Abstract
Obese women with metabolic syndrome are at increased risk for cardio-thrombo-metabolic dysfunction that leads to pregnancy-related venous thromboembolism (VTE), hypertensive disorders of pregnancy (HDP), and gestational diabetes mellitus (GDM). Indeed, maternal death secondary to a pregnancy-related VTE has an enormous impact on the childbearing population. Recent research has provided evidence that elucidates the pathogenesis of adverse outcomes in obese pregnant women with metabolic syndrome. The chronic inflammation elicited by dysregulated infiltration of macrophages into adipose tissue and increased thrombin generation by inflammatory cytokines with activation of the tissue factor pathway may play important roles in the pathogenesis; however, a simple question has yet to be answered. Specifically, “why does prepregnancy obesity increase the risk of pregnancy-related VTE in association with a high estrogenic and prothrombogenic state?” The present review of the extant literature has focused on further understanding obesity-related adverse outcomes in pregnancy by elucidating the underlying pathogenesis of metabolic syndrome.
Reference91 articles.
1. Hibbard JU, Gilbert S, Landon MB, Hauth JC, Leveno KJ, Spong CY, et al. Trial of labor or repeat cesarean delivery in women with morbid obesity and previous cesarean delivery. Obstetrics and Gynecology. 2006;108:125-133. DOI: 10.1097/01.AOG.0000223871.69852.31
2. Heit JA, Spencer FA, White RH. The epidemiology of venous thromboembolism. Journal of Thrombosis and Thrombolysis. 2016;41:3-14. DOI: 10.1007/s11239-015-1311-6
3. Butwick AJ, Abreo A, Bateman BT, Lee HC, El-Sayed YY, Stephansson O, et al. Effect of maternal body mass index on postpartum hemorrhage. Anesthesiology. 2018;128:774-783. DOI: 10.1097/ALN.0000000000002082
4. Anderson NH, LM MC, Fyfe EM, Chan EH, Taylor RS, Stewart AW, et al. The impact of maternal body mass index on the phenotype of pre-eclampsia: A prospective cohort study. BJOG. 2012;119:589-595. DOI: 10.1111/j.1471-0528.2012.03278.x
5. Gasse C, Boutin A, et al. Body mass index and the risk of hypertensive disorders of pregnancy: The great obstetrical syndromes (GOS) study. The Journal of Maternal-Fetal & Neonatal Medicine. 2017;13:1-6