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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 ca… Read more
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Immediately download your ebook while waiting for your print delivery. No promo code needed.
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.
This book would be of interest to researchers in obesity and fertility as well as gynecologists, anaesthetists, family doctors and healthcare planners
Foreword
About the Editors
Contributors
Section 1: Epidemiology
1. Worldwide Epidemic of Obesity
Introduction
Definitions of Overweight and Obesity
The Extent of the Problem
Temporal Trends
Factors Associated with Overweight and Obesity
Disease Burden and Impact on Health and Economy
International Response to the Epidemic
Conclusions
References
2. Social and Ethnic Determinants of Obesity
Introduction
Ethnic Factors
Social Factors
Dietary Factors
Conclusion
References
3. Genetic and Molecular Basis of Obesity
Introduction
Hereditary Factors Influencing BMI
Genetic–Molecular Interaction of Obesity
Regulation of Energy Balance – Molecular Basis
Regulation of Food Energy Intake
The Role of Hypothalamus
The Role of Leptin
Melanocortin Signalling Pathway
Control of Energy Expenditure
Adipogenesis
Interactions Among Social, Environmental, Genetic and Behavioural Factors in Obesity
Conclusion
References
4. The Psychological Basis of Obesity
Introduction
Eating Behaviour
Early Attachment and Trauma
Emotion Regulation
Personality Traits
Depression and Anxiety
Cognitive Factors
Summary
Acknowledgements
References
5. Obesity in Adolescence
Introduction
Prevalence of Childhood Obesity: A Global Perspective
Obesity and the Pubertal Transition
Factors Affecting Childhood and Adolescent Obesity
Adolescent Obesity – Adverse Outcomes
Polycystic Ovarian Syndrome in Adolescence
Obstetric Outcomes in Obese Adolescents
Management Principles
Management of PCOS in Adolescence
Conclusion
References
Section 2: Obesity and Reproduction
6. Obesity and Contraception
Introduction
Risks of Obesity in Pregnancy
Classification of Obesity Based on Body Mass Index
Potential Concerns with Obesity and Contraception
Obesity and Contraceptive Efficacy
Conclusion
References
7. Sexual Health and Obesity
Introduction
Obesity and Sexual Behaviour
Obesity and Sexual Dysfunction
Obesity and Sexual Health Outcomes
Conclusion
References
8. Obesity in PCOS and Infertility
Introduction
Obesity and Infertility – Possible Mechanisms
Impact of Obesity on Infertility Treatment
References
9. Obesity and Recurrent Miscarriage
Introduction
Obesity and Miscarriage
Obesity and Recurrent Miscarriage
Metabolic Effects of Obesity on Ovary
Endometrial Changes in Obesity
Management
Conclusion
References
10. Obesity and Assisted Reproduction
Introduction
Prevalence of Obesity in the Assisted Reproduction Sector
Evidence of Reduced Fertility in Obese Women
Specific Issues Relating to Art
Rationale for the Use of Assisted Reproduction
Practical Management of Obese Women Undertaking Art
Clinical Procedures
Effect of Obesity on the Results of Art
Safety Issues for Mothers and Offspring
Ethical Issues Relevant to Access to Services
Conclusion
References
Section 3: Obesity and Male Reproduction
11. Obesity and Sexual Dysfunction in Men
Physiology of Sexual Function
Sexual Dysfunction and Obesity-Related Co-morbidities
Evaluation
Treatment
Summary
References
12. Male Obesity – Impact on Semen Quality
Background
Impact on Semen Quality
Aetiological Theories
Treatment
Conclusions
References
13. Obesity, Bariatric Surgery and Male Reproductive Function
Introduction
Bariatric Surgical Techniques
Pathophysiology of the Hypothalamic–Pituitary–Gonadal Axis in Obesity
Summary and Practical Considerations
References
Section 4: Pregnancy and Obesity
14. Maternal Obesity and Developmental Priming of Risk of Later Disease
Introduction
Epidemiological Observations on Maternal Obesity, Macrosomia and Neonatal Adiposity
Maternal Obesity and Childhood Obesity
Maternal Pregnancy Weight Gain and Childhood Obesity
Maternal Diabetes, GDM and Glucose Effects
Relationship Between Maternal Hyperglycaemia and Neonatal Adiposity
Maternal Hyperglycaemia and Childhood Obesity
GDM and Cardiometabolic Diseases in the Offspring
Maternal Insulin Resistance, Hyperinsulinaemia and Foetal Growth
Glucose Metabolism and Foetal Growth
Maternal Lipid Supply and Foetal Growth
Effects on Vascular Function
Animal Models Using Maternal Obesity
Neurohormonal Changes
Placenta, Foetal Priming and Foetal Development
Epigenetics as the Unifying Mechanism in Foetal Priming of NCD Risk
Implications for Public Health Intervention
Acknowledgements
References
15. Foetal Ultrasound in Obese Pregnancy
Introduction
Excess Foetal Risks Associated with Obesity
Ultrasound Assessment in Obesity
Conclusion
References
16. Obesity and Prolonged Pregnancy
Introduction
Prolonged Pregnancy
Conclusion
References
17. Obesity and Venous Thromboembolism
Introduction
Epidemiology, Prevalence and Trends
Possible Underlying Mechanisms
Prevention of VTE in Obese Women During Pregnancy
Investigation and Diagnosis of VTE in the Obese Pregnant Woman
Treatment of VTE in the Obese Pregnant Woman
Conclusion
References
18. Obesity and pre-eclampsia
Definitions
Blood Pressure Measurement
Urine Testing
Changing Incidence of Obesity
Does Obesity Predispose to Pre-Eclampsia?
