Obesity is increasingly common and has an impact on a wide range of issues in pregnancy. Overweight women and pregnancy is an important concern. Here is how it can be managed well during your entire pregnancy:

In 1st trimester

  • Nutritional counselling and tailor-made diet plans are important as they need quality nutrition and at the same time should not put on too much weight.
  • They need to be screened for Glucose Intolerance / Diabetes.
  • The baseline BP should be recorded with the correct size of the cuff.
  • The prenatal test has lesser accuracy in obese/overweight women.
  • The Invasive procedures (amniocentesis and CVS) are difficult to perform in obese/overweight women. The risk of pregnancy loss after these procedures is higher in women with BMI > 40.

In 2nd trimester

  • The ultrasound is done for assessing the anatomy. This is challenging as it is difficult to see fetus due to abdominal fat and therefore some abnormalities may be missed.
  • Obese women have a higher risk of preeclampsia and diabetes. Therefore, regular assessment of the mother and baby is required.

In 3rd Trimester

  • The labor may be difficult and prolonged as the fetus may be overweight too.
  • There are increased chances of requiring instrumental delivery (vacuum or forceps) and thereby increasing chances of pelvic floor injuries to the mother and traumatic injuries to the newborn babies.
  • There is an increased risk of Emergency Caesarean Section due to obstructed labor.
  • Obesity and pregnancy are independent risk factors for venous thrombo-embolism. Therefore, the patient may require prophylaxis in the antenatal and postpartum periods.

Post-Partum

  • For contraception, intrauterine devices are an excellent choice for obese/overweight women.
  • There are no medicines that can help weight loss except when one has diabetes or glucose intolerance.
  • Bariatric surgery may have a role in the morbidly obese.

Pregnancy after Bariatric Surgery