Clinical management of obesity in pregnancy

doi:10.1017/CBO9780511782466.019

18 - Clinical management of obesity in pregnancy

from Section 5 - Management and policy

Published online by Cambridge University Press: 05 August 2012

Carolyn Chiswick and

Fiona C. Denison

Edited by

Matthew W. Gillman and

Lucilla Poston

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Matthew W. Gillman: Affiliation:
Harvard Medical School
Lucilla Poston: Affiliation:
King's College London

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Summary

Introduction

Obesity is now the commonest antenatal co-morbidity. With one in five of theantenatal population in both the US and the UK being obese, maternal obesitywill inevitably be encountered by all obstetricians, from those with aspecial interest in high-risk obstetrics, to those covering the deliverysuite out of hours. Therefore it is essential that all clinicians have theknowledge and expertise to manage obese women during pregnancy andlabor.

As reviewed in Chapter 4 pregnant women who are obese are at greater risk ofa wide range of pregnancy complications from pre-pregnancy, throughout theantenatal period, intrapartum, and postnatally (Table 18.1). The offspringof obese mothers are also at greater risk of perinatal morbidity andlong-term health problems. There are also technical challenges such as theavailability of appropriate equipment and moving and handling problems.

This chapter aims to provide a summary of the clinical management of obesityin pregnancy, based on evidence where it exists, and highlighting areaswhere further research is needed.

Pre-pregnancy care

Primary care services have a responsibility to ensure that all women ofchildbearing age are aware of the excess risks associated with obesity inpregnancy [ 1 ] . Any visit to a health care provider by a young woman whois overweight should be viewed as an opportunity to advise about the beneits of weight loss and strategies to achieve this [ 2 ]. Overweight womenplanning a pregnancy should be given the opportunity and encouragement tooptimize their pre-pregnancy weight. Losing 5% to 10% of their body weightprior to conception has signii cant health benei ts [3, 4] . For example,minimal weight loss in women with polycystic ovarian syndrome andanovulation can result in ovulation induction, restoration of fertility, andspontaneous conception. Rapid weight loss immediately prior to pregnancyshould not be encouraged as it is associated with poorer outcomes [2].

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Type: Chapter
Information: Maternal Obesity , pp. 223 - 236

DOI: https://doi.org/10.1017/CBO9780511782466.019 [Opens in a new window]

Publisher: Cambridge University Press

Print publication year: 2012

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