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JOGC

Guideline No. 392-Pregnancy and Maternal Obesity Part 2: Team Planning for Delivery and Postpartum Care

      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 Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology assessment-related agencies, clinical practice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

      • 1
        Unfavourable 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).
      • 2
        Electronic 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).
      • 3
        Decision-to-delivery time is increased in women with obesity (II-2).
      • 4
        Body mass index increases risk of surgical site infection and wound complications (II-2).
      • 5
        Anaesthetic risks are increased with maternal obesity (II-2).
      • 6
        Rates of successful breastfeeding are reduced for women with obesity (II-2).
      • 7
        Several effective contraceptive choices are available to women with obesity (III).
      • 8
        Women with obesity are at higher risk of postpartum depression and anxiety (II-2).
      • 9
        Antenatal, labour and delivery, and postnatal care may be more complex in women with obesity (III).

      Recommendations

      • 1
        Electronic 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).
      • 2
        Women with obesity may benefit from higher dosage of preoperative antibiotics for Caesarean birth (I A).
      • 3
        It is recommended to reapproximate the subcutaneous tissue layers at the time of Caesarean birth to reduce wound complications (II-2 A).
      • 4
        Antenatal assessment with obstetric anaesthesia may assist in planning for safer birth for women with obesity (III A).
      • 5
        Postoperative 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).
      • 6
        Women with obesity should be offered lactation support in the postpartum period (III C)
      • 7
        Women with obesity should be screened for postpartum depression and anxiety given that maternal obesity is a risk factor for these conditions (II-2 A).
      • 8
        Counselling regarding weight management in the postpartum period is suggested in order to minimize risks in subsequent pregnancies (II-2 A).
      • 9
        Obstetric 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)
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      REFERENCES

        • Hermann M
        • Le Ray C
        • Blondel B
        • et al.
        The risk of prelabor and intrapartum cesarean delivery among overweight and obese women: possible preventive actions.
        Am J Obstet Gynecol. 2015; 212: 241.e1-241.e9
        • Vinturache A
        • Moledina N
        • McDonald S
        • et al.
        Pre-pregnancy body mass index (BMI) and delivery outcomes in a Canadian population.
        BMC Pregnancy Childbirth. 2014; 14: 422
        • Sebire NJ
        • Jolly M
        • Harris JP
        • et al.
        Maternal obesity and pregnancy outcome: a study of 287,213 pregnancies in London.
        Int J Obes Relat Metab Disord. 2001; 25: 1175-1182
        • Crane JM
        • Murphy P
        • Burrage L
        • et al.
        Maternal and perinatal outcomes of extreme obesity in pregnancy.
        J Obstet Gynaecol Can. 2013; 35: 606-611
        • Gauthier T
        • Mazeau S
        • Dalmay F
        • et al.
        Obesity and cervical ripening failure risk.
        J Matern Fetal Neonatal Med. 2012; 25: 304-307
        • Beckwith L
        • Magner K
        • Kritzer S
        • et al.
        Prostaglandin versus mechanical dilation and the effect of maternal obesity on failure to achieve active labor: a cohort study.
        J Matern Fetal Neonatal Med. 2017; 30: 1621-1626
        • Pevzner L
        • Powers BL
        • Rayburn WF
        • et al.
        Effects of maternal obesity on duration and outcomes of prostaglandin cervical ripening and labor induction.
        Obstet Gynecol. 2009; 114: 1315-1321
        • Kawakita T
        • Iqbal SN
        • Huang CC
        • et al.
        Nonmedically indicated induction in morbidly obese women is not associated with an increased risk of cesarean delivery.
        Am J Obstet Gynecol. 2017; 217: 451.e1-451.e8
        • Schuster M
        • Madueke-Laveaux OS
        • Mackeen AD
        • et al.
        The effect of the MFM obesity protocol on cesarean delivery rates.
        Am J Obstet Gynecol. 2016; 215: 492.e1-492.e6
        • Lee VR
        • Darney BG
        • Snowden JM
        • et al.
        Term elective induction of labor and perinatal outcomes in obese women: retrospective cohort study.
        BJOG. 2016; 123: 271-278
        • Gibbs Pickens CM
        • Kramer MR
        • Howards PP
        • et al.
