Antenatal care for obese women

26.1

Introduction

• Obesity poses an increased risk for women before, during, and after pregnancy.

• Traditionally obesity is calculated using weight and height and is classified by the WHO (World Health Organization) into class I BMI (Body Mass Index) 30.0–34.9, class II 35.0–39.9, and class III 40 or greater

• Obesity is a worldwide pandemic but the prevalence is not uniform across different regions and countries.

26.2

According to the WHO (2016) report

• In the United States, approximately 70% of women are overweight or obese.

• The prevalence was 67% in United Kingdom;

• 59% in Sweden;

• 29% in Japan; and.

• Only 20% in India.

• Although these figures may help target the approaches against obesity associated comorbidities, individualised approaches are required in different regions.

• Nevertheless, the principles of management remain the same and will be addressed in this chapter.

26.3

Antepartum care of obese women

Obesity in pregnancy is associated with increased risks of the following:

• Miscarriage

• Congenital abnormalities

• Gestational diabetes

• Hypertensive disorders of pregnancy

• Venous thromboembolism (VTE).

• Foetal risks, including macrosomia which increases the risk of shoulder dystocia with its sequalae as brachial plexus injury, still birth, and prematurity.

• Intrapartum changes and risks as difficulties in placing venous access, in palpating the presenting parts or foetal size, and in recording external foetal heart rate tracing.

• Dysfunctional and prolonged labour, increased caesarean section, less rates of successful vaginal birth after caesarean section

• Anaesthetic complications: obese women are at higher risk of anaesthesia-related complications including higher initial failure rate of epidural insertion, increased resite rates and failed intubation.

• Obesity is regarded as a significant risk factor to maternal mortality from anaesthetic complications.

• Postpartum risks including postpartum haemorrhage, wound infections, and wound dehiscence.

• VTE.

• Lower rates of initiation and maintenance of breast feeding.

• Postpartum weight retention for the mother.

• COVID-19: obesity increases the morbidity and mortality from Coronavirus-19 infection and this seems independent of other risk factors.

26.4

Prepregnancy counselling

• An excellent opportunity to initiate and counsel regarding healthy lifestyle, eating, and exercise as well as optimising health and weight loss before embarking on the pregnancy.

• If the woman has undergone bariatric surgery, she should be advised to wait for 12–18 months before getting pregnant.

• During this time these women are usually actively losing most weight to optimise the weight loss. Additionally, it gives time to address nutritional deficiencies.

26.5