OBESITY IN PREGNANCY

1. OBESITY IN PREGNANCY
Dr Nidaa Khan
Specialist Obstetrics and Gynecology
Life Medical Centre
Dubai Silicon Oasis

2. ABSTRACT
 INTRODUCTION
 CLASSIFICATION FOR BMI
 EFFECTS OF OBESITY ON PREGNANCY
 PRENATAL CARE
 ANTEPARTUM SCREENING AND MANAGEMENT
 FETAL SURVEILLANCE
 PLANNING LABOR AND BIRTH
 POSTNATAL CARE
 BARIATRIC SURGERY

3. INTRODUCTION
 Obesity is the most common medical condition in women of reproductive age with
21.3% of the antenatal population being obese and fewer than one-half of
pregnant women (47.3%) having a body mass index (BMI) within the normal range.
 The implications of obesity relative to pregnancy often are unrecognized,
overlooked, or ignored because of the lack of specific evidence-based treatment
options.
 The management of obesity requires long-term approaches ranging from
nutritional, behavioral, or surgical interventions.
 Therefore, an understanding of the management of obesity during pregnancy is
essential, and management should begin before pregnancy and continue through
the postpartum period.

4. CLASSIFICATION ACCORDING TO BMI
WEIGHT STATUS BODY MASS INDEX(Kg/m2)
UNDER WEIGHT LESS THAN 18.5
NORMAL RANGE 18.5-24.9
OVER WEIGHT 25-29.9
OBESE MORE THAN 30
OBESE CLASS 1 30-34.9
OBESE CLASS 2 35-39.9
OBESE CLASS 3 MORE THAN 40

5. EFFECTS OF OBESITY ON PREGNANCY

6. FETAL COMPLICATIONS & CHILDHOOD
MORBIDITIES
 Fetuses of obese gravidas are at increased risk of macrosomia and impaired
growth.
 Long-term risks for the offspring of obese women include an increased risk of
metabolic syndrome and childhood obesity.
 Maternal obesity also has been linked to altered behavior in the offspring, including
an increased risk of autism spectrum disorders, childhood developmental delay
and Attention deficit hyperactivity disorder.

7. PRE-PREGNANCY CARE
 What care should be provided in the primary care setting to women of
childbearing age with obesity who wish to become pregnant?

8. What nutritional supplements should be recommended
to women with obesity who wish to become pregnant?
Women with a booking BMI ≥30 kg/m2 may be advised to take 10
micrograms Vitamin D supplementation daily during pregnancy and while
breastfeeding.

9. What is the acceptable gestational weight gain in obese women?
When and how often should maternal weight, height and BMI be
measured?
ANTEPARTUM MANAGEMENT

10. ANTEPARTUM MANAGEMENT
What dietetic and exercise advice should be offered in pregnancy?
 As noted, recommended weight gain in obese women is 11 to 20 pounds, and several
dietary interventions to limit weight gain to these targets have been reported.
 These include lifestyle interventions and physical activity.
 Weight loss is not recommended in pregnancy.
What is the role of anti-obesity drugs in pregnancy?

11. ANTEPARTUM MANAGEMENT
What specific risk assessments are required for anaesthesia?
 Evaluation by the anesthesia team is performed at a prenatal visit or on arrival at the labor unit.
 Anesthetic risk included
Technical problems with regional analgesia - 6%
Use of general anesthesia - 6%
Hypotension - 3%
Overall anesthetic complications - 8.4%
What special considerations are recommended for screening, diagnosis and management of
gestational diabetes in women with obesity?
A Glucose Tolerance Test (GTT) should be undertaken at 28 weeks gestation for all women
with a BMI > 30kg/m2

12. ANTEPARTUM MANAGEMENT
 What special considerations are recommended for screening, diagnosis and
management of hypertensive complications of pregnancy in women with obesity?
Women with a booking BMI > 35 have an increased risk of pre-eclampsia and should be
monitored for Pre-eclampsia 3 weekly between 24 -32 weeks, and 2 weekly from 32 weeks
to birth.

13. ANTEPARTUM MANAGEMENT
 What special considerations are recommended for prevention, screening, diagnosis
and management of venous thromboembolism in women with obesity?

14. ANTENATAL SCREENING
 What special considerations does maternal obesity have for screening for
chromosomal anomalies during pregnancy
 What special considerations does maternal obesity have for screening for structural
anomalies during pregnancy?

15. FETAL SURVEILLANCE
 How and when should the fetus be monitored antenatally?
 How and when should the fetus be monitored during labour?
There is no evidence to support continuous fetal monitoring during labour in the absence of
other comorbidities, or medical or obstetric complications. Guidelines recommends that
intermittent fetal heart monitoring should be offered to low-risk women.
All women with BMI ≥ 35 to have serial ultrasound scans for fetal growth carried out at
28 weeks, 32 weeks, 36 weeks and 39 weeks.

16. PLANNING LABOUR AND BIRTH
 What should be discussed with women with maternal obesity regarding labour and
birth?
 Is maternal obesity an indication for caesarean section?

17. PLANNING LABOUR AND BIRTH
 Is macrosomia and maternal obesity an indication for induction of labour and/or
caesarean section?
 What specific surgical techniques are recommended for performing caesarean
section on the obese woman (including incision, closure)?
Surgical access to the uterus can be very challenging in some women with obesity due to the
presence of a large panniculus.
Compared with transverse infrapanniculus incisions, vertical suprapanniculus incisions are
associated with increased operative morbidity, including bleeding and classical hysterotomy and
prolonged postoperative hypoxemia and respiratory compromise.

18. PLANNING LABOUR AND BIRTH
 What postoperative wound care is recommended following caesarean section in
women with obesity?

19. POSTNATAL CARE
 Encourage early mobilisation irrespective of the mode of birth.
 TED stockings are recommended for the duration of the hospital stay, irrespective
of mode of birth.
 How can the initiation and maintenance of breastfeeding in women with maternal
obesity be optimised?

20.  What contraception advice should be provided to women with maternal obesity
following pregnancy?
Contraception should be discussed before discharge.
The advice should reflect the high risk of thromboembolism with combined oral
contraceptive pills.
 All women with a booking BMI >30 who have been diagnosed with gestational
diabetes should have a test of glucose tolerance approximately 6 weeks after
giving birth and an annual screening for cardio-metabolic risk factors, and lifestyle
and weight management advice.

21. BARIATRIC SURGERY
 What are the clinical risks of previous bariatric surgery to maternal and fetal health during
pregnancy?
 How should women with previous bariatric surgery be cared for during pregnancy?
 Guidelines recommend that women who have undergone bariatric surgery be assessed for
vitamin and nutritional sufficiency.
 When indicated, vitamin B12 and D, folic acid, and calcium supplementation are given. Vitamin A
deficiency has also been reported.
 Women with a gastric band should be monitored by their bariatric team during pregnancy
because adjustments of the band may be necessary.
 Finally, special vigilance is appropriate for signs of intestinal obstruction.

22. REFERENCES
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mother and baby: a systematic review of reviews. Obesity Reviews. 2015 Aug;16(8):621-38.
 Hales CM, Carroll MD, Fryar CD, Ogden CL. Prevalence of obesity among adults and youth: United States,
2015–2016.

23. REFERENCES
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24. THANK YOU