        Term elective induction of labor and pregnancy outcomes among obese women and their offspring.
        Obstet Gynecol. 2018; 131: 12-22
        • Hehir MP
        • Morrison JJ
        The adipokine apelin and human uterine contractility.
        Am J Obstet Gynecol. 2012; 206: 359.e1-359.e5
        • Moynihan AT
        • Hehir MP
        • Glavey SV
        • et al.
        Inhibitory effect of leptin on human uterine contractility in vitro.
        Am J Obstet Gynecol. 2006; 195: 504-509
        • Carlhall S
        • Kallen K
        • Blomberg M
        Maternal body mass index and duration of labor.
        Eur J Obstet Gynecol Reprod Biol. 2013; 171: 49-53
        • Kominiarek MA
        • Zhang J
        • Vanveldhuisen P
        • et al.
        Contemporary labor patterns: the impact of maternal body mass index.
        Am J Obstet Gynecol. 2011; 205: 244.e1-244.e8
        • Cedergren MI
        Non-elective caesarean delivery due to ineffective uterine contractility or due to obstructed labour in relation to maternal body mass index.
        Eur J Obstet Gynecol Reprod Biol. 2009; 145: 163-166
        • Ray A
        • Hildreth A
        • Esen UI
        Morbid obesity and intra-partum care.
        J Obstet Gynaecol. 2008; 28: 301-304
        • Aina-Mumuney A
        • Hwang K
        • Sunwoo N
        • et al.
        The impact of maternal body mass index and gestational age on the detection of uterine contractions by tocodynamometry: a retrospective study.
        Reprod Sci. 2016; 23: 638-643
        • Euliano TY
        • Nguyen MT
        • Marossero D
        • et al.
        Monitoring contractions in obese parturients: electrohysterography compared with traditional monitoring.
        Obstet Gynecol. 2007; 109: 1136-1140
        • Wuntakal R
        • Kaler M
        • Hollingworth T
        Women with high BMI: should they be managed differently due to antagonising action of leptin in labour?.
        Med Hypotheses. 2013; 80: 767-768
        • Carlson NS
        • Corwin EJ
        • Lowe NK
        Oxytocin augmentation in spontaneously laboring, nulliparous women: multilevel assessment of maternal BMI and oxytocin dose.
        Biol Res Nurs. 2017; 19: 382-392
        • Soni S
        • Chivan N
        • Cohen WR
        Effect of maternal body mass index on oxytocin treatment for arrest of dilatation.
        J Perinat Med. 2013; 41: 517-521
        • Lee L
        • Dy J
        • Azzam H
        Management of spontaneous labour at term in healthy women.
        J Obstet Gynaecol Can. 2016; 38: 843-865
        • Liston R
        • Sawchuck D
        • Young D
        Fetal health surveillance: Intrapartum consensus guideline.
        J Obstet Gynaecol Can. 2018; 40: e298-e322
        • Sheth Thakkar S
        • Lammers S
        • Hahn PM
        • et al.
        The use of intermittent auscultation in parturients of varying BMI categories: experience from a mid-sized tertiary care obstetrical unit.
        J Obstet Gynaecol Can. 2015; 37: 310-313
        • Cohen WR
        • Hayes-Gill B
        Influence of maternal body mass index on accuracy and reliability of external fetal monitoring techniques.
        Acta Obstet Gynecol Scand. 2014; 93: 590-595
        • Jezewski J
        • Matonia A
        • Kupka T
        • et al.
        Determination of fetal heart rate from abdominal signals: evaluation of beat-to-beat accuracy in relation to the direct fetal electrocardiogram.
        Biomed Tech (Berl). 2012; 57: 383-394
        • Cedergren MI
        Maternal morbid obesity and the risk of adverse pregnancy outcome.
        Obstet Gynecol. 2004; 103: 219-224
        • Zhang C
        • Wu Y
        • Li S
        • et al.
        Maternal prepregnancy obesity and the risk of shoulder dystocia: a meta-analysis.
        BJOG. 2018; 125: 407-413
        • Cosson E
        • Cussac-Pillegand C
        • Benbara A
        • et al.
        Pregnancy adverse outcomes related to pregravid body mass index and gestational weight gain, according to the presence or not of gestational diabetes mellitus: a retrospective observational study.
