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.

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.

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.

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.

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 plan and help her get lactation support/consultation, if needed.