Obesity is associated with multiple adverse reproductive outcomes such as infertility, ovulation dysfunction, miscarriage, preeclampsia, gestational diabetes mellitus, preterm delivery, operative delivery, and fetal growth disorders. Although the prevalence of maternal obesity is increasing, it is unclear which method of weight loss is most effective before conception to improve reproductive outcomes. This article reviews the amount of weight loss needed to improve ovulation and fertility, behavioral methods for optimal weight loss, as well as medical and surgical interventions to promote weight loss with the intention of providing a tool to promote weight loss in the preconception period. Behavioral modification that includes motivational interviewing, energy intake restriction, and increased energy expenditure is first-line therapy. Behavioral therapy has been shown to improve menstrual cyclicity, ovulation, conception rates, hormone profile, and amount of weight loss. Bariatric surgery and drug therapy may be used in overweight or obese patients who fail behavioral modification. However, women who undergo bariatric surgery or drug therapy must be cautioned about safety profiles, nutritional requirements, and some adverse pregnancy outcomes such as intrauterine growth restriction. There are several areas for further investigation including amount of weight loss needed to resume ovulation by obesity class and improve reproductive outcomes, safety and efficacy of very low energy diets in the preconception period, as well as safety of obesity medications in the preconception period.
Obstetricians and gynecologists, family physicians
After completing this CME activity, physicians should be better able to identify adverse reproductive outcomes associated with maternal obesity as well as evaluate weight loss strategies used to improve reproductive outcomes in obese patients and the pros and cons associated with each strategy.