        Diabetes Metab. 2016; 42: 38-46
        • Boulvain M
        • Senat M-V
        • Perrotin F
        • et al.
        Induction of labour versus expectant management for large-for-date fetuses: a randomised controlled trial.
        Lancet. 2015; 385: 2600-2605
        • Caughey AB
        • Cahill AG
        • Guise JM
        • et al.
        Safe prevention of the primary cesarean delivery.
        Am J Obstet Gynecol. 2014; 210: 179-193
      1. Royal College of Obstetricians and Gynaecologists. Shoulder Dystocia. Green-top Guideline No. 42. 2nd Edition. March 2012.

        • Paganelli S
        • Soncini E
        • Comitini G
        • et al.
        Sonographic fetal weight estimation in normal and overweight/obese healthy term pregnant women by gestation-adjusted projection (GAP) method.
        Arch Gynecol Obstet. 2016; 293: 775-781
        • Aksoy H
        • Aksoy U
        • Karadag OI
        • et al.
        Influence of maternal body mass index on sonographic fetal weight estimation prior to scheduled delivery.
        J Obstet Gynaecol Res. 2015; 41: 1556-1561
        • Pulman KJ
        • Tohidi M
        • Pudwell J
        • et al.
        Emergency Caesarean section in obese parturients: is a 30-minute decision-to-incision interval feasible?.
        J Obstet Gynaecol Can. 2015; 37: 988-994
        • Vaananen AJ
        • Kainu JP
        • Eriksson H
        • et al.
        Does obesity complicate regional anesthesia and result in longer decision to delivery time for emergency cesarean section?.
        Acta Anaesthesiol Scand. 2017; 61: 609-618
        • Conner SN
        • Tuuli MG
        • Longman RE
        • et al.
        Impact of obesity on incision-to-delivery interval and neonatal outcomes at cesarean delivery.
        Am J Obstet Gynecol. 2013; 209: 386.e1-386.e6
        • Dennis AT
        • Lamb KE
        • Story D
        • et al.
        Associations between maternal size and health outcomes for women undergoing caesarean section: a multicentre prospective observational study (The MUM SIZE Study).
        BMJ Open. 2017; 7e015630
        • Stamilio DM
        • Scifres CM
        Extreme obesity and postcesarean maternal complications.
        Obstet Gynecol. 2014; 124: 227-232
        • Conner SN
        • Verticchio JC
        • Tuuli MG
        • et al.
        Maternal obesity and risk of post-cesarean wound complications.
        Am J Perinatol. 2014; 31: 299-304
        • Smaill FM
        • Grivell RM
        Antibiotic prophylaxis versus no prophylaxis for preventing infection after cesarean section.
        Cochrane Database Syst Rev. 2014; 10CD007482
        • van Schalkwyk J
        • Van Eyk N
        No. 247-Antibiotic prophylaxis in obstetric procedures.
        J Obstet Gynaeol Can. 2017; 39: e293-e2e9
        • Young OM
        • Shaik IH
        • Twedt R
        • et al.
        Pharmacokinetics of cefazolin prophylaxis in obese gravidae at time of cesarean delivery.
        Am J Obstet Gynecol. 2015; 213: 541.e1-541.e7
        • Swank ML
        • Wing DA
        • Nicolau DP
        • et al.
        Increased 3-gram cefazolin dosing for cesarean delivery prophylaxis in obese women.
        Am J Obstet Gynecol. 2015; 213: 415.e1-415.e8
        • Valent AM
        • DeArmond C
        • Houston JM
        • et al.
        Effect of post-cesareandelivery oral cephalexin and metronidazole on surgical site infection among obese women: a randomized clinical trial.
        JAMA. 2017; 318: 1026-1034
        • Machado LS
        Cesarean section in morbidly obese parturients: practical implications and complications.
        N Am J Med Sci. 2012; 4: 13-18
        • Wall PD
        • Deucy EE
        • Glantz JC
        • et al.
        Vertical skin incisions and wound complications in the obese parturient.
        Obstet Gynecol. 2003; 102: 952-956
        • Sutton AL
        • Sanders LB
        • Subramaniam A
        • et al.
        Abdominal incision selection for cesarean delivery of women with class III obesity.
