Preconception and Pregnancy in Women with Obesity, Postbariatric Surgery, and Polycystic Ovarian Syndrome

The increasing prevalence of maternal obesity around the world has significant implications for the short- and long-term health outcomes of both mother and child. This public health crisis requires a multidisciplinary effort to begin to address the complex and far-reaching impacts. There is a critical need for health-care providers to understand how to care for pregnant patients who are obese in order to optimize outcomes during the pregnancy and positively influence subsequent pregnancies and the future health of the offspring. Even more important, everyone—from front-line providers to leaders to researchers to leaders of health-care systems—must be familiar with the evidence for preventive interventions that are most effective. This chapter focuses on the role of the clinician in caring for the obese gravida but highlights important gaps that need to be filled by basic and clinical science and health services research. Because many women with polycystic ovarian syndrome also have an elevated body mass index, this chapter also includes a special section addressing the issues unique to PCOS in pregnancy, in both obese and normal-weight women.