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OBESITY AND PREGNANCY
Dr. Osama Yahia
Afif General Hospital
• Overweight is defined as a body mass
index (BMI) of 25-29.9
• Obesity is defined as a BMI of 30 or
• There are 3 levels or classes within the
general category of obesity reflect the
increasing health risk.
• Lower risk (Class I) is a BMI of 30-34.4
• Medium risk (Class II) is a BMI of 35-39-
• Highest risk (Class III or morbid
obesity)- is a BMI of 40 or greater.
BODY MASS INDEX
• Is a simple index of weight-for-height and is
calculated by dividing a person’s weight in
kilograms by the square of their height in
• The prevalence of obesity
in pregnancy has been
increased from 9-10% in
the early 1990s to 16-19%
in the 2000s. (UK)
• 2/3 of US women of child
bearing age are obese or
RISK OF OBESITY DURING
• Depression and Anxiety
• Gestational Diabetes
• D.M in the future
• D.M of their children. Obese women are
screened for Gestational Diabetes and
screened later in pregnancy as well.
• Pre-eclampsia and Eclampsia: the baby may
need to delivered early.
• Stroke in rare cases
• Prolonged pregnancy
• Sleep apnea which
can cause fatigue,
high blood pressure,
eclampsia and heart
and lung disorders.
• Lower breastfeeding
• Induced labor
• Higher cesarean
• Dysfunctional labor
• Post partum
• Wound infection
• Maternal death
• Fetal Congenital Anomaly such as heart defects and
neural tube defects
• Problems with diagnostic tests. The too much body fat
can make it difficult to see certain problems with the
baby’s anatomy on an ultrasound exam. Checking the
baby’s heart rate during pregnancy may be difficult.
• Macrosomia with increase risk of injury of the baby
e.g. shoulder dystocia.
• Increased cesarean delivery
• Obesity of infants later in life, DM & heart diseases
• Preterm birth (2 folds increase) due to
problem associated with obesity such
as pre-eclampsia. Baby have an
increased risk of short-term and long-
term health problems.
• Stillbirth (2 folds risk) the higher the
BMI the greater the risk of still birth.
PRE PREGNANCY CARE
• Primary Care services should ensure that all
women of childbearing age have the
opportunity to optimize their weight before
• Women of childbearing age with a BMI ≥ 30
should receive information and advice about
the risks of obesity during pregnancy and
childbirth, and be supported to lose weight
• Losing weight before pregnancy is the
best way to decrease the risk of
• Losing a small amount of weight (5-
7% of weight or about 10-20 pounds)
can improve the overall health and
pave the way for healthier pregnancy.
• To lose weight more calories are used
than take in. This can be done by
eating healthy foods and exercise.
• Women will achieve & maintain a healthy
weight before, during and after pregnancy if they:
base meals on starchy foods such as potatoes, bread, rice and
Eat fibre-rich foods such as oats, beans, peas, lentils, grain seeds,
fruit and vegetables, as well as wholegrain bread and brown rice
Eat low fat diet and avoid increasing their fat and/ or calorie
Eat at least five portions of variety of fruits and vegetables each
day, in place of foods higher in fat and calories.
Eat as little as possible of fried food, drinks and confectionery high
in added sugars such as cakes, pastries and frizzy drinks; and other
food high in fat and sugar such as some take-away and fast foods.
Watch the portion size of meals and snacks, and how often they
• Make activities such as walking, cycling,
swimming, aerobics and gardening part of
everyday life and build activity into daily
life for example by taking the stairs instead
of the lift or taking a walk at lunchtime.
• The aim is to be moderately active ( for
example biking, brisk walking and general
gardening)for 60 minutes, or vigorously
active (jogging, swimming laps) for 30
minutes on most days of the week. It does
not have to do this amount at once. For
instance, exercise 20 minutes 3 times a
• Minimize sedentary activities, such as
sitting for long periods watching television, at a
computer or playing videogames.
• Walk, cycle or use another mode of transport
involving physical activities.
• If trial to lose weight through diet change or
exercise and still BMI of 30 or greater or a BMI
of at least 27 with certain medical conditions,
such as diabetes or heart disease, weight-loss
medications may be suggested.
• Those medications should not be taken if the
obese woman is trying to become pregnant or
is already pregnant.
