Placental dysfunction in obese women and antenatal surveillance strategies

•Obesity is associated with significant short-term and long-term feto-maternal complications.•Excess gestational weight gain is associated with metabolic disorders.•Placental dysfunction is mediated through inflammatory pathways.•Antenatal surveillance, counselling on ideal weight gain and screening and management of complications are the key for good outcomes.•Metformin is not recommended in non-diabetic obese women.

This review is aimed at discussing placental dysfunction in obesity and its clinical implication in pregnancy as well as an antenatal surveillance strategy for these women. Maternal obesity is associated with adverse perinatal outcome. Obesity is an independent risk factor for fetal hyperinsulinaemia, birthweight and newborn adiposity. Maternal obesity is associated with childhood obesity and obesity in adult life. Obesity induces a low-grade inflammatory response in placenta, which results in short- and long-term programming of obesity in fetal life. Preconception and antenatal counselling on obstetrics risk in pregnancy, on diet and lifestyle in pregnancy and on gestational weight gain is associated with a better outcome. Fetal growth velocity is closely associated with maternal weight and gestational weight gain. Careful monitoring of gestational weight gain and fetal growth, and screening and management of obstetrical complications such as gestational diabetes and pre-eclampsia, improves perinatal outcome. The use of metformin in non-diabetic obese women is under investigation; further evidence is required before recommending it.