Obesity affects 8%–12% of pregnancies1
A pre-pregnancy body mass index (BMI) of 30 kg/m2 or greater is linked with an increased risk of adverse outcomes in pregnancy.1 The risk of preeclampsia doubles with each 5–7 kg/m2 increase in pre-pregnancy BMI.1 In anticipation of pregnancy, weight management options may include lifestyle changes, pharmacotherapy and bariatric surgery, where appropriate. Pre-pregnancy screening may include assessment of liver, cardiac, respiratory and thyroid function, in addition to a lipid profile.2 If the person presents after conceiving, screening may be modified depending on history. Early screening for type 2 diabetes mellitus with glycosylated hemoglobin is encouraged.1
Controlled weight gain and daily acetylsalicylic acid (ASA) during pregnancy are evidence-based strategies to prevent preeclampsia2
With a pre-pregnancy or first-trimester BMI of 30 kg/m2 or greater, a total gestational weight gain of 5–9 kg is recommended.2 Low-dose ASA (75–150 mg) can reduce the risk of preeclampsia by 62%, and should be started before 16 weeks’ gestation and taken until 36 weeks’ gestation.3
Obesity is associated with increased risk of cesarean delivery4
A higher incidence of dystocia in the first stage of labour accounts for this increased risk. The odds of ineffective uterine contractility increase in a dose-dependent fashion with class of obesity (odds ratio 2.14, 2.72 and 3.98 in people with class I, II and III obesity, respectively).4 Pregnant people with obesity are more likely to require induction of labour with increased failure rates. However, studies show that planned induction at term may decrease rates of cesarean delivery, macrosomia and neonatal morbidity.4
Breastfeeding should be recommended
People with obesity are less likely than people who are not obese to start breastfeeding, and tend to breastfeed for a shorter duration.4 Lactation education should emphasize the benefits of breastfeeding — including protection against sudden infant death syndrome, childhood obesity and maternal cardiovascular risk4,5 — and also provide information on challenges and management options.4
Weight bias is common, and people with obesity often experience shaming by health care providers6
Stigmatizing language erodes the therapeutic alliance and deters patients from seeking care. People-first language should be used (e.g., “person with obesity” rather than “obese person”).4
Footnotes
Competing interests: None declared.
This article has been peer reviewed.
This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY-NC-ND 4.0) licence, which permits use, distribution and reproduction in any medium, provided that the original publication is properly cited, the use is noncommercial (i.e., research or educational use), and no modifications or adaptations are made. See: https://creativecommons.org/licenses/by-nc-nd/4.0/
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- Obesity affects 8%–12% of pregnancies1
- Controlled weight gain and daily acetylsalicylic acid (ASA) during pregnancy are evidence-based strategies to prevent preeclampsia2
- Obesity is associated with increased risk of cesarean delivery4
- Breastfeeding should be recommended
- Weight bias is common, and people with obesity often experience shaming by health care providers6
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