        Am J Perinatol. 2016; 33: 547-551
        • Mehasseb MK
        • Shafi MI
        Supra-umbilical vertical midline abdominal incision in morbidly obese gynaecological oncology patients.
        J Obstet Gynaecol. 2013; 33: 505-507
        • Tixier H
        • Thouvenot S
        • Coulange L
        • et al.
        Cesarean section in morbidly obese women: supra or subumbilical transverse incision?.
        Acta Obstet Gynecol Scand. 2009; 88: 1049-1052
        • Smid MC
        • Smiley SG
        • Schulkin J
        • et al.
        The Problem of the pannus: physician preference survey and a review of the literature on cesarean skin incision in morbidly obese women.
        Am J Perinatol. 2016; 33: 463-472
        • Alexander CI
        • Liston WA
        Operating on the obese woman—a review.
        BJOG. 2006; 113: 1167-1172
        • Chelmow D
        • Rodriguez EJ
        • Sabatini MM
        Suture closure of subcutaneous fat and wound disruption after cesarean delivery: a meta-analysis.
        Obstet Gynecol. 2004; 103: 974-980
        • Gates S
        • Anderson ER
        Wound drainage for caesarean section.
        Cochrane Database Syst Rev. 2013; 12CD004549
        • Mackeen AD
        • Schuster M
        • Berghella V
        Suture versus staples for skin closure after cesarean: a metaanalysis.
        Am J Obstet Gynecol. 2015; 212 (621.e1–10)
        • Zaki MN
        • Wing DA
        • McNulty JA
        Comparison of staples vs subcuticular suture in class III obese women undergoing cesarean: a randomized controlled trial.
        Am J Obstet Gynecol. 2018; 218: 451.e1-451.e8
        • Ruhstaller K
        • Downes KL
        • Chandrasekaran S
        • et al.
        Prophylactic wound vacuum therapy after cesarean section to prevent wound complications in the obese population: a randomized controlled trial (the ProVac study).
        Am J Perinatol. 2017; 34: 1125-1130
        • Smid MC
        • Dotters-Katz SK
        • Grace M
        • et al.
        Prophylactic negative pressure wound therapy for obese women after cesarean delivery: a systematic review and meta-analysis.
        Obst Gynecol. 2017; 130: 969-978
        • Heard C
        • Chaboyer W
        • Anderson V
        • et al.
        Cost-effectiveness analysis alongside a pilot study of prophylactic negative pressure wound therapy.
        J Tissue Viability. 2017; 26: 79-84
        • Yu L
        • Kronen RJ
        • Simon LE
        • et al.
        Prophylactic negative-pressure wound therapy after cesarean is associated with reduced risk of surgical site infection: a systematic review and meta-analysis.
        Am J Obstet Gynecol. 2018; 218 (200–10.e1)
        • Walter CJ
        • Dumville JC
        • Sharp CA
        • et al.
        Systematic review and meta-analysis of wound dressings in the prevention of surgical site infections in surgical wounds healing by primary intention.
        Br J Surg. 2012; 99: 1185-1194
        • Durnwald CP
        • Ehrenberg HM
        • Mercer BM
        The impact of maternal obesity and weight gain on vaginal birth after cesarean section success.
        Am J Obstet Gynecol. 2004; 191: 954-957
        • Hibbard JU
        • Gilbert S
        • Landon MB
        • et al.
        Trial of labor or repeat cesarean delivery in women with morbid obesity and previous cesarean delivery.
        Obstet Gynecol. 2006; 108: 125-133
        • Chauhan SP
        • Magann EF
        • Carroll CS
        • et al.
        Mode of delivery for the morbidly obese with prior cesarean delivery: vaginal versus repeat cesarean section.
        Am J Obstet Gynecol. 2001; 185: 349-354
        • Faucett AM
        • Allshouse AA
        • Donnelly M
        • et al.
        Do obese women receive the necessary interventions to achieve vaginal birth after Cesarean?.
        Am J Perinatol. 2016; 33: 991-997
        • Grasch JL
        • Thompson JL
        • Newton JM
        • et al.
        Trial of labor compared with cesarean delivery in superobese women.
