Table 3.
Suggested recommendations for the clinical care of obese women before, during and after pregnancy (modified from Yu et al. 59 and Ramsay et al. 34)
| Prepregnancy |
| Counsel for prepregnancy weight loss through lifestyle modification, including diet and regular exercise |
| Encourage folate supplementation and consider higher dose of 5 mg a day |
| Antenatal |
| Booking |
| Weigh all mothers and calculate BMI to identify individuals at risk |
| Advise on risks of obesity in pregnancy |
| Discuss recommended weight gain during pregnancy according to pre-pregnancy BMI |
| Refer to dietician for dietary advice |
| Suggest regular moderate-intensity activity, unless contraindicated |
| Recommend detailed anomaly scan and serum screening for congenital abnormality |
| Diabetes |
| Consider screening for GDM |
| Hypertension |
| Consider screening for preeclampsia by uterine artery Doppler if facilities permit |
| Recommend low dose aspirin as prophylaxis against preeclampsia |
| Provide regular antenatal visits with blood pressure checks |
| Thromboembolism |
| Assess thrombosis risk and provide thromboprophylaxis with adequate dose of anticoagulant for an appropriate duration if required |
| Anaesthetic review |
| Consider anaesthetic review before delivery |
| Regional anaesthesia usually preferred unless contraindicated |
| Anticipation of problems and effective preparation in terms of equipment, monitoring and personnel |
| General anaesthesia, if required, should be delivered with tracheal intubation and controlled ventilation |
| General |
| Plan delivery to allow optimum management by experienced obstetricians |
| Postpartum |
| Postoperative care that includes close monitoring, early mobilization and physiotherapy; a high-dependency setting may be appropriate |
| Consider prophylactic postpartum antibiotics if vaginal delivery is complicated and provide perioperative antibiotics for caesarean delivery |
| Judicious use of neuraxial, oral and intravenous opioids for postoperative pain |
| Encourage breastfeeding and provide specific support |
| Encourage weight loss and increased physical exercise prior to next pregnancy |
| Assess thrombosis risk postpartum and ensure good hydration and early mobilization after any operative delivery and specific antithrombotic interventions including graduated elastic compression stockings and/or pharmacological thromboprophylaxis if indicated |
| Consider extended thromboprophylaxis after discharge |
| Arrange postnatal review at six weeks to discuss any problems and potential for future intervention |
BMI = body mass index; GDM = gestational diabetes milletus