Adipokines
Is ‘Pre-Eclampsia’ in the Obese Pregnant Women Really Underlying Chronic (Essential) Hypertension?
Final Considerations
References
19. Obesity, Insulin Resistance and Placental Dysfunction – Foetal Growth
Introduction
Obesity and the Endocrine Environment
Placenta and Insulin Resistance
Placental Size
Placental Transporter System
Placenta and Inflammatory Response
Prothrombotic State
Diabetes and the Placenta
The Intrauterine Growth-Restricted Foetus
Conclusions
References
Section 5: Obesity and Gestational Diabetes
20. Screening for Gestational Diabetes
Introduction
Overweight as a Risk Factor for GDM
Pathophysiology
Diagnosis of GDM
Treatment of GDM
Implications Related to GDM
References
21. Obesity and Metabolic Disorders During Pregnancy and Pregnancy Outcome
Introduction
Obesity and Gestational Diabetes
Impact of Obesity and/or Diabetes During Pregnancy on the Offspring
Interventions
Conclusions
References
22. Obesity, Polycystic Ovaries and Impaired Reproductive Outcome
Introduction
Obesity and Reproductive Health
Pathogenic Mechanisms
Polycystic Ovary Syndrome
Obesity in Pregnancy
Gestational Weight Gain in Obese Women
Guidelines for Management for Obese Women of Reproductive Age
Management of Obesity in Pregnancy
References
23. Pregnancy and Metabolic Syndrome of Obesity
Introduction
Lipid Metabolism and Fat Deposition in Lean Pregnancy
Lipid Metabolism and Fat Deposition in Obese Women
Glucose Metabolism in Lean and Obese Pregnancy
Adiposity, Obesity and IR: Potential Mechanisms
Amino Acid Metabolism in Lean and Obese Pregnancy
Pre-eclampsia, Obesity and Metabolic Syndrome of Pregnancy
Intervention Strategies in Maternal Obesity and Effects on Metabolism
Conclusion
References
Section 6: Obesity and Labour
24. Induction of Labour in Obese Women
Background
Indications for Induction of Labour
Women with a Previous Caesarean Section
Assessment Prior to Induction of Labour
Methods of Inducing Labour
Foetal Well-Being
Summary
References
25. Challenges of Intrapartum Care in Obese Women
Introduction
Preterm and Post-term Pregnancy
Induction of Labour
Place of Delivery
Equipment Required
Labour and Intrapartum Monitoring
Labour Dystocia
Caesarean Section in the Obese Woman
Macrosomia and Shoulder dystocia
Post-partum Care
Perinatal Morbidity
Risks in Subsequent Pregnancy
Conclusion
References
26. The Role of the Midwife During Pregnancy, Labour and Post-partum
The Role of the Midwife in Pregnancy
Specialist Clinics for Women with a BMI≥30kg/m2
The Role of the Midwife in Labour
The Role of the Midwife in the Post-partum Period
Conclusion
References
27. Anaesthetic Issues During Labour
Introduction
Conclusion
References
28. Maternal Obesity and the Risk of Stillbirth
Background
Epidemiology
Pathophysiology
Direct Risk Factors
Indirect Risk Factors
Management
References
29. Obesity, Diabetes, Placental Pathology and Foetal Malformations
Introduction
Obesity, Diabetes and the Umbilical Cord Coiling
Obesity, Diabetes and the Placenta
Obesity and Other Placental Changes
Obesity, Diabetes and Foetal Pathology
Conclusion
References
30. Post-Natal Care for the Recently Delivered Obese Women
Introduction
Background
Implications of Obesity for Planning of Post-Natal Care
Post-Natal Morbidity
Severe Maternal Morbidity as an Indicator of Quality of Maternity Care
Planning Post-Natal Care
Current Guidance to Inform the Content and Timing of Post-Natal Care
References
Section 7: Interventions to Improve Care of Women During Pregnancy
31. Anti-Obesity Drugs for Obese Women Planning Pregnancy
Introduction
Classification of Anti-Obesity Drugs
Drugs for Weight Reduction in Reproductive-Age Women: Pharmacology and Clinical Efficacy
