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.
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.
- Counsel patients about the limits of ultrasound in detecting birth defects.
- 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.
Labor and Delivery
- Work with your patient to create a birthing plan and discuss pain management methods.
- 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.
- 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 plan and help her get lactation support/consultation, if needed.