        Obstet Gynecol. 2017; 130: 994-1000
      2. Practice guidelines for obstetric anesthesia: an updated report by the American Society of Anesthesiologists Task Force on Obstetric Anesthesia and the Society for Obstetric Anesthesia and Perinatology.
        Anesthesiology. 2016; 124: 270-300
        • Lamon AM
        • Habib AS
        Managing anesthesia for cesarean section in obese patients: current perspectives.
        Local Reg Anesth. 2016; 9: 45-57
        • Singh S
        • Wirth KM
        • Phelps AL
        • et al.
        Epidural catheter placement in morbidly obese parturients with the use of an epidural depth equation prior to ultrasound visualization.
        ScientificWorldJournal. 2013; 2013695209
        • Vricella LK
        • Louis JM
        • Mercer BM
        • et al.
        Impact of morbid obesity on epidural anesthesia complications in labor.
        Am J Obstet Gynecol. 2011; 205: 370.e1-370.e6
        • Robinson HE
        • O'Connell CM
        • Joseph KS
        • et al.
        Maternal outcomes in pregnancies complicated by obesity.
        Obstet Gynecol. 2005; 106: 1357-1364
        • Torloni M
        • Betran A
        • Horta B
        • et al.
        Prepregnancy BMI and the risk of gestational diabetes: a systematic review of the literature with meta‐analysis.
        Obes Rev. 2009; 10: 194-203
        • Blomberg M
        Maternal obesity, mode of delivery, and neonatal outcome.
        Obstet Gynecol. 2013; 122: 50-55
        • Scott-Pillai R
        • Spence D
        • Cardwell CR
        • et al.
        The impact of body mass index on maternal and neonatal outcomes: a retrospective study in a UK obstetric population, 2004-2011.
        BJOG. 2013; 120: 932-939
        • Lisonkova S
        • Muraca GM
        • Potts J
        • et al.
        Association between prepregnancy body mass index and severe maternal morbidity.
        JAMA. 2017; 318: 1777-1786
        • Schummers L
        • Hutcheon JA
        • Bodnar LM
        • et al.
        Risk of adverse pregnancy outcomes by prepregnancy body mass index: a population-based study to inform prepregnancy weight loss counseling.
        Obstet Gynecol. 2015; 125: 133-143
      3. ACOG practice bulletin no 156: obesity in pregnancy.
        Obstet Gynecol. 2015; 126: e112-e126
        • Myles TD
        • Gooch J
        • Santolaya J
        Obesity as an independent risk factor for infectious morbidity in patients who undergo cesarean delivery.
        Obstet Gynecol. 2002; 100: 959-964
        • Alanis MC
        • Villers MS
        • Law TL
        • et al.
        Complications of cesarean delivery in the massively obese parturient.
        Am J Obstet Gynecol. 2010; 203: 271.e1-271.e7
        • Bourjeily G
        • Paidas M
        • Khalil H
        • et al.
        Pulmonary embolism in pregnancy.
        Lancet. 2010; 375: 500-512
        • Brown HL
        • Hiett AK
        Deep vein thrombosis and pulmonary embolism in pregnancy: diagnosis, complications, and management.
        Clin Obstet Gynecol. 2010; 53: 345-359
        • Simpson EL
        • Lawrenson RA
        • Nightingale AL
        • et al.
        Venous thromboembolism in pregnancy and the puerperium: incidence and additional risk factors from a London perinatal database.
        BJOG. 2001; 108: 56-60
        • Kamel H
        • Navi BB
        • Sriram N
        • et al.
        Risk of a thrombotic event after the 6-week postpartum period.
        N Engl J Med. 2014; 370: 1307-1315
        • Tepper NK
        • Boulet SL
        • Whiteman MK
        • et al.
        Postpartum venous thromboembolism: incidence and risk factors.
        Obstet Gynecol. 2014; 123: 987-996
        • Abdul Sultan A
        • Grainge MJ
        • West J
        • et al.
        Impact of risk factors on the timing of first postpartum venous thromboembolism: a population-based cohort study from England.
        Blood. 2014; 124: 2872-2880
        • James A
        Practice bulletin no. 123: thromboembolism in pregnancy.
        Obstet Gynecol. 2011; 118: 718-729
        • Kevane B
        • Donnelly J
        • D'Alton M
        • et al.
        Risk factors for pregnancy-associated venous thromboembolism: a review.
