Obesity and Pregnancy

Originally written By: Sean Bourke, MD, Edited by Karen Callen, MD

For many women, weight management is a lifelong challenge, and planning to become pregnant can be great a motivator for adopting a healthy lifestyle. Knowing the facts about excess maternal weight with its attendant health risks for moms and babies, can help inform the choices obese women make while planning pregnancy and once they have conceived.

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Obesity is defined as having a body mass index of 30 Kg/square meters or more, or being approximately 30 pounds above a normal weight. We calculate and record your BMI at every office visit and you can calculate your BMI yourself if you know your height and weight.

For a woman of reproductive age, obesity is correlated with subfertility, infertility and increased risk for several pregnancy complications.

Prior to becoming pregnant, an obese woman can expect a higher chance than her normal weight counterpart to experience the following:

  • Subfertility most commonly related to ovulatory dysfunction
  • Increased time to pregnancy and decrease spontaneous pregnancy rates even in ovulatory women.
  • Lower success rates with fertility treatments including IVF
  • Requirement of higher doses of ovulatory agents

 Once pregnant, an obese woman faces higher risks for pregnancy complications including:

  • Higher miscarriage rates
  • Higher rates of non-identical twins
  • Gestational and Type II diabetes
  • Pregnancy associated high blood pressure
  • Pre-term birth, both spontaneous and indicated
  • Going past the due date
  • Urinary tract infections
  • Obstructive sleep apnea
  • Increased need for induction of labor

 During labor and delivery, the complications associated with obesity include higher risks for:

  • Longer labors
  • Increased size of babies with increased risk for shoulder dystocia (baby getting stuck after delivery of the head)
  • Increase rate of cesarean delivery
  • Lower success rates of vaginal birth after cesarean
  • Higher epidural anesthetic failure rates
  • Severe perineal tears
  • Excessive bleeding with delivery

 For an obese woman, after giving birth, there are increased rates of:

  • Difficulty in initiating and maintaining breastfeeding
  • Prolonged hospitalization due to complications from infection and hemorrhage
  • Life threatening venous blood clots

As part of pregnancy planning, it is our goal at Golden Gate to address the problem of obesity prior to conception if at all possible. Achieving goals for healthy weight gain during pregnancy for all women helps to minimize the challenge of losing “baby fat” in the postpartum period. This helps to prevent the cycle of ever increasing weight with each pregnancy. We recommend a medically supervised weight loss program for women who need extra assistance, and we have worked well with the team of experts at JumpstartMD who provide women with the nutritional guidance and emotional support necessary to achieve and maintain more healthy weights. Getting it right prior to conception and after delivery sets the stage for healthier moms and kids for many years to come!

UpToDate for Patients: For more information on weight loss, consult the medical information resource doctors trust


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