Table 3.

Good clinical practice recommendations for pregnancy obesity (timepoint B)

Recommendation		Strength
B.1.1	All pregnant women should have their height and weight measured at their first antenatal visit. This can be used to calculate body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters). Data should be recorded in the medical records.	Conditional
B.1.2	Approaches to monitor and manage gestational weight gain should be integrated into routine antenatal care practices.	Strong
B.1.3	Pregnant women with a BMI ≥30 should be advised to avoid high gestational weight gain. Weight gain should be limited to 5–9 kg.	Strong
B.2.1	The mainstay of weight management during pregnancy is diet and exercise. Health professionals should provide general nutrition information and advice on a healthy diet to manage weight during pregnancy. Where resources permit, individual plans for diet and exercise for weight management should be put in place.	Conditional
B.2.2	Moderate intensity and appropriate exercise should be encouraged during pregnancy.	Strong
B.2.3	Women with obesity should continue to take folic acid during at least the first trimester.	Strong
B.2.4	Women with previous bariatric surgery require closer screening and monitoring of their nutritional status and fetal growth throughout pregnancy. They should be referred to a dietitian for advice about their nutritional needs and, where possible, have consultant‐led care.	Conditional
B.3.1	All pregnant women with obesity in early pregnancy should be provided with accurate and accessible information about the risks associated with obesity and how they may be minimized.	Conditional
B.3.2	Women should be informed that some screening processes for chromosomal anomalies are less effective in obesity.	Strong
B.3.3	All pregnant women should be advised individually on mode of delivery, considering the risk of emergency cesarean delivery.	Conditional
B.4.1	Where possible, healthcare facilities should have clearly defined pathways for the management of pregnant women with obesity. The adequacy of resources and equipment available should be considered when making decisions around care, especially for women with a BMI ≥40.	Conditional
B.4.2	Women with obesity with multiple gestations require increased surveillance and may benefit from consultation with a maternal–fetal medicine consultant.	Strong
B.4.3	All pregnant women with a BMI ≥30 should be screened for gestational diabetes in early pregnancy.	Strong
B.4.4	Where available, an appropriately sized blood pressure cuff should be used for measurements. The cuff size used at the earliest time point should be documented in the medical records.	Conditional
B.4.5	To help prevent pre‐eclampsia, prophylactic aspirin from early pregnancy can be recommended to women with obesity who have other moderate to high risk factors.	Strong
B.4.6	Clinicians should be aware that women with a BMI ≥30, before pregnancy or in early pregnancy, have a pre‐existing risk factor for developing venous thromboembolism during pregnancy. Risk of antenatal and postnatal venous thromboembolism should be assessed.	Strong
B.4.7	If available, women with a BMI ≥35 should be referred for serial assessment of fetal size using ultrasound as they are more likely to have inaccurate symphysis–fundal height measurements.	Conditional
B.4.8	Due to the elevated risk of stillbirth associated with obesity, greater fetal surveillance is recommended in the third trimester in the case of reduced fetal movements.	Conditional
B.4.9	Women with a BMI ≥30 are at increased risk of mental health problems, including anxiety and depression. Healthcare professionals should offer psychological support, screen for anxiety and depression, and refer for further support where appropriate and available.	Strong
B.4.10	Induction of labor is recommended at 41+0 weeks of gestation for women with a BMI ≥35 owing to their increased risk of intrauterine death.	Strong
B.4.11	Women with a BMI ≥40 should be referred to an anesthetist for assessment in the antenatal period.	Conditional
B.4.12	Electronic fetal monitoring is recommended for women in active labor with a BMI ≥35. Intrauterine pressure catheters and fetal scalp electrodes may help.	Conditional
B.4.13	In the case of vaginal delivery for women with a BMI ≥40, early placement of an epidural catheter is advisable in the case of an emergency cesarean delivery.	Conditional
B.4.14	Establish venous access in early labor for women with a BMI ≥40 and consider a second cannula.	Conditional
B.4.15	Women with a BMI ≥30 having a cesarean delivery are at increased risk of wound infection and should receive prophylactic antibiotics at the time of surgery. Women with obesity may benefit from higher doses.	Strong
B.4.16	Active management of the third stage should be recommended to reduce the risk of postpartum hemorrhage.	Strong
B.4.17	Postoperative pharmacologic thromboprophylaxis should be prescribed based on maternal weight.	Conditional
B.4.18	Mechanical thromboprophylaxis is recommended before and after cesarean delivery. Where available, women with a BMI ≥35 should be given graduated compression stockings, or other interventions such as sequential compression devices, after cesarean delivery until mobilization, which should be encouraged early.	Conditional