        J Perinat Med. 2014; 42: 417-425
        • Blondon M
        • Harrington L
        • Boehlen F
        • et al.
        Pre-pregnancy BMI, delivery BMI, gestational weight gain and the risk of postpartum venous thrombosis.
        Thromb Res. 2016; 145: 151-156
        • Bates SM
        • Greer IA
        • Middeldorp S
        • et al.
        VTE, thrombophilia, antithrombotic therapy, and pregnancy: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines.
        Chest. 2012; 141: e691S-e736S
        • Overcash RT
        • Somers AT
        • LaCoursiere DY
        Enoxaparin dosing after cesarean delivery in morbidly obese women.
        Obstet Gynecol. 2015; 125: 1371-1376
        • Baker JL
        • Michaelsen KF
        • Sorensen TI
        • et al.
        High prepregnant body mass index is associated with early termination of full and any breastfeeding in Danish women.
        Am J Clin Nutr. 2007; 86: 404-411
        • Rasmussen KM
        • Kjolhede CL
        Prepregnant overweight and obesity diminish the prolactin response to suckling in the first week postpartum.
        Pediatrics. 2004; 113: e465-e471
        • Lepe M
        • Bacardi Gascon M
        • Castaneda-Gonzalez LM
        • et al.
        Effect of maternal obesity on lactation: systematic review.
        Nutr Hosp. 2011; 26: 1266-1269
        • Krause KM
        • Lovelady CA
        • Ostbye T
        Predictors of breastfeeding in overweight and obese women: data from Active Mothers Postpartum (AMP).
        Matern Child Health J. 2011; 15: 367-375
        • Turcksin R
        • Bel S
        • Galjaard S
        • et al.
        Maternal obesity and breastfeeding intention, initiation, intensity and duration: a systematic review.
        Matern Child Nutr. 2014; 10: 166-183
        • Bever Babendure J
        • Reifsnider E
        • Mendias E
        • et al.
        Reduced breastfeeding rates among obese mothers: a review of contributing factors, clinical considerations and future directions.
        Int Breastfeed J. 2015; 10: 21
        • Visram H
        • Finkelstein SA
        • Feig D
        • et al.
        Breastfeeding intention and early post-partum practices among overweight and obese women in Ontario: a selective population-based cohort study.
        J Matern Fetal Neonatal Med. 2013; 26: 611-615
        • Chuang CH
        • Chase GA
        • Bensyl DM
        • et al.
        Contraceptive use by diabetic and obese women.
        Womens Health Issues. 2005; 15: 167-173
        • Curtis KM
        • Tepper NK
        • Jatlaoui TC
        • et al.
        U.S. medical eligibilitycriteria for contraceptive use, 2016.
        MMWR Recomm Rep. 2016; 65: 1-103
        • Black A
        • Guilbert E
        • Costescu D
        • et al.
        Canadian contraception consensus (part 3 of 4): chapter 8–progestin-only contraception.
        J Obstet Gynaecol Can. 2016; 38: 279-300
        • Black A
        • Guilbert E
        • Costescu D
        • et al.
        No. 329-Canadian contraception consensus part 4 of 4 chapter 9: combined hormonal contraception.
        J Obstet Gynaecol Can. 2017; 39 (229–68.e5)
        • Edelman AB
        • Carlson NE
        • Cherala G
        • et al.
        Impact of obesity on oral contraceptive pharmacokinetics and hypothalamic-pituitary-ovarian activity.
        Contraception. 2009; 80: 119-127
        • Westhoff CL
        • Torgal AH
        • Mayeda ER
        • et al.
        Pharmacokinetics of a combined oral contraceptive in obese and normal-weight women.
        Contraception. 2010; 81: 474-480
        • Westhoff CL
        • Torgal AH
        • Mayeda ER
        • et al.
        Ovarian suppression in normal-weight and obese women during oral contraceptive use: a randomized controlled trial.
        Obstet Gynecol. 2010; 116: 275-283
        • Chin JR
        • Swamy GK
        • Ostbye T
        • et al.
        Contraceptive use by obese women 1 year postpartum.
        Contraception. 2009; 80: 463-468
        • Maclean CC
        • Thompson IS
        Postpartum care and contraception in obese women.