• Bariatric Surgery may be an option for people
who are very obese or who have major health
problems caused by obesity. If weight loss surgery has
done, pregnancy should be delayed for 12-24 months
• If there are fertility problems they may resolve on
their own with rapidly lose the excess weight. It is
important to be aware of this because the increase
in fertility can lead to unplanned pregnancy.
• Some types of Bariatric Surgery may affect how the
body absorbs medications taken by mouth,
including birth control pills, switch to another form
of birth control may be needed.
• Despite the risk, obese woman can have a
healthy pregnancy. She takes careful
management of weight, attention to diet and
exercise, regular prenatal care to monitor for
complications, and special considerations for
labor and delivery.
• Women with a BMI ≥30 wishing to become
pregnant should be advised to take 5mg folic
acid supplementation daily, starting at least one
month before conception and continuing during
the first trimester of pregnancy.
• All pregnant women should have their weight
and height measured, and their body mass
index calculated at the antenatal booking visit.
• All pregnant women with a booking BMI ≥30
should be provided with accurate and
accessible information about the risks
associated with obesity in pregnancy and how
they may be minimized.
• Pregnant women with booking BMI ≥40
should have an antenatal consultation with an
obstetric anaesthetist, so that potential difficulties
with venous access, regional or general anethesia
can be identified.
• Women with booking BMI≥30 should be
assessed at their first antenatal visit and through
pregnancy for the risk of thromboembolism.
Antenatal and post delivery thromboprophylaxis
should be considered.
• Women with booking BMI ≥35 have an increased
risk of pre-eclampsia and should have
surveillance during pregnancy.
• All pregnant women with a booking BMI ≥30
should be screened for gestational diabetes
• Women with booking BMI ≥30 are advised to
take 10 micrograms Vitamin D supplementation
daily during pregnancy and while breastfeeding.
• Finding a balance between eating healthy foods
and staying at a healthy weight is important. In
the 2nd and 3rd trimester, a pregnant woman
needs an average of 300 extra calories a day.
• Dieting during pregnancy is not recommended as
it may harm the health of unborn child.
• Exercise during pregnancy: pregnant women
begins with 5 minutes of exercise a day and add
5 minutes each week. The goal is to stay active
for 30 minutes on most –preferably all-days of
the week. Walking is a good choice if she is new
to exercise. Swimming is another good exercise
for pregnant women. The water supports their
weight and can avoid injury and muscle strain.
• Weight will be tracked at each prenatal visit.
The growth of their babies will be checked.
• If they are gaining less than the
recommended guidelines, and if their
babies are growing well, they do not have to
increase their weight gain. If their babies
are not growing well, change may need to
be made to their diet & exercise plan.
• Overweight and obese women have longer labors than women of
normal weight. It can be harder to monitor the baby during labor.
For these reasons, obesity during pregnancy increase the
likelihood of having a cesarean delivery. If a caesarean delivery is
needed, the risk of infection , bleeding and other complications
are greater for an obese woman than for a woman of normal
• Women with booking BMI ≥30 should have individualized decision
• Women with BMI ≥ 35 should give birth in a consultant-led
obstetric unit with appropriate neonatal services.
• In the absence of other obstetric or medical indication obesity
alone is not and indication for induction of labor and a normal
birth should be encouraged.
• The duty Anesthetist covering labor ward should
be informed when a woman with a BMI ≥40 is
admitted to the labor if delivery or operative
intervention is anticipated.
• All women with BMI ≥30 should be
recommended to have active management of
the 3rd stage of labor.
• Women with a BMI ≥30 having cesarean section
have increased risk wound infection and should
receive prophylactic antibiotics at the time of
CARE AFTER DELIVERY
• Stick to healthy eating and exercise habits to
reach a normal weight.
• Breastfeeding is recommended for the first year
of a baby’s life, not only is breastfeeding the best
way to feed the baby, it also may help with post
partum weight loss. Women who breastfeed their
babies for at least a few months tend to lose
pregnancy weight faster than women who do not
• All women with BMI ≥30 who have been
diagnosed with gestational diabetes should have a
test of glucose tolerance approximately 6 weeks
POST NATAL CONTRACEPTION
• IUDs and contraceptive implants are the most
effective contraceptives for obese women.
Contraceptive pills, patches and vaginal rings
are effective options; however obese women
should be made aware of a potential
increased risk of venous thromboembolism.
• Vasectomy & hysteroscopic sterilization carry
the least surgical risk for obese women.