Over the past two decades, obesity has occupied a central part in health menaces. Estimates indicate over 60% of young US citizens are overweight. Obesity among older individuals is rising, and if to take the obvious implications for health into consideration, there is a need to understand its effects on fertility (Gillman et al, 2012). Obesity refers to accumulation of excess body fat to levels that create impairment of a person’s health. Various measures exist, but the WHO defines an obese person as one with a BMI above 30kg/m2. In particular, maternal obesity continues to be a productive menace and a social burden that has an association with a wide range of adverse, sometimes fatal pregnancy outcomes. Obese and overweight women continue to increase from 9.9% in 1990 to 16% in 2005 (Lewis, 2007). Heslehurst (2007) sums up the effects of obesity on impairing fertility through ovulation control, oocyte, embryo, endometrial development and implantation, and loss of pregnancy. This study explores the effects of obesity in relation to fertility, fecundability and pregnancy outcomes. The consequent understanding is translated into exploration of intervention.

Clark et al (1995) indicate that lifestyle changes such as weight loss programs and regular physical exercises restore menstrual regulations. The test that was conducted on Australian group of people showed 95% resumption of the menstrual cycle, 56% were impregnated naturally, and 25% were fecundated through assisted conception after 6 months in a weight loss program.

Significance of the Study. The study of obesity with time to pregnancy is fundamental in the pursuit of better health care. Knowledge of its effects offers an insight beyond the corridors of health to families, lifestyles and economics. Firstly, knowledge of this study is critical in informing mothers about the necessity to adapt to appropriate lifestyles, and thus escape fatal consequences of obesity. Secondly, health professionals can make use of the information and findings of this research in order to refine their intervention mechanisms. Specifically, the appropriate timing in managing obese expectant mothers should be regarded. Additionally, health professionals may make use of the results to better understand the appropriate information to disseminate and advise victims of obesity particular weight loss programs (Bouchard et al., 2010). Thirdly, the results of this study critically look beyond the health implications of obesity and pregnancy, and forecast future economic implications of pregnancy outcomes. It is, thus, invaluable to be added to the existing thought, regarding the cost of this pandemic.

Gaps in the Literature. This study will lay particular emphasis on the social-economic burden of maternal obesity. It identifies that there are a plethora of studies that show the effects of obesity on fertility, fecundability and pregnancy outcomes. However, few studies consider the compounded effects of the phenomenon as the post-birth socio-economic burden and strain on health care. The researcher will indicate cost efficiency analysis of intervention mechanisms such as weight loss programs, and compare them with post-birth costs of babies born to obese mothers.

Obesity and Maternal Health Outcomes. Benson (2006) indicates that maternal obesity is a major risk factor for mortality of expectant women. It is associated with a wide range of medical complications, placed at the top in contribution of high risk during pregnancy. Studies by Sebire et al (2001) indicate that obese women are likely to enter pregnancy with gestational diabetes mellitus, thromboembolic disease, type 2 diabetes, asthma, pre-eclampsia, among other weight-related diseases. This risk exposure may extend to perinatal and postpartum stages. Maternal obesity can be distinguished by various perinatal complications and may also lead to postpartum anemia as a consequence of postpartum hemorrhage. According to Hilson et al (2006), there is also a host of postpartum infections accompanying maternal obesity such as pyrexia, post-ceaserian infections, and genital tract infections among others.

Obesity predisposes women to pregnancy loss and higher chances of miscarriage as Hamilton-Fairly et al (1992) indicate that a higher BMI is associated with loss of pregnancy at its early stages. Li and Chao (2006) further indicate that obese women are more likely to experience lactation failure during delivery. Their studies point out that establishment of post-delivery lactation among obese women is lower due to abnormal prolactin responses. Additionally, mechanical challenges arising from size such as difficulty in breastfeeding constitute these maternal outcomes. Thus, pregnancy outcomes of obese mothers, especially postpartum complications, create compound challenges leading to aspects such as formula feeding that further brings to risk of obesity of their children (Hediger, 1999).

Maternal Obesity and Fertility. A complex system of hormones works to balance the menstrual cycle, endometrial development and ovulation. Studies indicate that maternal obesity adversely disturbs this balance through indirect and direct mechanisms. Hippocrates documented its  effects on fertility are due to putative causes that fall into categories of pathophysiological, sociological and psychosocial aspects (Lloyd et al, 1978). It affects the HPO axis and imbalances the menstrual cycle, which is the genesis of infertility. In their studies, Hartz et al (1979) show a 3.1 times rate of menstrual disturbance in obese women. In conclusion, obesity leads to lower fertility by indirectly leading to imbalanced levels of leptin, insulin and adipokines.

Maternal Obesity and Fecundability. Cresswel (2011) notes that body functions under hormonal guidelines and imbalance impair a woman’s ability to regulate follicular development and maturation of the oocyte. Studies show that obesity causes imbalances such as high leptin in obese women. High leptin causes impairment of fecundity; this is involved with studies indicating that obese women have a three times high chance of infertility in comparison to women with normal weight (Rich et al, 1994). Zaadstra et al (1993) note that obese women have impairment of fecundity in natural and medically assisted cycles. According to Zaadstra, a Dutch study on maternal effects on fecundability with 500 female participants showed a 30% reduction in conception probability.

Sample Selection. The researcher will use random sampling technique to pick obese women attending a clinic of postnatal care, and those trying to conceive on both natural and assisted methods. The clinics will be picked randomly while the respondents will be selected on the basis of their conception method, obese/overweight status and attendance to a weight loss program.

Sample Size. This research will be a cohort study of 80 women in four categories: 10 who are morbidly obese (BMI>35kg/m2), 30 who are obese (BMI 30-34.9kg/m2), 30 who are overweight (BMI 25-29.9 kg/m2) and 10 with normal weight (BMI 20-24.9 kg/m2) as a control. Observations on pregnancy complications ease conception. Moreover, perinatal, obstetric and postpartum observations will be carried out through unvariate and multivariate analysis.

Research Instruments. The researcher will make use of interviews and direct observation for 6 months. He will observe the conception success of the obese women, monitor pregnancy progress for those who were successfully conceived, but faced problems such as complications/miscarriage, and also monitor the effects of weight loss program on both conception rates and health during pregnancy.

Reliability and Validity. This researcher will conduct a thorough interview with the respondents and review the effectiveness of interviews and observation as instruments through a pilot study.

Conclusion

In conclusion, it is clear that obesity impairs hormonal balance and, thus, affects fertility, fecundity and pregnancy outcomes as a consequence. The summative effects on the HPO axis through high leptin levels and effects on the hypothalamus are clear from the study. Obesity also lowers fecundity through the leptin hormone while it lowers fertility through reduction of sex hormone-binding factor and high testosterone (Cresswel, 2011). The pregnancy outcomes are evident through higher miscarriages, mechanical issues, delay in lactose release and other postpartum complications. Appropriate intervention mechanisms such as physical activity and timely administration of management of obese expectant mothers improve fatalities and lower socio-economic costs (Bouchard et al., 2010).

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