Obesity: Insight into Problems with Reproduction and Beyond
Reproduction, the enigma and mystery of human race, bears the burden of increased weight like all other system but this is more significant for us as it directly has on adverse effect on the future generations. Obesity which has reached epidemic proportions is observed to be higher among women than men. It affects all stages of a woman life.The impact of obesity on reproductive function can be attributed primarily to endocrine mechanism. Let us understand how obesity changes the endocrine milieu making it unfavorable for reproduction.
Abdominal obesity is associated with high levels of insulin. Chronic hyperinsulinemia causes increased ovarian androgen production, increased LH secretion from pituitary and decreased sex hormone binding globulin (SHBG) production leading to increase in free circulating androgens. Fat tissue aromatises these androgens to estrogen leading to a chronic hyper estrogenic environment. Increased leptin and other inflammatory factors from adipocytes inhibit follicular development.
The imbalance in estrogens and androgens cause irregular ovulation or anovulation. Obesity accounts for infertility in 15-20% of infertile patients. Also due to poor quality of ova can lead to sub fertility. Obese patients require higher doses of drugs, prolonged treatment and still do not respond to fertility treatments satisfactorily.
Obesity has ill effects on male reproductive function as well. In obese men, more androgens are converted to estrogens in peripheral fat. Increased estrogens further inhibit gonadotropin secretion leading to decreased sex hormone.
Even if she completes her pregnancy uneventfully, an obese mother causes the infant to have increased degree of adipocytes predisposing the baby for childhood obesity. The abnormal milieu to which the child was exposed to in utero leads to metabolic diseases in children born to obese mother earlier in life. Various studies have shown the association of childhood obesity and earlier onset diabetes and cardiovascular diseases to maternal obesity.
Stringent anti-obesity measures need to be implemented in women, due to detrimental effects of obesity on pregnancy and trans generational outcomes. The prevention or treatment of obesity needs to be done before conception.
Even a 5% decrease in weight, improves fertility in obese mothers. British fertility society recommends that women who have BMI of 30 or above and less than 35yrs of age should defer their infertility treatment. They should first be encouraged to lose weight to achieve a BMI of 25 without co-morbid disease. It is the only scientific method today for surgical weight loss and long term management of weight loss.
ACOG (American college of obstetrician and gynecologists) has also endorsed that after bariatric surgery, there is a decrease in the risk of hypertension and PIH, gestational diabetes and macrosomia. The risk of preterm delivery and congenital anomalies are also reduced as are labour and delivery complication.
Furthermore, there are studies comparing pregnancy outcomes before and after bariatric surgery in the sane woman. They have shown significant improvement in the health outcome of pregnancy, both for the mother and the child. A recent study with large number of pregnancies (298) showed that previous bariatric surgery is not associated with adverse prenatal outcomes. In fact, surgery benefited not only the mother with less pregnancy complications but benefit was also seen among children.
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