Derek Ebot-Akoachere, Mercer University College of Pharmacy
According to the United States Surgeon General, the Centers for Disease Control and Prevention, and the National Institutes of Health, obesity is a health issue of nationwide epidemic proportions,  Almost one-third of women of childbearing age are considered obese , and obesity is associated with many pregnancy complications including congenital malformations (CMF).  The relationship between obesity in pregnancy and CMF has been investigated, but there is little data associating increasing severity of obesity and CMF.
|Risk of major congenital malformations in relation to maternal overweight and obesity severity |
|Design||Population based cohort; N= 1,243,957|
|Objective||To estimate the risks of major congenital malformations in the offspring of mothers who are underweight, overweight, or obese in classes I, II or III compared with normal weight mothers in early pregnancy|
|Study Groups||Underweight (n= 29,864); normal weight (n= 756,432); overweight (n= 311,339); obese I (n= 103,085); obese II (n= 31,883); obese III (n= 11,354)|
|Methods||Singleton births in Sweden from 2001 to 2014 were included.
The following were excluded: multiple births, stillbirths, lack of valid personal identification from the mother and infant, infants with chromosomal aberrations, genetic and malformation syndromes with known causes. Weight categories were classified as follows: underweight (BMI <18.5), normal weight (BMI 18.5 to <25), overweight (BMI 25 to <30), obese I (BMI 30 to <35), obese II (BMI 35 to <40), and obese III (BMI ≥40).
|Duration||14 years (2001-2014)|
|Primary Outcome Measure||Presence of any major congenital malformations in liveborn infants|
|Adverse Events||Common Adverse Events: N/A|
|Serious Adverse Events: N/A|
|Percentage that Discontinued due to Adverse Events: N/A|
|Study Author Conclusions||The risks of major congenital malformations in offspring progressively increase with maternal overweight and severity of obesity.|
Organogenesis occurs within the first eight weeks of gestation. Since preventive effects of weight reduction in early pregnancy cannot be expected past this time, efforts should be made to encourage women of reproductive age to adopt a healthy lifestyle and obtain a normal body weight before conception. The study was restricted to live births, which excludes malformations ending in miscarriage or stillbirth. Maternal height used to calculate BMI was self-reported, which may introduce some degree of recall bias. In the midst of a nationwide obesity epidemic, inspiring patients to improve diet and physical activity before conception may decrease the risk of pregnancy complications, benefiting both mother and child.
 Office of the Surgeon General (US); Office of Disease Prevention and Health Promotion (US); Centers for Disease Control and Prevention (US); National Institutes of Health (US). The Surgeon General’s Call To Action To Prevent and Decrease Overweight and Obesity. Rockville (MD): Office of the Surgeon General (US); 2001. Available at: https://www.ncbi.nlm.nih.gov/books/NBK44206/. Accessed: July 6, 2017
 Ogden CL, Carroll MD, Mcdowell MA, Flegal KM. Obesity among adults in the United States–no statistically significant change since 2003-2004. NCHS Data Brief. 2007;(1):1-8.
 Scialli AR. Teratology Public Affairs Committee position paper: maternal obesity and pregnancy. Birth Defects Res Part A Clin Mol Teratol. 2006;76(2):73-7.
 Persson M, Cnattingius S, Villamor E, et al. Risk of major congenital malformations in relation to maternal overweight and obesity severity: cohort study of 1.2 million singletons. BMJ. 2017;357:j2563.