Maternal Obesity and Cardiovascular Health

Thank you to Nicole Crossley, RN, BSN, RDN, LD and Emily Jones, PhD, RNC-OB, FAHA, FPCNA for this article on maternal obesity and cardiovascular health.

Cardiovascular Maternal Health

Cardiovascular disease (CVD) is the leading cause of mortality in women.1 This trend is also seen in women of childbearing age, in whom cardiovascular-related causes have become the number one cause of maternal mortality, or pregnancy-related death.2 Higher rates of cardiovascular pregnancy-related mortality have been noted among non-Hispanic black and non-Hispanic American Indian/Alaska Native (AI/AN) women.3 Additionally, a woman’s cardiometabolic risk is impacted by unintended complications during pregnancy, also known as maternal morbidity.4,5 Women who experience pregnancy complications such as gestational diabetes (GDM), preeclampsia, gestational hypertension, preterm birth, having a small-for-gestational-age infant, or placental abruption have been identified as having a greater risk for continued metabolic disease risk and development throughout the lifespan.6-8

The Role of Maternal Obesity and Postpartum Weight Retention

Postpartum Weight Retention, Stress, and Eating Behaviors

Clinical Takeaways for Cardiovascular Nurses

Related Maternal Obesity and Health Resources


  1. Benjamin EJ, Muntner P, Alonso A, et al. Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association [published correction appears in Circulation. 2020 Jan 14;141(2):e33]. Circulation. 2019;139(10):e56-e528. doi:10.1161/CIR.0000000000000659
  2. CDC. Pregnancy Mortality Surveillance System: Centers for Disease Control and Prevention; 2020 [cited 2021 October 11].
  3. Petersen EE, Davis NL, Goodman D, et al. Racial/Ethnic Disparities in Pregnancy-Related Deaths – United States, 2007-2016. MMWR Morb Mortal Wkly Rep. 2019;68(35):762-765. Published 2019 Sep 6. doi:10.15585/mmwr.mm6835a3
  4. American College of Obstetricians and Gynecologists and the Society for Maternal–Fetal Medicine, Kilpatrick SK, Ecker JL. Severe maternal morbidity: screening and reviewAm J Obstet Gynecol. 2016;215(3):B17-B22. doi:10.1016/j.ajog.2016.07.050
  5. Rich-Edwards JW, Fraser A, Lawlor DA, Catov JM. Pregnancy characteristics and women’s future cardiovascular health: an underused opportunity to improve women’s health?. Epidemiol Rev. 2014;36(1):57-70. doi:10.1093/epirev/mxt006
  6. Cusimano MC, Pudwell J, Roddy M, Cho CK, Smith GN. The maternal health clinic: an initiative for cardiovascular risk identification in women with pregnancy-related complications. Am J Obstet Gynecol. 2014;210(5):438.e1-438.e4389. doi:10.1016/j.ajog.2013.12.001
  7. Fraser A, Nelson SM, Macdonald-Wallis C, et al. Associations of pregnancy complications with calculated cardiovascular disease risk and cardiovascular risk factors in middle age: the Avon Longitudinal Study of Parents and Children. Circulation. 2012;125(11):1367-1380. doi:10.1161/CIRCULATIONAHA.111.044784
  8. Hauspurg A, Ying W, Hubel CA, Michos ED, Ouyang P. Adverse pregnancy outcomes and future maternal cardiovascular disease. Clin Cardiol. 2018;41(2):239-246. doi:10.1002/clc.22887
  9. American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins–Obstetrics. Obesity in Pregnancy: ACOG Practice Bulletin, Number 230. Obstet Gynecol. 2021;137(6):e128-e144. doi:10.1097/AOG.0000000000004395
  10. Saucedo M, Esteves-Pereira AP, Pencolé L, et al. Understanding maternal mortality in women with obesity and the role of care they receive: a national case-control study. Int J Obes (Lond). 2021;45(1):258-265. doi:10.1038/s41366-020-00691-4
