Makindo Medical Notes

Definition

Obesity during pregnancy is defined as a body mass index (BMI) of ≥30 kg/m². It is associated with increased maternal and fetal risks and requires specific management strategies to minimize complications.

Maternal Risks

• Gestational Diabetes Mellitus (GDM): Increased risk due to insulin resistance.
• Preeclampsia: Higher incidence of hypertension and preeclampsia.
• Thromboembolism: Higher risk of venous thromboembolism (VTE) - reduced mobility/increased blood coagulability.
• Caesarean Delivery: Increased likelihood of a caesarean section, both elective and emergency.
• Postpartum Hemorrhage: Increased risk of excessive bleeding after delivery.
• Infection: Higher risk of wound infections, urinary tract infections, and endometritis.
• Sleep Apnoea: Obesity can lead to obstructive sleep apnoea, risks of hypoxia and cardiovascular complications .

Fetal Risks

• Macrosomia: Increased likelihood of large-for-gestational-age (LGA) babies, leading to delivery complications like shoulder dystocia.
• Congenital Anomalies: Increased risk of neural tube defects, heart defects, and other congenital anomalies.
• Stillbirth: Higher risk of intrauterine fetal demise (IUFD).
• Preterm Birth: Higher risk of spontaneous and medically indicated preterm deliveries.
• Childhood Obesity: Offspring of obese mothers are more likely to develop obesity and metabolic disorders in later life.

Antenatal Care

• Preconception Counseling: Discuss weight loss and healthy BMI before conception to minimize pregnancy risks.
• Regular Screening for GDM: Early screening for gestational diabetes is recommended, with follow-up testing in the second trimester.
• Blood Pressure Monitoring: Frequent monitoring of blood pressure to identify and manage preeclampsia early.
• Ultrasound Monitoring: More frequent fetal growth scans to monitor for fetal macrosomia and amniotic fluid abnormalities.
• Nutritional Counseling: Provide guidance on appropriate weight gain, emphasizing a balanced diet rich in vitamins and minerals.
• Physical Activity: Encourage regular physical activity tailored to the patient’s ability and safety.

Delivery Considerations

• Caesarean Section: Increased risk due to obesity-related complications. Plan appropriately, considering anaesthesia risks (e.g., difficult intubation or epidural placement).
• Labour Management: Careful monitoring of labour progression, potential complications like fetal distress or shoulder dystocia.
• Postpartum Haemorrhage Prevention: Prophylactic use of uterotonics may be needed to prevent hemorrhage.
• Venous Thromboembolism Prevention: Consider thromboprophylaxis for high-risk patients, especially after caesarean delivery.

Postpartum Care

• Weight Management: Discuss postpartum weight loss strategies to minimize future risks in subsequent pregnancies and overall health.
• Breastfeeding: Encourage breastfeeding, which can assist in weight loss and improve the baby's health.
• Monitor for Complications: Increased risk of postpartum infections and delayed wound healing should be monitored closely.

Long-Term Considerations

• Future Pregnancies: Counsel patients on the importance of achieving a healthy weight before future pregnancies to reduce maternal and fetal risks.
• Chronic Conditions: Monitor and manage the increased risk of chronic conditions like diabetes, hypertension, and cardiovascular disease in women with a history of obesity during pregnancy.

Obesity during pregnancy presents significant risks for both the mother and fetus. Proper antenatal care, including early screening for gestational diabetes, blood pressure monitoring, and fetal growth assessments, is essential for minimizing complications. Management should include lifestyle modifications, nutritional counseling, and regular physical activity. Delivery and postpartum care require careful planning to mitigate risks such as caesarean section, postpartum hemorrhage, and venous thromboembolism.