1. Wisconsin Womens HealthFoundations 2012 Dialogue Chanel T. Tyler, MD Assistant Professor University of Wisconsin School of MedicineDepartment of Obstetrics and Gynecology Division of Maternal Fetal Medicine

2. 23 Million (1/3 of )adult women in the UnitedStates are obese Non-Hispanic black women 49% Mexican-American women 38% Non-Hispanic white women 31% 18% of obstetric causes of maternal deathrelated to obesity 80% of anesthesia-related maternal mortalityrelated to obesity 3. Women of Childbearing Age Percent Overweight or ObeseFlegal KM, et al. Prevalence and trends in obesity among US adults, 1999-2008.JAMA 2010;303:235-41. 4. Increased risk of gestational diabetes Primarily related to an exaggeratedincrease in insulin resistance in the obesestate Women who are obese during pregnancyand develop gestational diabetes have a2-fold increased prevalence ofsubsequent type2 diabetes Increased risk of gestationalhypertension 5. Increased risk of preeclampsia Among the morbidly obese this is almost 5-fold Prevalence of LGA infants is almost 4 times as highamong the morbidly obese than those with normalBMI. Increased risk of having SGA infant, however afteradjusting for preeclampsia the risk is no longerstatistically significant. Increased risk of antepartum stillbirths Almost 3-fold (Cedergren et al) 6. Additional Risks Puerperium deep venous thrombosis Endomyometritis Postpartum hemorrhage Prolonged hospitalizations Wound infections Dehiscence 7. Waller et al Found in a population-based controlstudy that for every incremental unitincrease (kg/m2) in BMI, the risk ofNTD increased by 7% 8. Wolfe et alHeart 50.5%BMI VisualizationUmbilical25.8%Less thancord 10th %90.2%Diaphragm 17% 97.5th % 63%Kidneys10% 9. Risk of Induction Increased risk of post-term pregnancy Subsequently there is an increasedincidence of labor induction estimatedto be between 1.7-2.2 fold. 10. Weiss et al 2004 Increased risk of operative delivery Instrumental delivery increased by 18% inwomen with BMI 35.1-40 Increased 34% in women with BMI >40 Cesarean delivery more common:47.4% compared to control patients20.7% 11. VBAC The success rate for VBAC in themassively obese patient has beenfound to be just 15% More than 50% of these VBACattempts are complicated by infectiousmorbidity Jordan h. Perlow Obstetric Intensive Care Manual second edition 2004 12. Operative Risks Increased operative times Found in the morbidly obese compared tonormal and obese women (p