625(1)
Limitation of Resources
625(1)
Generalised Rather than Individualised Approach
625(1)
What Can We Offer?
625(7)
Individualised Care
626(1)
Education and Awareness
626(1)
Preconception Counselling
626(3)
Multidisciplinary Approach
629(1)
Group Therapy
629(1)
Pharmacotherapy
629(1)
Bariatric Surgery
630(1)
Follow-Up/Support from the Clinic
631(1)
How Much Weight Do You Need to Lose?
632(1)
Maintenance of Weight Loss
632(1)
Cost-Effectiveness of Weight-Loss Strategies
633(1)
How Can We Improve the Services and Promote Weight Loss?
633(1)
Conclusions
634(1)
References
634(3)
46 Summary and Research Recommendations
637
Tahir Mahmood
Sabaratnam Arulkumaran
Introduction
637(16)
Environmental, Genetic and Psychological Factors
637(2)
Sexual Health
639(1)
Reproduction
639(1)
Male Reproduction
640(1)
Impact of Pre-Pregnancy Obesity
641(1)
Issues Related to Pregnancy
641(2)
Gestational Diabetes and Metabolic Syndrome
643(2)
Intrapartum Care and Pregnancy Outcome
645(2)
Interventions to Improve Care of Women During Pregnancy
647(2)
Long-Term Impact of Obesity
649(1)
Obesity and Gynaecology
650(1)
Health Service Planning
651(2)
Research Agenda
653(3)
Sexual Health and Fertility
654(1)
Infertility
654(1)
Pregnancy Care
654(1)
Intrapartum Care
655(1)
Gynaecological Disorders
655(1)
The Future Service Planning
656(1)
References
656
Tahir Mahmood, CBE, MD, FRCPI, FFRSH, MBA, FACOG, FRCPE, FEBCOG, FRCOG Consultant Gynecologist and Clinical Director Women , Children and Clinical Services Directorate , Victoria Hospital, NHS Fife, Kirkcaldy, Scotland, UK Past Vice-President Standards, Royal College of Obstetricians and Gynecologists (2007-2010); President, European Board and College of Obstetrics and Gynecology (EBCOG, 2014-2017); Past President of Edinburgh Obstetrical Society ( 2012-2014); Past President of the Northern Obstetrical and Gynaecological Society of Scotland ( 1999-2011), National Lead for Heavy Menstrual Bleeding Audit in England and Wales (2010-2015), FIGO Hyperglycaemia in Pregnancy Working Group ( 2014-2016); and is currently International UNFPA Consultant for EECA Region, Chair of EBCOG Standards of Care and Position Statements Group, and Life Trustee Lindsay Stewart R&D Foundation of the Royal College of Obstetrician and Gynaecologists. In the recent past, he has held honorary senior Clinical Lectureships at the Universities of Edinburgh, Dundee and St. Andrews in Scotland. He has edited 10 manuscripts and has published more than 200 research papers and chapters. He was appointed as Commander of the order of the British Empire (CBE) in the New Years honours list (2012) by Her Majesty Queen Elizabeth, the 2nd Sir Sabaratnam Arulkumaran, PhD, DSc, FRCOG, FRCS, FACOG, Emeritus Professor of Obstetrics and Gynaecology (O&G) of St. Georges University, London; Foundation Professor of O&G, University of Nicosia, Visiting Professor, Institute of Global Health Innovation, Imperial College, London; Past President of the Royal College of Obstetricians and Gynaecologists (2007-2010); President: International Federation of Obstetrics & Gynaecology (FIGO) 2012-2015; Head, Dept. of Obstetrics & Gynaecology, St Georges University Hospital, London, UK (1997-2013). National award recipient of Knight Bachelor in the UK and Sri Lanka Ranjana in Sri Lanka for services to Medicine.
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