Algorithmic approach to antenatal care for women with obesity

Obesity has become a new epidemic, affecting all ethnic and racial groups. In the developed world its incidence is persistently increasing, resulting in higher rates of overweight and obesity than normal body mass index in some countries. Pregnancies in women with obesity are at increased risk for adverse maternal and neonatal outcomes. Fetal risks include preterm birth, large for gestational age, macrosomia, shoulder dystocia, congenital anomalies, birth injury, stillbirth, cerebral palsy, and neonatal and infant death. Maternal risks include hypertensive disorders of pregnancy, gestational diabetes, cesarean delivery, anesthetic and surgical complications, endometritis, thromboembolic diseases, and postpartum hemorrhage. These increased risks could be mitigated by careful surveillance during pregnancy. This chapter will address the antenatal care of women with obesity. We will review different published guidelines and compare between them while focusing on preconception, antenatal, and intrapartum care. Our recommendations will follow a proposed checklist for obstetric care planning that we find useful to ensure that all aspects of care are addressed in a timely fashion.