Abstract
Objective
This guideline will review key aspects in the pregnancy care of women with obesity.
Part I will focus on Preconception and Pregnancy Care. Part II will focus on Team
Planning for Delivery and Postpartum Care.
Intended Users
All health care providers (obstetricians, family doctors, midwives, nurses, anaesthesiologists)
who provide pregnancy-related care to women with obesity.
Target Population
Women with obesity who are pregnant or planning pregnancies.
Evidence
Literature was retrieved through searches of Statistics Canada, Medline, and The Cochrane
Library on the impact of obesity in pregnancy on antepartum and intrapartum care,
maternal morbidity and mortality, obstetric anaesthesia, and perinatal morbidity and
mortality. Results were restricted to systematic reviews, randomized controlled trials/controlled
clinical trials, and observational studies. There were no date or language restrictions.
Searches were updated on a regular basis and incorporated in the guideline to September
2018. Grey (unpublished) literature was identified through searching the websites
of health technology assessment and health technology assessment-related agencies,
clinical practice guideline collections, clinical trial registries, and national and
international medical specialty societies.
Validation Methods
The content and recommendations were drafted and agreed upon by the authors. Then
the Maternal-Fetal Medicine Committees peer reviewed the content and submitted comments
for consideration, and the Board of the Society of Obstetricians and Gynaecologists
of Canada (SOGC) approved the final draft for publication. Areas of disagreement were
discussed during meetings at which time consensus was reached. The level of evidence
and quality of the recommendation made were described using the Evaluation of Evidence
criteria of the Canadian Task Force on Preventive Health Care.
Benefits, Harms, and Costs
Implementation of the recommendations in these guidelines may increase obstetrical
provider recognition of the issues affecting pregnant individuals with obesity, including
clinical prevention strategies, communication between the health care team, the patient
and family as well as equipment and human resource planning. It is hoped that regional,
provincial and federal agencies will assist in the education and support of coordinated
care for pregnant individuals with obesity.
Guideline Update
SOGC guideline will be automatically reviewed 5 years after publication. However,
authors can propose another review date if they feel that 5 years is too short/long
based on their expert knowledge of the subject matter.
Sponsors
This guideline was developed with resources funded by the SOGC.
Summary Statements
- 1Unfavourable cervix and induction of labour are more common with maternal obesity. The role of induction of labour and risk of Caesarean birth remains unclear (II-2).
- 2Electronic fetal monitoring is recommended for women in active labour with a body mass index >35 kg/m2. Cervical assessment, uterine monitoring, and fetal heart rate monitoring may be more challenging with higher degrees of maternal body mass index (III).
- 3Decision-to-delivery time is increased in women with obesity (II-2).
- 4Body mass index increases risk of surgical site infection and wound complications (II-2).
- 5Anaesthetic risks are increased with maternal obesity (II-2).
- 6Rates of successful breastfeeding are reduced for women with obesity (II-2).
- 7Several effective contraceptive choices are available to women with obesity (III).
- 8Women with obesity are at higher risk of postpartum depression and anxiety (II-2).
- 9Antenatal, labour and delivery, and postnatal care may be more complex in women with obesity (III).
Recommendations
- 1Electronic fetal monitoring is recommended for women in active labour with a body mass index >35 kg/m2. Intrauterine pressure catheters may assist in assessment of labour contractions. Fetal scalp electrodes may be helpful to ensure continuous fetal monitoring when indicated (III B).
- 2Women with obesity may benefit from higher dosage of preoperative antibiotics for Caesarean birth (I A).
- 3It is recommended to reapproximate the subcutaneous tissue layers at the time of Caesarean birth to reduce wound complications (II-2 A).
- 4Antenatal assessment with obstetric anaesthesia may assist in planning for safer birth for women with obesity (III A).
- 5Postoperative thromboprophylaxis is recommended, at appropriate dosing for the given body mass index, due to the greater risk of venous thromboembolism following Caesarean birth with women with obesity (II-3 A).
- 6Women with obesity should be offered lactation support in the postpartum period (III C)
- 7Women with obesity should be screened for postpartum depression and anxiety given that maternal obesity is a risk factor for these conditions (II-2 A).
- 8Counselling regarding weight management in the postpartum period is suggested in order to minimize risks in subsequent pregnancies (II-2 A).
- 9Obstetric team planning may be helpful for women with obesity to navigate the steps in antenatal, labour and delivery, and postnatal care (III-3 A).
Key Words
ABBREVIATIONS:
BMI (body mass index), DMPA (Medroxyprogesterone acetate), IUDs (intrauterine devices), VBAC (vaginal birth after Caesarean section), VTE (venous thromboembolism)To read this article in full you will need to make a payment
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Article Info
Publication History
No. 392, November 2019 (Replaces No. 239, February 2010)
Footnotes
This document reflects emerging clinical and scientific advances on the date issued and is subject to change. The information should not be construed as dictating an exclusive course of treatment or procedure to be followed. Local institutions can dictate amendments to these opinions. They should be well-documented if modified at the local level. None of these contents may be reproduced in any form without prior written permission of the publisher.
All people have the right and responsibility to make informed decisions about their care in partnership with their health care providers. In order to facilitate informed choice, patients should be provided with information and support that is evidence-based, culturally appropriate, and tailored to their needs.
This guideline was written using language that places women at the centre of care. The SOGC is committed to respecting the rights of all people—including transgender, gender non-binary, and intersex people—for whom the guideline may apply. We encourage health care to engage in respectful conversation with patients regarding their gender identity as a critical part of providing safe and appropriate care. The values, beliefs, and individual needs of each patient and their family should be sought and the final decision about the care and treatment options chosen by the patient should be respected.
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Copyright
© 2019 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.
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- Correction to Guideline 392Journal of Obstetrics and Gynaecology Canada Vol. 42Issue 3
- PreviewThe authors of the guideline “Guideline No. 392-Pregnancy and Maternal Obesity Part 2: Team Planning for Delivery and Postpartum Care”1 would like to revise their recommendation on electronic fetal monitoring for women with a BMI 35 kg/m2to reflect the current guidelines on fetal health surveillance.2 Guidance has been amended to reflect that electronic fetal monitoring “can be considered” rather than “is recommended” for women in active labour with a body mass index >35 kg/m2.
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