🔑 Key Learning

  • Defined as BMI > 30 at the first antenatal visit.
  • Associated with increased maternal and foetal complications.
  • Key interventions:
    • Screen for gestational diabetes
    • 5 mg folic acid (BMI > 30)
    • Assess pre-eclampsia risk - consider aspirin 75-150 mg
    • Early anaesthetic review, and consider VTE prophylaxis.

📊 Definition and Epidemiology

  • Obesity in pregnancy is defined as BMI > 30 at booking.
  • 21% of pregnant women in the UK are obese.
  • Only 47% have a normal BMI at booking.

⚠️ Complications

Maternal

  • Pre-eclampsia
  • Gestational diabetes
  • VTE/PE
  • Postpartum haemorrhage
  • Increased risk of labour induction and C-section
  • Mental health disorders (e.g. anxiety, depression)

Fetal

  • Congenital anomalies
  • Fetal macrosomia
  • Stillbirth and neonatal death
  • Difficulties with breastfeeding initiation and maintenance

🩺 Management

Antenatal

  • Encourage pre-pregnancy weight optimisation.
  • Screen for gestational diabetes.
  • Prescribe 5 mg folic acid from pre-conception to 12 weeks gestation if BMI > 30.
    • High risk for neural tube defects
  • Consider aspirin 75-150 mg OD from 12 weeks until birth if BMI > 35 or other RFs for pre-eclampsia. 

Intrapartum

  • Assess VTE risk and consider prophylactic LMWH.
  • Early anaesthetic review for women with high BMI.

Postnatal

  • Support weight management and healthy lifestyle advice.
  • Offer breastfeeding support.
  • Discuss planning for future pregnancies with MDT involvement.

🔗 Useful Links and References

RCOG Guidelines- Care of Women with Obesity in Pregnancy