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Obesity in Pregnancy: Epidemiology, Mechanisms, Nutritional and Metabolic Management

The global epidemic of obesity is widely acknowledged as a serious challenge to improvement of global health and sustainable development goals. Women of reproductive age are particularly affected globally, with high prevalences and ongoing increases in the prevalence of obesity. Women in low- and middle-income countries are at great risk due to resource constraints and are also subject to the potential "dual burden" of prevalent undernutrition in the face of increasing obesity. This article reviews current evidence regarding the epidemiology of pregnancy obesity, with particular regard to its links with hyperglycemia in pregnancy and the relative individual- and population-level impacts of these conditions. We then consider the underlying pathophysiologic mechanisms by which obesity is related to adverse pregnancy outcomes. We proceed to review the evidence regarding the role of dietary, lifestyle, and more comprehensive measures in treating obesity in women of reproductive age, highlighting the limited efficacy of current, traditional "diet and/or exercise" approaches. We then conclude with an overview of the potential role of pharmacotherapy and bariatric surgery in this area.