The photo has been out for awhile as seen in this 2008 video
http://www.youtube.com/watch?v=3EMdQm8Mguw
Here is something someone did testing the pic
I tried a different test. Using that video for the timeline (which could be off) the photo of black hand Ann is before Sr/Obama at the airport. Take Ann's height to SR and then compare to Obama's height to SR and then compare to the black hand pic.
If anyone has a good timeline reference for those photos it would be helpful since Obama's is bigger in the black hand Ann photo.
Some have suggested that it is Obama that was put into that picture. You can't see Maya's purse behind his leg but that could be possible because of the angle of the photo.
As for Russians not doing a good job of forging photos- there are a lot of examples on the net of just how good they were - before there was such a thing as Photoshop.
I went to a site that many claim is either operated by the CIA or has CIA posting on it. Mixed reviews. Some say photo degradation and others say edited photo. I don't have a conclusion. It does look to me like Ann could be pregnant in that photo.
It is possible that Ann was holding some kind of purse. Notice Obama's shoulder. There is some kind of handle there. Say his shirt sleeve dips down over her wrist. It is possible for a hand to look large at a certain angle when in a fist holding a purse. Notice that Grandpas arm is almost dark. The chairs can be explained away by different seats. It is possible there were different seating sections there. The angle could be due to the camera. Still, I have no conclusion about it being fake or not.