Pregnancy in an obese woman

Preparation for pregnancy in an obese woman

It is recognized that weight reduction is the most important goal in preparation for pregnancy. This increases the chances of getting pregnant and reduces the risk of complications during pregnancy. It is also necessary to supplement folic acid at a dose 2 times higher (800ug/day) than women of normal weight. It is also recommended to perform an OGTT test during the preconception period in women with insulin resistance.

Pregnancy in an obese woman

A mother-to-be should not gain more than 7 kg throughout her pregnancy if she was previously obese. It is necessary to take care of diet and regular meals. Physical activity is also important. It is recommended min. 150 minutes of physical activity per week. Ideally, this includes walking, running or stationary biking, and swimming. Thromboprophylaxis with low-molecular-weight heparins is also a very important issue in obese pregnant women. The decision to use them is made by the attending physician. It is recommended for women with 2. degree of obesity, as well as those with thrombosis risk factors.  

Complications of pregnancy in an obese woman

Pregnancy in a woman with obesity is associated with possible complications. These can be divided into fetal complications, maternal complications and those associated with childbirth. Among them are: recurrent miscarriages, fetal defects, abnormal growth – growth restriction (SGA. FGR) or macrosomia (LGA). The mother-to-be is more likely to develop hyperglycemia, hypertension, venous thrombosis or recurrent urinary tract infections. This, in turn, implies further complications of pregnancy such as the risk of shoulder dystocia, development of pre-eclampsia or pyelonephritis.

Woman with obesity and childbirth

Obesity in itself is not an indication for a cesarean section. However, it is important to remember that complications in an obese woman occur not only during pregnancy, but can also occur during childbirth. Obese women are more likely to have a surgical delivery, perineal damage, shoulder dystocia or perinatal hemorrhage. Wounds from perineal sutures or cesarean sections also heal worse and are more likely to become infected.

Pregnancy in an obese woman is a high-risk pregnancy, so it is recommended that the mother-to-be be under the care of doctors in the center by 3. degree of reference.

Bibliography:

Guidelines of the Polish Society of Gynecologists and Obstetricians on the obstetric care of women with obesity, Ginekologia Polska 2023