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.