Plus-size Pregnancy Care

The American College of Obstetricians and Gynecologists (ACOG) supports a holistic approach to managing obesity in pregnancy and offers recommendations and guidelines on care before, during, and after pregnancy.1

The following tips suggest some ways providers can support a plus-size woman during pregnancy, while providing high-quality, comprehensive, and respectful care to plus-size women who are or wish to become pregnant.

This checklist is adapted from ACOG Practice Bulletin No. 156: Obesity in Pregnancy. external link

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Before Pregnancy

For women with obesity who aren’t yet pregnant, weight loss before pregnancy is the most effective way to reduce the risk of obesity-related complications during pregnancy.

Icon of the outline of a pregnant woman’s torso in profile.

During Pregnancy

  • Counsel patients about the limits of ultrasound in detecting congenital anomalies.
  • Consider:
    • Early pregnancy screening for glucose intolerance (gestational diabetes or overt diabetes) based on risk factors.
    • Consulting with the anesthesia service, especially for patients with obstructive sleep apnea.
  • Calculate body mass index (BMI) at the first prenatal visit and refer to the National Academy of Medicine (formerly the Institute of Medicine) recommendations for healthy weight gain during pregnancy.2
  • Use BMI and weight gain recommendations to guide nutrition and physical activity counseling.
Icon of a newborn wrapped in a blanket.

Labor and Delivery

  • Work with your patient to create a birthing plan and discuss pain management methods.
  • Consider:
    • Placing an early epidural catheter after discussing risks and benefits with the patient.
    • Allowing a longer first stage of labor before performing cesarean delivery for labor arrest.
  • Arrange facilities and equipment that accommodate patient needs, such as:
    • Appropriate birthing beds and monitoring equipment (e.g., larger blood pressure cuffs and wheelchairs).
    • Facility doors to accommodate large beds and additional staff needed to move patients safely.
Icon of an adult holding an infant.

After Pregnancy

  • Consider behavioral interventions to improve both nutrition and physical activity, as combined efforts have been proven to improve postpartum weight loss better than physical activity alone.
  • Continue counseling the patient on nutrition and physical activity, especially before she begins planning another pregnancy.
  • Work with your patient to create a breastfeeding external link plan and help her get lactation support/consultation, if needed.


  1. American College of Obstetricians and Gynecologists (ACOG). (2015). ACOG Practice Bulletin No. 156: Obesity in pregnancy. Obstetrics & Gynecology, 126(6), e112–e126. doi: 10.1097/AOG.0000000000001211
  2. ACOG. (2013). ACOG Committee Opinion No. 548: Weight gain during pregnancy. Obstetrics & Gynecology, 121(1), 210–212. doi: 10.1097/01.AOG.0000425668.87506.4c
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