Obesity, O&G and RiskObesity, O&G and Risk
Diana Hamilton-FairleyDiana Hamilton-FairleyConsultant Obstetrician and GynaecologistConsultant Obstetrician and Gynaecologist
Guys and St. Thomas’ NHS Foundation TrustGuys and St. Thomas’ NHS Foundation Trust
AimsAims
Obesity is a public health issueObesity is a public health issue Impact of obesity on women’s healthImpact of obesity on women’s health Weight loss does make a differenceWeight loss does make a difference Clinicians have a powerful role to playClinicians have a powerful role to play
Health RisksHealth Risks
Which of these is the greatest risk to health?
RiskRisk
The possibility of The possibility of suffering harm or loss; suffering harm or loss; danger. danger.
A factor, thing, element, A factor, thing, element, or course involving or course involving uncertain danger; uncertain danger;
The danger or probability The danger or probability of loss to an insurer. of loss to an insurer.
One considered with One considered with respect to the possibility respect to the possibility of loss: of loss: a poor risk.a poor risk.
The EpidemicThe Epidemic
““Child obesity has Child obesity has doubled in a decade”doubled in a decade”
21% increased risk of 21% increased risk of cancer in girlscancer in girls
Double the risk of Double the risk of dying before 50dying before 50
0
5
10
15
20
25
30
1995 2004
GirlsBoysAdults
Reproductive Years – Obesity, Reproductive Years – Obesity, Hirsutism and MenstruationHirsutism and Menstruation
0
10
20
30
40
50
60
70
80
Hirsutism Regular Oligo Amen
Lean
Obese
P<0.01 P<0.01
%
PCOS
ImplicationsImplications
AnovulationAnovulation MenorrhagiaMenorrhagia Endometrial HyperplasiaEndometrial Hyperplasia AnaemiaAnaemia
Hirsutism / AcneHirsutism / Acne Psychological impactPsychological impact
Obesity and Ovulation inductionObesity and Ovulation induction
0
10
20
30
40
50
60
70
80
90
Ovulation Pregnant Miscarriage
Lean
Obese
P<0.02 NS P<0.01
Obesity and MiscarriageObesity and Miscarriage
Risk of miscarriage before a live birth in Risk of miscarriage before a live birth in 13,123 consecutive pregnancies13,123 consecutive pregnancies
BMI
19-25
25-29
>29
1
1.42
2.06
Reproductive Years Reproductive Years Pregnancy - Pregnancy - Gestational DiabetesGestational Diabetes
96 801 Nulliparous women96 801 Nulliparous womenPrepregnancy weightPrepregnancy weight
Baeton et al.2001 Am J Pub Health 91;436 - 439
BMI
19-25 (71.7%)
25-29.9 (18.2%)
>30 (10.1%)
1
2.4
5.2
Pre-eclampsia and EclampsiaPre-eclampsia and Eclampsia
BMI
19-25
25-29.9
>30
1
2.0
3.3
Baeton et al.2001 Am J Pub Health 91;436 - 439
Delivery at <32 weeksDelivery at <32 weeks
BMI
19-25
25-29.9
>30
1
1.3
1.5
Baeton et al.2001 Am J Pub Health 91;436 - 439
Caesarean DeliveryCaesarean Delivery
BMI
19-25
25-29.9
>30
1
1.8
2.7
Baeton et al.2001 Am J Pub Health 91;436 - 439
Other increased risks in Other increased risks in pregnancypregnancy
Congenital abnormalityCongenital abnormality 3 fold3 fold ThromboembolismThromboembolism 12 fold12 fold Failed Trial of LabourFailed Trial of Labour 87% vs 20-87% vs 20-
40%40%
Shoulder Dystocia and neonatal Shoulder Dystocia and neonatal injuryinjury
BMI > 30kg/m2
Second stage >20 mins Birthweight > 4.5kg
Mehta et al. 2006 J Perinatology 26;85-8
Infant DeathInfant Death
BMI
19-25
25-29.9
>30
1
1.5
2.0
Baeton et al.2001 Am J Pub Health 91;436 - 439
Mean maternal glucose concentrations and infant Mean maternal glucose concentrations and infant mortalitymortality
Obese ParentsObese Parents
Increase the risk of obese childrenIncrease the risk of obese children– Increased risk of early onset Type 2 DMIncreased risk of early onset Type 2 DM– Increased risk of metabolic syndromeIncreased risk of metabolic syndrome
Glucose intolerance, raised VLDL, Decreased HDL, Glucose intolerance, raised VLDL, Decreased HDL, Hypertension, Increased risk for cardiovascular Hypertension, Increased risk for cardiovascular diseasedisease
– Increased risk of cancerIncreased risk of cancer
Increased risk of dying before children reach Increased risk of dying before children reach adulthoodadulthood
Disease for which Obesity is a Disease for which Obesity is a risk factorrisk factor
DiseaseDisease RiskRisk Risk in PCOSRisk in PCOS
DiabetesDiabetes 3.83.8 5 fold5 fold
Cardiovascular Cardiovascular diseasedisease
2.12.1
Stroke > IHDStroke > IHD
0.7 (NS)0.7 (NS)
HypertensionHypertension 5.65.6
Endometrial Endometrial CancerCancer
3 – 10 fold3 – 10 fold DependsDepends
Risk factors in endometrial cancerRisk factors in endometrial cancer
RiskRisk Fold riskFold risk
ObesityObesity 3 - 103 - 10
NulliparityNulliparity 22**
Late MenopauseLate Menopause 2.42.4**
““bloody bloody menopause”menopause”
44**
DiabetesDiabetes 2.82.8**
HypertensionHypertension 1.51.5**
Unopposed E2Unopposed E2 9.5 9.5
Complex Complex HyperplasiaHyperplasia
2929**
Risk of SurgeryRisk of Surgery
Obesity increases your risk of needing a Obesity increases your risk of needing a HysterectomyHysterectomy– Infection 15.3% vs 11.3% (p<0.01)Infection 15.3% vs 11.3% (p<0.01)– Bleeding no differenceBleeding no difference– Increased duration of surgeryIncreased duration of surgery– Increased LOSIncreased LOS
Manual Handling Manual Handling Surgical difficultySurgical difficulty
Weight lossWeight loss
Obesity and PCOSObesity and PCOS
0
10
20
30
40
50
60
70
80
90
Menses Fertility Hirsutism
>5%
<5%
Does weight loss treat symptoms?Does weight loss treat symptoms?
Does weight loss improve Does weight loss improve outcomeoutcome
In pregnancy reduces In pregnancy reduces Congenital abnormalityCongenital abnormality MiscarriageMiscarriage GDM, macrosomiaGDM, macrosomia Pre-eclampsiaPre-eclampsia PrematurityPrematurity Caesarean sectionCaesarean section
PostpartumPostpartum Type 2 DMType 2 DM HypertensionHypertension Cancer (Endometrial)Cancer (Endometrial)
Treatment algorithm for obesityTreatment algorithm for obesity
What is our role?What is our role? Young fit women - INFORMATIONYoung fit women - INFORMATION Actively treat obesity in gynaecology and Actively treat obesity in gynaecology and
subfertility clinicssubfertility clinics Pre-conception obesity clinicsPre-conception obesity clinics Pregnancy advice on weight gainPregnancy advice on weight gain Postpartum follow-up and supportPostpartum follow-up and support
Obesity is a Public Health Obesity is a Public Health IssueIssue
We all have a role to play in We all have a role to play in reducing the risksreducing the risks
Top Related