Obesity is becoming increasingly common amongst the UK population and has emerged as one of the key risk factors in obstetric care. According to the Royal College of Obstetrician and Gynaecologists (RCOG) detailing the Care of Women with Obesity in Pregnancy, women who are obese are at an increased risk of complications related to pregnancy compared to those of a healthy BMI.
Pregnant women with obesity are at increased risk the following conditions:
- miscarriage
- gestational diabetes
- pre-eclampsia
- foetal macrosomia
Understanding these risks and the recommended strategies is important to those who are obese and pregnant in to maintain a healthy pregnancy.
What is Obesity in Pregnancy?
In 2018 according to the article Care of Women with Obesity in Pregnancy, 21.3% of pregnant women are classified as obese, while fewer than half (47.3%) have a body mass index (BMI) within the normal range.
Obesity in Pregnancy refers to people who enter pregnancy with a BMI of 30 or above.
However, it is important to note that you should not try and lose weight during your pregnancy. This weight loss will not reduce the chance of complications and may not be safe to yourself and your pregnancy. (1)
BMI categories for adults:
What are the risks for Obesity and Pregnancy?
The best way to protect yourself and your pregnancy is to attend all your antenatal appointments. This ensures your midwife, doctor and other health professionals can help you throughout and take the steps to manage or prevent any problems that may arise. (1)
What are the maternal risks?
1. Gestational Diabetes Mellitus (GDM)
If you are obese in pregnancy this is a risk factor for gestational diabetes, this means you will be offered a test for gestational diabetes, the screening test is called an oral glucose tolerance test (OGTT) which will take around 2 hours. This test is done between 24 and 28 weeks pregnant. (2)
You can find out more about how gestational diabetes is treated here.
2. Pre-eclampsia and hypertension
Women with obesity have a significantly higher risk of developing pregnancy-induced hypertension known as high blood pressure during pregnancy and preeclampsia, a condition characterised by high blood pressure and signs of damage to other organ systems.
3. Increased risk of miscarriage and stillbirth
People who are obese before and during pregnancy are more likely to develop conditions such as gestational diabetes and a preeclampsia which can negatively impact the pregnancy. Complications resulting in miscarriage and still birth can occur due to placental dysfunction and umbilical cord complications.
4. Increased chance of caesarean section and surgical complications
The risk of complications is increased during labour and giving birth in those who are obese.
Complications include:
- Preterm birth – your baby being born before 37 weeks of pregnancy
- A longer period being in labour
- Your baby may become ‘stuck’ during birth this is known as shoulder dystocia
- You may also have to have an emergency caesarean section to deliver your baby.
You are more likely to have an instrumental delivery or a caesarean section if you are obese while pregnant. It is mostly likely you will discuss labour pain relief with an anaesthetist. You may experience more complications during the caesarean section or after including heavy bleeding, wound infection and anaesthetic complications.
Risks for your baby if you're overweight in pregnancy
Stillbirth
Problems for your baby can include being born early (before 37 weeks), and an increased chance of stillbirth. Please note that not all still births can be prevented, but there are some things you can do to reduce the risk. Advice can be found here.
Other health conditions
There is also a higher chance of your baby having a health condition, such as a neural tube defect like spina bifida or heart defects.
Obesity in pregnancy may also result in large-for-gestational-age (LGA) babies or birth injuries as a result from difficult labor.
Obesity in pregnancy can also lead to increased risk of childhood obesity and type 2 diabetes.
RCOG Guidelines on Obesity in Pregnancy
The RCOG (Royal College of Obstetricians and Gynaecologists) provides evidence-based guidance for managing obesity in pregnancy.
A summary of the recommendations include:
- Preconception care: Women with obesity should receive counselling about weight management before pregnancy.
- BMI measurement at booking: Early antenatal care should include BMI recording to identify risks.
- Nutritional guidance: Encourage a healthy, balanced diet rather than weight loss during pregnancy.
- Physical activity: Safe exercise such as walking, swimming, or prenatal yoga is recommended.
- Increased monitoring: Extra scans may be needed to monitor foetal growth.
- Delivery planning: Women with high BMI may require consultant-led care and planned delivery strategies.
Why is it important to manage obesity during pregnancy?
Managing obesity in pregnancy not only improves pregnancy outcomes but can also reduce long-term health risks for both the person who is pregnant and the baby. Children of maternal obesity are more likely to develop metabolic disorders in their lifetime whereas the person facing obesity in pregnancy may experience a higher lifetime risk of cardiovascular disease and type 2 diabetes.
Obesity and pregnancy require careful medical attention and lifestyle management. However, it is important that you do not try to lose weight while pregnant and make sure you attend all medical appointments throughout your pregnancy. Following the RCOG guidelines will help to reduce risks and potentially improve health outcomes. With appropriate antenatal care, nutrition and support women with obesity in pregnancy can have safe and healthy pregnancies.
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