Stillbirth and infant mortality

© 2012 Springer-Verlag Berlin Heidelberg. All rights are reserved. Large epidemiological studies have during the last 15 years provided consistent evidence that obese women face an approximately twofold increase in risk of stillbirth or losing their baby within the first year of life - an excess risk that increases with the severity of obesity. The causal mechanisms behind these associations remain largely unknown. Although maternal obesity is associated with a wide range of complications in the mother and neonate that may impair fetal and infant survival, the increased risk of stillbirth and infant mortality is virtually unchanged when accounting for these factors. However, obese women with clinically uncomplicated pregnancies show perturbed cardiometabolic profiles, which may be harmful to the fetus by pathways not yet uncovered. Also, risk of stillbirth with placental dysfunction or in postterm pregnancies was found to be especially high in obese women, indicating that some of the excess risk may have a placental origin. To further understand the associations between maternal obesity and late fetal and infant death, we need better and more detailed clinical data, which is difficult to obtain on a population level given the rarity of the outcomes. The best prevention seems still to assure that a woman conceives at a healthy weight, which is not possible once pregnancy has occurred. This poses a great challenge for antenatal care providers in a global setting where obesity in young women is still on the rise