Women, Obesity, and Reproductive Health: What Clinicians Need to Know

Hi, I am Dr. Emilia Hovinen, and I am a specialist in gynecology and obstetrics, obesity doctor, and an associate professor at the University of Helsinki.

Obesity influences every stage of a woman’s reproductive life, fertility, pregnancy, postpartum recovery, and even breastfeeding experiences. It is essential to understand these interactions for providing effective and compassionate care. Obesity is not simply a matter of weight, but a complex chronic condition linked with hormonal, metabolic, and psychosocial factors.

In this five-minute CPD, we’ll explore insights from the European Association for the study of obesity, EASOs, position statement on women with obesity across the reproductive life, fertility, preconception, pregnancy, postpartum and breastfeeding. Obesity is an adiposity-based chronic disease that reflects excess or dysfunctional body fat rather than simply high body weight as a number.

BMI is just a quick screening tool and it does not capture fat distribution or metabolic risk. IASA recommends complementing BMI with at least one other anthropometric measure, such as waist to height ratio or, when available, bioimpedance.

In a clinical conversation, using person-first language is important. For example, we can say “woman living with obesity” rather than “an obese woman” because this supports care, empathy, and helps to reduce stigma within healthcare settings. because women with obesity often experience stigma and not just in society, but also in healthcare encounters.

This can impact their psychological health, but also affect directly reproductive health because women might skip routine screening for HPV or gestational diabetes due to experience stigma and fear of judgment. The tone and discussion should always around lifestyle be supportive, never judgmental, or filled with stereotypes.

Obesity affects fertility even when menstrual cycles are regular. Women with a BMI above 29 may see a 4% reduction in pregnancy rate per BMI unit. And after BMI 30, ovulatory problems are three times more common. Fortunately, already a 5% to 10% weight loss improves ovulation and fertility outcomes.

Polycystic ovary syndrome or PCOS is the most common endocrine disorder in women affecting up to 13% of women. So it is as common as migraine. And more than half of these women also have obesity.

The core pathophysiological feature of PCOS is insulin resistance and androgen excess, which of course explain why obesity care, healthy eating and regular exercise form the foundation for managing PCOS. Metformin should be considered when BMI exceeds 25. And of course, obesity management medications, specifically GLP-1-GIB agonist, may be additionally used to support weight management in case of obesity.

In the preconception period, it is important to screen for obesity-related comorbidities, such as diabetes, hypertension, dyslipidemia, and renal and liver dysfunction. Obesity management medications offer a great possibility for weight management before pregnancy.

However, there is no safety data on any medication during pregnancy, and therefore they should be discontinued before conception. The safety period ranges from four days with liractatide to eight weeks with semaglutide.

Regular checkups and continuous lifestyle support is essential to prevent excessive weight gain. It’s also important to remember folate supplementations, starting three months before conception to prevent congenital malformations of the fetus, specifically neural tube defects. The recommended dose is between 400 micrograms to 5 milligrams daily and at least 800 micrograms after bariatric surgery.

During pregnancy, monitoring weight should be just a part of the holistic care, focusing on the well-being of both mother and child. Gestational weight guidance should be individualized based on each woman’s overall health status and metabolic profile.

For women with obesity, the recommended gestational weight gain is five to nine kilos and even lower for women who have class two or three obesity. However, rather than obsessing about certain numeric targets, care plan should be tailored to support each mother individually.

Lifestyle interventions during pregnancy have the potential to prevent pregnancy complications and improve offspring health and they should focus on personalized nutrition plans and moderate daily exercise.

In first trimester, all pregnant women with obesity should be screened for hyperglycemia, giving a possibility to diagnose undetected type 2 diabetes or early gestational diabetes. Low-dose aspirin starting from week 11 can reduce preeclampsia risk in women with obesity and additional risk factors.

Then in the end of pregnancy in the third trimester, enhanced fetal surveillance is advised from 34 weeks on because unfortunately there is an increased risk of stillbirth.

Postpartum care doesn’t end at discharge. The aim of the life course approach is to reduce long-term health risks and improve outcomes also in future pregnancies. Discussing contraception options is an integral part of postpartum care.

Long-acting reversible contraceptives such as IUDs and implants offer great options considering both breastfeeding and risk of thrombosis. Women living with obesity often face additional challenges with breastfeeding.

An individualized support and practical counseling can help them meet their own breastfeeding goals and also improve long-term health outcomes for both mother and child.

In conclusion, obesity management across reproductive life is not a single intervention. It’s a continuum of compassionate, evidence-driven care. Each phase offers a chance to support women’s health and, by extension, the health of future generations.

I am Dr. Emilia Hoevenen for 5 Minute CPD. Be sure to check out additional resources on this page and more learning at easo.org.