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Care of Women with Obesity in Pregnancy (Green-top Guideline No. 72)

Published: 22/11/2018

Access the PDF version of the guideline

 

This is the second edition of this guideline. The first edition was published in 2010 as a joint guideline with the Centre of Maternal and Child Enquiries under the title Management of Women with Obesity in Pregnancy.


Obesity is becoming increasingly prevalent in the UK population and has become one of the most commonly occurring risk factors in obstetric practice with 21.3% of the antenatal population being obese and fewer than one-half of pregnant women (47.3%) having a body mass index (BMI) within the normal range. Pregnant women who are obese are at greater risk of a variety of pregnancy-related complications compared with women of normal BMI, including pre-eclampsia and gestational diabetes. Pregnant women who are obese are also at increased risk of caesarean birth. Maternal size can make the assessment of fetal size, presentation and external monitoring of fetal heart tracing more challenging during pregnancy. Initiation and maintenance of breastfeeding are also more difficult in the women with obesity.

While the majority of the recommendations within this guideline pertain to women with a BMI 30 kg/m2 or greater, some recommendations are specific to women in the higher classes of obesity only. Obese women with a BMI below a specified threshold may also benefit from recommendations in a higher BMI group, depending on individual circumstances. However, the chosen BMI cut-offs reflect careful consideration given to the balance of medical intervention versus risk, differences in local prevalence of maternal obesity and resource implications for local healthcare organisations.

The recommendations cover interventions prior to conception, and during and after pregnancy.

 


Declarations of interest

Professor FC Denison MRCOG, Edinburgh: Professor Denison has several grant applications pending and has design protection rights for a device. Professor Denison is also Vice Chair of NICE MTAC Board and a Member of Grant Awarding Bodies (Tenovus, CSO).

Dr NR Aedla MRCOG, Edinburg: None declared.

Dr O Keag MRCOG, Edinburgh: None declared.

Dr K Hor, Speciality Trainee, Princess Royal Maternity Hospital, Glasgow: None declared.

Professor RM Reynolds FRCP, FRCPE, Professor of Metabolic Medicine and Honorary Consultant Physician, University of Edinburgh and Edinburgh Royal Infirmary: None declared.

Dr A Milne, Consultant Obstetric Anaesthetist, Edinburgh Royal Infirmary: Dr Milne had received an Edinburgh and Lothian’s Health Foundation £33,458 grant for project entitled, ‘Integrated ultrasound needle to facilitate placement of regional anaesthesia in obese pregnant women.”

Mrs A Diamond, Weight Management and Specialist Bariatric Dietician, Edinburgh Royal Infirmary: Mrs Diamond has received honoraria for diet input to SPCDs study day. Mrs Diamond has also received payment for diet/lifestyle lecture on diabetes course (Oct 2016).

Patient information

Information about being overweight in pregnancy and after birth