Pharmacological Anti-Obesity Treatment in Women Contemplating Pregnancy
Concluding Remarks
References
32. Anti-Obesity Surgery for Women Planning Pregnancy?
Introduction and Background
The Global Obesity Epidemic
Obesity and Reproductive Function
The Effects of Obesity on Pregnancy
Bariatric Surgery: Overview and Indications
The Surgical Options
Pre-Operative Assessment for Bariatric Surgery
Special Considerations in a Post-Bariatric Patient
Role of Bariatric Surgery to Treat Obesity-Related Female Reproductive Abnormalities
Conclusion
References
33. Evidence-Based Approach to the Management of Obese Pregnant Women
Background
Pre-Pregnancy Weight Management
Weight Management Interventions in Pregnancy
Nutritional Supplementation for Obese Women in Pregnancy
Prophylaxis for Pre-eclampsia and Thromboembolism
Screening for Gestational Diabetes
Public Health Measures on Obesity
Recommendations for Clinical Practice
Recommendations for Research
References
34. Multimodal Framework for Reducing Obesity-Related Maternal Morbidity and Mortality
Introduction
Obesity in Women of Reproductive Age
Obesity-Related Maternal Mortality
Obesity-Related Maternal Morbidity
The Concept of a Multimodal Framework
Primary Prevention of Obesity-Related Maternal Mortality and Morbidity
Secondary Prevention of Obesity-Related Maternal Mortality and Morbidity
Tertiary Prevention of Obesity-Related Maternal Mortality and Morbidity
Conclusion
References
35. Developing Standards of Care for Obese Women During Pregnancy
Introduction
What Is a Standard in Health Care?
How to Develop Standards
What Measures Should be Used When Defining Standards of Care?
The Obesity Epidemic
Pre-Pregnancy Care
Early Pregnancy Care
Aspects of Care During Pregnancy
Post-Natal Care
Organisation
References
Section 8: Long-Term Impact of Obesity
36. Maternal Obesity – The Road to Diabetes and Cardiovascular Risk
Introduction
The Link Between Maternal Obesity and Offspring Obesity, Diabetes and Cardiovascular Risk – Hypotheses and Possible Mechanisms
Conclusions
References
37. Obesity and Female Malignancies
Introduction
Epidemiology
Mechanisms Relating Obesity to Female Malignancies Risks
Effect of Obesity on Management of Female Malignancies
Future Directions
References
38. Obesity and Menstrual Disorders
Obesity: The Problem
Obesity and Abnormal Uterine Bleeding
Polyps
Malignancy and Hyperplasia
Ovulatory Dysfunction
The Endometrium
Polycystic Ovary Syndrome
Obesity in the Absence of PCOS
Summary
Acknowledgements
References
39. Developing HRT Prescribing in Obese Women
Introduction
Effect of Menopause on Metabolic Factors
Managing Menopausal Symptoms in Obese Women
Alternatives to HRT
Conclusion
References
40. Incontinence and Prolapse in the Obese Woman
Introduction
Incidence and Prevalence
Normal Bladder Function and Causes of Incontinence in Women
Obesity and Urinary Incontinence
Obesity and Faecal Incontinence
Obesity and Prolapse
Weight Loss and the Effects Upon Continence and Prolapse
Continence and Prolapse Surgery in the Obese Woman
Conclusion
References
41. Laparoscopic Surgery in Obese Women
Introduction
Conclusion
References
Section 9: The Future Research and Health Service Planning
42. Obese Women and Quality of Life
Quality of Life
Obesity and Quality of Life
Physical Functioning
Psychological Functioning
Social Functioning
Body Image
Obesity and Quality of the Childbearing Experience
Conclusion
References
43. Understanding Eating Behaviour and Lifestyle Issues in Women – Implications for Obesity Development and Prevention
Introduction
Current Diet and Lifestyle Issues
Socio-Cultural Influences on Eating and Lifestyle Behaviours
Individual-level Influences
Conclusion
Acknowledgements
References
44. Planning for the Future: Maternity Services in 2035
Planning for the Future: Maternity Services in 2035
Projected Prevalence of Obesity in 2035
Key Health Burdens of Obesity in Pregnancy
Current Model of Care
Future Model of Care
How Can We Deliver this Care?
Research Needed to Inform Future Planning
Summary
References
45. Providing Infertility Services for Obese Women
Introduction
What Is the Current Situation?
Evidence for BMI Restriction to Fertility Services and Not Providing Service
What Is the Need?
What Are the Potential Barriers?
What Can We Offer?
Maintenance of Weight Loss
Cost-Effectiveness of Weight-Loss Strategies
How Can We Improve the Services and Promote Weight Loss?
Conclusions
References
46. Summary and Research Recommendations
Introduction
Research Agenda
References
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