Obesity in Pregnancy

Last updated 05.10.12


 

Definition

- Obesity during pregnancy

 

Features

- Increasingly common & clinically important

- Around 50% pregnant women are either overweight or obese

 

Complications

- Antenatal

- GDM

- Miscarriage

- Stillbirth

- Pre-eclampisa

- VTE: DVT, PE

- OSA

- Maternal death

- IUGR, macrosomia

- Intrapartum

- IOL

- Failure to progress

- Assisted delivery

- LUSCS

- PPH

- Shoulder dystocia

- Difficulty with fetal monitoring (CTG, etc.)

- Difficult labour analgesia

- Anaesthetic

- Positioning

- Spinal &/or Epidural placement

- Maintaining airway

- Increased need for ICU post delivery

- Post Partum

- Delayed wound healing

- Increased wound infection

- Greater need for breast feeding support

- PND

 

Complications

 

Ix

- BMI

- Ideally pre-pregnancy otherwise at first available visit

- OGTT at 14/40 & 26/40: GDM, DM2

 

Mx

- Expected weight change in pregnancy

- +/- Aspirin 100mg from 14/40

- Supplementation

- Increased folate requirements: 5mg Daily if BMI >30

- Iodine 150mcg

- Viramin D

- Dietician & exercise physiologist R/V

- Mobilisation & VTE risk

- Influenza vaccination as increased risk of morbidity

- Anaesthetic assessment prior to delivery for suitability for local obstetric service

- Labour

- IV access when in labour if BMI >40

- Early Epidural if indicated

- Early notification of anaesthetics

   

 

References

 

NICE guidelines

RANZCOG Management of Obesity in Pregnancy, C-Obs 49, March 2013