  11. Guelinckx I, Devlieger R, Beckers K, Vansant G. Maternal obesity: pregnancy complications, gestational weight gain and nutrition. Obes Rev. 2008;9(2):140-150. doi:10.1111/j.1467-789X.2007.00464.x
  12. Pregnancy Risk Assessment Monitoring System. Prevalence of Selected Maternal and Child Health Indicators for All PRAMS Sites, Pregnancy Risk Assessment Monitoring System (PRAMS), 2016–2019.
  13. Leonard SA, Main EK, Scott KA, Profit J, Carmichael SL. Racial and ethnic disparities in severe maternal morbidity prevalence and trends. Ann Epidemiol. 2019;33:30-36. doi:10.1016/j.annepidem.2019.02.007
  14. Maner JK, Dittmann A, Meltzer AL, McNulty JK. Implications of life-history strategies for obesity. Proc Natl Acad Sci U S A. 2017;114(32):8517-8522. doi:10.1073/pnas.1620482114
  15. Whitaker K, Young-Hyman D, Vernon M, Wilcox S. Maternal stress predicts postpartum weight retention. Matern Child Health J. 2014;18(9):2209-2217. doi:10.1007/s10995-014-1470-7
  16. Bogaerts A, Van den Bergh BRH, Ameye L, et al. Interpregnancy weight change and risk for adverse perinatal outcome. Obstet Gynecol. 2013;122(5):999-1009. doi:10.1097/AOG.0b013e3182a7f63e
  17. Poston L, Caleyachetty R, Cnattingius S, et al. Preconceptional and maternal obesity: epidemiology and health consequences. Lancet Diabetes Endocrinol. 2016;4(12):1025-1036. doi:10.1016/S2213-8587(16)30217-0
  18. Christenson A, Johansson E, Reynisdottir S, Torgerson J, Hemmingsson E. Women’s Perceived Reasons for Their Excessive Postpartum Weight Retention: A Qualitative Interview Study. PLoS One. 2016;11(12):e0167731. Published 2016 Dec 9. doi:10.1371/journal.pone.0167731
  19. Pedersen P, Baker JL, Henriksen TB, et al. Influence of psychosocial factors on postpartum weight retention. Obesity (Silver Spring). 2011;19(3):639-646. doi:10.1038/oby.2010.175
  20. Bergmann N, Gyntelberg F, Faber J. The appraisal of chronic stress and the development of the metabolic syndrome: a systematic review of prospective cohort studiesEndocr Connect. 2014;3(2):R55-R80. doi:10.1530/EC-14-0031
  21. Gebreab SZ, Vandeleur CL, Rudaz D, et al. Psychosocial Stress Over the Lifespan, Psychological Factors, and Cardiometabolic Risk in the Community. Psychosom Med. 2018;80(7):628-639. doi:10.1097/PSY.0000000000000621
  22. Torres SJ, Nowson CA. Relationship between stress, eating behavior, and obesity. Nutrition. 2007;23(11-12):887-94. Epub 2007/09/18. doi: 10.1016/j.nut.2007.08.008. PubMed PMID: 17869482.
  23. Bijlholt M, Van Uytsel H, Ameye L, Devlieger R, Bogaerts A. Eating behaviors in relation to gestational weight gain and postpartum weight retention: A systematic review. Obes Rev. 2020;21(10):e13047. Epub 2020/06/02. doi: 10.1111/obr.13047. PubMed PMID: 32476253.
  24. Stunkard AJ, Messick S. The three-factor eating questionnaire to measure dietary restraint, disinhibition and hunger. J Psychosom Res. 1985;29(1):71-83. doi:10.1016/0022-3999(85)90010-8
  25. Bellisle F, Clément K, Le Barzic M, Le Gall A, Guy-Grand B, Basdevant A. The Eating Inventory and body adiposity from leanness to massive obesity: a study of 2509 adults. Obes Res. 2004;12(12):2023-2030. doi:10.1038/oby.2004.253
  26. Kruger R, De Bray JG, Beck KL, Conlon CA, Stonehouse W. Exploring the Relationship between Body Composition and Eating Behavior Using the Three Factor Eating Questionnaire (TFEQ) in Young New Zealand Women. Nutrients. 2016;8(7):386. Published 2016 Jun 23. doi:10.3390/nu8070386
  27. Hanson M, Barker M, Dodd JM, et al. Interventions to prevent maternal obesity before conception, during pregnancy, and post partum. Lancet Diabetes Endocrinol. 2017;5(1):65-76. doi:10.1016/S2213-8587(16)30108-5

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