Individuals with psychiatric disorders are at higher risk for obesity than the general population, as well as for medical comorbidity, such as diabetes, hypertension, hyperlipidemia, and cardiovascular disease.  Moreover, many medications for psychiatric disorders worsen this risk, particularly pharmacotherapy with atypical (second-generation) antipsychotic medications, used not only used for psychotic disorders, but increasingly as mood stabilizers and for treatment refractory depression and anxiety. Almost 4% of adults in the U.S. were treated with an atypical antipsychotic in 2009, with the most common indication being depression or bipolar disorder (1).  In 2011, 3.1 million Americans were treated with an atypical antipsychotic drug (2).  The number has most likely increased, as there have been new FDA indications given for the use of commonly experienced mood disorders (bipolar disorder and depression).  Atypical antipsychotic medications also independently increase the risk of metabolic dysregulation such as increasing glucose resistance and diabetes risk and dyslipidemia, in addition to raising the risk of overweight and obesity.

The risk of obesity and metabolic dysregulation has profound implications for women of reproductive age and has transgenerational consequences.  Obesity during pregnancy increases the risk of adverse maternal and neonatal outcomes.  This includes major birth defects, prematurity and other obstetrical risks, and potential long-lasting consequences for offspring (3-5).  It is also extremely important to develop strategies for women of reproductive age to prevent the weight gain that is associated with pregnancies, as many women are not successful at weight loss after pregnancy, and subsequent pregnancies may exacerbate obesity and the risk of diabetes and other medical comorbidities.

The Institute of Medicine (IOM) and the American Congress of Obstetricians and Gynecologists (ACOG) have both established recommended ranges of weight gain during pregnancy (6,7). These recommendations for gestational weight gain vary based on pregravid body mass index (BMI) category. The guidelines recommend that women who are overweight or obese at the beginning of pregnancy gain less weight during pregnancy than women who begin pregnancy within a normal weight range. It is estimated that 43% of pregnant women gain more weight than what is recommended by the Institute of Medicine (6).

To date, there has been limited research to help women who are trying to conceive or who are pregnant lose weight or gain within recommended ranges, respectively.  We are interested in helping women who are trying to conceive or planning pregnancy lose weight in anticipation of pregnancy, and helping women who are pregnant keep weight gain within recommended amounts.  Lifestyle interventions focused on exercise, activity, and nutritional components such as the Diabetes Prevention Program have been demonstrated as beneficial in individuals at risk for diabetes and other health problems related to obesity.  We are seeking to tailor a similar intervention for overweight or obese women with psychiatric diagnoses, who are either planning pregnancy or who are pregnant.

For more information about the study:

https://womensmentalhealth.org/research/lifestyle-intervention-research-study/

Marlene P. Freeman, MD

 

References:

  1. Olfson M, Blanco C, Liu S, Wang S, Correll CU. National Trends in the Office-Based Treatment of Children, Adolescents, and Adults With Antipsychotics. Arch Gen Psychiatry. 2012;69(12):1247-1256. doi:10.1001/archgenpsychiatry.2012.647.
  2. http://www.nytimes.com/2012/09/25/health/a-call-for-caution-in-the-use-of-antipsychotic-drugs.html?_r=0
  3. Creanga AA, Berg CJ, Syverson C, Seed K, Bruce FC, Callaghan WM. Pregnancy-related mortality in the United States, 2006–2010. Obstetrics & Gynecology. 2015;125(1):5-12.
  4. Stothard KJ, Tennant PW, Bell R, Rankin J. Maternal overweight and obesity and the risk of congenital anomalies: a systematic review and meta-analysis. Jama. 2009;301(6):636-50.
  5. Li M, Fallin MD, Riley A, Landa R, Walker SO, Silverstein M, et al. The Association of Maternal Obesity and Diabetes With Autism and Other Developmental Disabilities. Pediatrics. 2016:peds. 2015-206.
  6. Rasmussen KM, Abrams B, Bodnar LM, Butte NF, Catalano PM, Siega-Riz AM. Recommendations for weight gain during pregnancy in the context of the obesity epidemic. Obstetrics and gynecology. 2010;116(5):1191.
  7. Weight gain during pregnancy. Committee Opinion No. 548. American College of Obstetricians and Gynecologists. Obstet Gynecol 2013;121:210–2. http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Weight-Gain-During-Pregnancy
  8. https://www.niddk.nih.gov/about-niddk/research-areas/diabetes/diabetes-prevention-program-dpp/Pages/default.aspx;