Table 4.
Adjustments to Routine Prenatal Care in Obese Pregnant Women
| Risk Factor | Recommended Care |
| Increased risk of neural tube defect | • Preconception folic acid supplementation (4 mg daily ideally 3 months prior to pregnancy through the first trimester) |
| • Maternal serum AFP (15–20 weeks) | |
| • Detailed fetal anatomy survey (18–20 weeks) | |
| Increased risk of hypertensive disorders of pregnancy, including preeclampsia | • Baseline 24-hour urinalysis in second trimester |
| • Baseline liver and renal function tests in second trimester | |
| • Blood pressure and urine dip for protein at each prenatal visit | |
| • There is no effective way to prevent preeclampsia | |
| Increased risk of gestational diabetes (GDM) | • Consider early screening with 1-hour nonfasting 50-g glucose load test (GLT) at 16–20 weeks. If positive, check a definitive 3-hour 100-g glucose tolerance test (GTT) to confirm the diagnosis of GDM. If negative, repeated GLT at the usual gestational age of 24–28 weeks |
| Increased risk of unexplained stillbirth | • Consider weekly antepartum fetal testing with NST and/or BPP beginning at 36 weeks, especially in women with a BMI ≥ 40 kg/m2 (although this has not been shown to definitively improve perinatal outcome) |
| Increased risk of anesthesia complications | • ACOG recommends a prelabor or early intrapartum anesthesia consultation for all women with a BMI ≥ 40 kg/m2 |
| • Consider early epidural placement in labor | |
| • Recheck epidural placement if the patient is transferred to the operative room for cesarean delivery because of increased risk of migration of the epidural catheter | |
| Failure to lose weight after delivery is associated with subsequent adverse maternal health problems, including complications of future pregnancies | • Continue nutrition counseling and exercise program after delivery |
| • Consider consulting a weight loss specialist to optimize postpartum weight loss before attempting another pregnancy | |
| • If complicated by GDM, check 2-hour 75-g GTT at or after 6-week postpartum visit |
ACOG, The American College of Obstetricians and Gynecologists; AFP, α-fetoprotein; BMI, body mass index; BPP, biophysical profile; NST, non-stress test.