Screening for Obesity in Reproductive-Aged Women || Preventing Chronic Disease: November 2011: 11_0032

 

Screening for Obesity in Reproductive-Aged Women

Chloe Zera, MD, MPH; Susan McGirr; Emily Oken, MD, MPH

Suggested citation for this article: Zera C, McGirr S, Oken E. Screening for obesity in reproductive-aged women. Prev Chronic Dis 2011;8(6):A125. http://www.cdc.gov/pcd/issues/2011/nov/11_0032.htm. Accessed [date].

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Abstract

Although obesity screening and treatment are recommended by the US Preventive Services Task Force, 1 in 5 women are obese when they conceive. Women are at risk for complications of untreated obesity particularly during the reproductive years and may benefit from targeted screening. Risks of obesity and potential benefits of intervention in this population are well characterized. Rates of adverse pregnancy outcomes including gestational diabetes, preeclampsia, cesarean delivery, and stillbirth increase as maternal body mass index increases. Offspring risks include higher rates of congenital anomalies, abnormal intrauterine growth, and childhood obesity. Observational data suggest that weight loss may reduce risks of obesity-related pregnancy complications. Although obesity screening has not been studied in women of reproductive age, the effect of obesity and the potential for significant maternal and fetal benefits make screening of women during the childbearing years an essential part of the effort to reduce the impact of the obesity epidemic.

Introduction

In 2009, 26% of US adult women reported a body mass index (BMI) in the obese range (≥30 kg/m²) (1).
With rates of both adult and adolescent obesity increasing, the prevalence of obesity among women of childbearing age (aged 15-44 y) can also be expected to increase. The US Preventive Services Task Force (2) and the National Heart, Lung, and Blood Institute (NHLBI) (3) recommend screening all adults for obesity in clinical settings, but neither specifically mentions screening for women during their reproductive years. Although the Centers for Disease Control and Prevention’s Select Panel on Preconception Care released recommendations in 2006 to improve the preconception care of women, which included addressing prepregnancy obesity, obesity remains an undertreated chronic disease that affects at least 1 in 5 pregnancies (4). One factor contributing to the gap between recommendation and practice may be that for the 20% of women of childbearing age who are uninsured, preventive care services are often provided episodically in settings such as federally funded family planning programs rather than in traditional primary care settings.

The effect of untreated obesity among women of childbearing age includes adverse reproductive outcomes as well as adverse outcomes for these women’s offspring. Although women who are obese may be at increased risk for unplanned pregnancy and contraceptive failure (5), infertility rates are higher among obese women than among normal-weight women (6). Once a woman is pregnant, both maternal and fetal risks are increased by high maternal BMI. Pregnancy-associated morbidity and mortality are higher in obese women than in normal-weight women (7). The offspring of obese women face an increased risk of obesity and other chronic metabolic diseases (8). Women of childbearing age are therefore a uniquely at-risk population who may benefit from targeted screening.

Our objective was to develop recommendations for screening in women of childbearing age by focusing on the efficacy, benefits, and potential harms of screening in this population. This article is part of a series of articles focused on screening women of reproductive age for chronic health conditions, particularly women seeking care at clinics that receive Title X Family Planning funding.

We systematically reviewed the literature on obesity screening in women of reproductive age. We searched the MEDLINE database for articles published from January 1, 1998, to July 1, 2010. We used the search terms “obesity” or “BMI” and “screen” or “assessment” limited to humans aged 19 to 64 years to identify potentially relevant articles. Using these parameters, we were unable to identify any studies that focused on the feasibility, acceptability, risks, benefits, or costs of obesity screening in women of childbearing age. We therefore chose to frame our discussion of screening by summarizing the current evidence surrounding the risks of obesity before and during pregnancy, reviewing potential risks and benefits of obesity treatment as part of preconception care, highlighting gaps in current screening practices, and proposing recommendations for screening opportunities in the population of women who may become pregnant.

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Preventing Chronic Disease: November 2011: 11_0032