Obesity in pregnancy = BMI โฅ30 kg/mยฒ. It is linked to increased maternal and fetal risks. Management must focus on prevention, monitoring, and reducing complications ๐ฉบ.
๐คฐ Maternal Risks
- ๐ฌ Gestational Diabetes (GDM): Insulin resistance โ risk โ requires early screening & monitoring.
- ๐ Preeclampsia: Higher risk of hypertensive disorders of pregnancy.
- ๐ฉธ Thromboembolism (VTE): Due to immobility + hypercoagulable state.
- ๐ชท Caesarean Delivery: โ elective & emergency C-sections, anaesthetic challenges.
- ๐จ Postpartum Haemorrhage: Uterine atony risk โ โ prophylactic oxytocics recommended.
- ๐ฆ Infection: Wound, urinary tract, and endometritis risk higher.
- ๐ด Sleep Apnoea: Risk of maternal hypoxia & cardiac stress.
๐ถ Fetal Risks
- ๐ Macrosomia: LGA โ shoulder dystocia, birth trauma.
- ๐ง Congenital Anomalies: NTDs, cardiac defects โ risk.
- โฐ๏ธ Stillbirth: Higher incidence of IUFD.
- โณ Preterm Birth: Spontaneous or iatrogenic preterm deliveries.
- ๐ Childhood Obesity: Long-term metabolic disease risk in offspring.
๐ฉบ Antenatal Care
- ๐งพ Preconception Counselling: Optimise weight & comorbidities before pregnancy.
- ๐ฌ Early GDM Screening: At booking + repeat at 24โ28 weeks.
- ๐ฉธ BP Monitoring: Frequent checks for preeclampsia risk.
- ๐ฅ๏ธ Ultrasound Monitoring: Growth scans for macrosomia/polyhydramnios.
- ๐ฅ Nutritional Counselling: Support safe gestational weight gain (per NICE guidance).
- ๐ถ Physical Activity: Encourage safe, low-impact exercise.
๐ Delivery Considerations
- ๐ชท C-Section Planning: Anticipate technical/anaesthetic challenges (airway, regional block).
- โฑ๏ธ Labour Management: โ monitoring; shoulder dystocia preparedness.
- ๐ฉธ PPH Prevention: Use prophylactic uterotonics; higher vigilance required.
- ๐งฆ VTE Prophylaxis: LMWH postnatally for high-risk women, especially post-C-section.
๐ธ Postpartum Care
- โ๏ธ Weight Management: Structured postpartum support to reduce risks in future pregnancies.
- ๐ผ Breastfeeding: Encouraged โ aids weight control, improves neonatal outcomes.
- ๐ฆ Infection Monitoring: Wound care & close review due to delayed healing risk.
๐ฎ Long-Term Considerations
- ๐คฐ Future Pregnancies: Strongly advise achieving healthy weight before next pregnancy.
- โค๏ธ Chronic Conditions: Higher lifetime risk of type 2 diabetes, hypertension, CVD.
๐ Key OSCE Pearls
- โ ๏ธ Always mention early GDM screening + growth scans.
- ๐ฉโโ๏ธ Remember anaesthetic risks in labour/delivery (airway, epidural).
- ๐ฉธ Always consider thromboprophylaxis after C-section in obese mothers.
- ๐ผ Promote breastfeeding for maternal & infant benefit.
๐ References