        Clin Obstet Gynecol. 2016; 59: 204-215
        • Freeman L
        Condom use to aid cervical visualization during speculum examination.
        Can Fam Physician. 2018; 64: 297-298
        • Jain J
        • Jakimiuk AJ
        • Bode FR
        • et al.
        Contraceptive efficacy and safety of DMPA-SC.
        Contraception. 2004; 70: 269-275
        • Segall-Gutierrez P
        • Taylor D
        • Liu X
        • et al.
        Follicular development and ovulation in extremely obese women receiving depo-medroxyprogesterone acetate subcutaneously.
        Contraception. 2010; 81: 487-495
        • Bahamondes L
        • Brache V
        • Meirik O
        • et al.
        A 3-year multicentre randomized controlled trial of etonogestrel- and levonorgestrel-releasing contraceptive implants, with non-randomized matched copper-intrauterine device controls.
        Hum Reprod. 2015; 30: 2527-2538
        • Zieman M
        • Guillebaud J
        • Weisberg E
        • et al.
        Contraceptive efficacy and cycle control with the Ortho Evra/Evra transdermal system: the analysis of pooled data.
        Fertil Steril. 2002; 77: S13-S18
        • McNicholas C
        • Zhao Q
        • Secura G
        • et al.
        Contraceptive failures in overweight and obese combined hormonal contraceptive users.
        Obstet Gynecol. 2013; 121: 585-592
        • Edelman A
        • Cherala G
        • Lim JY
        • et al.
        Contraceptive failures in overweight and obese combined hormonal contraceptive users.
        Obstet Gynecol. 2013; 122: 158-159
        • Edelman A
        • Jensen JT
        • Bulechowsky M
        • et al.
        Combined oral contraceptives and body weight: do oral contraceptives cause weight gain? A primate model.
        Hum Reprod. 2011; 26: 330-336
        • Gallo MF
        • Lopez LM
        • Grimes DA
        • et al.
        Combination contraceptives: effects on weight.
        Cochrane Database Syst Rev. 2014; 1CD003987
        • Buchwald H
        • Avidor Y
        • Braunwald E
        • et al.
        Bariatric surgery: a systematic review and meta-analysis.
        JAMA. 2004; 292: 1724-1737
        • American College of Obstetricians and Gynecologists
        ACOG practice bulletin no. 105: bariatric surgery and pregnancy.
        Obstet Gynecol. 2009; 113: 1405
        • Jensen MD
        • Ryan DH
        • Apovian CM
        • et al.
        2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society.
        J Am Coll Cardiol. 2014; 63: 2985-3023
      4. Obesity and reproduction: a committee opinion.
        Fertil Steril. 2015; 104: 1116-1126
        • Getahun D
        • Kaminsky LM
        • Elsasser DA
        • et al.
        Changes in prepregnancy body mass index between pregnancies and risk of primary cesarean delivery.
        Am J Obstet Gynecol. 2007; 197: 376.e1-376.e7
        • Getahun D
        • Ananth CV
        • Peltier MR
        • et al.
        Changes in prepregnancy body mass index between the first and second pregnancies and risk of large-for-gestational-age birth.
        Am J Obstet Gynecol. 2007; 196: 530.e1-530.e8
        • Jain AP
        • Gavard JA
        • Rice JJ
        • et al.
        The impact of interpregnancy weight change on birthweight in obese women.
        Am J Obstet Gynecol. 2013; 208: 205.e1-205.e7
        • Callegari LS
        • Sterling LA
        • Zelek ST
        • et al.
        Interpregnancy body mass index change and success of term vaginal birth after cesarean delivery.
        Am J Obstet Gynecol. 2014; 210: 330.e1-330.e7
        • Cnattingius S
        • Villamor E
        Weight change between successive pregnancies and risks of stillbirth and infant mortality: a nationwide cohort study.
        Lancet. 2016; 387: 558-565
        • Glazer NL
        • Hendrickson AF
        • Schellenbaum GD
        • et al.
        Weight change and the risk of gestational diabetes in obese women.
        Epidemiology. 2004; 15: 733-737
        • Nehring I
        • Schmoll S
        • Beyerlein A
        • et al.
        Gestational weight gain and long-term postpartum weight retention: a meta-analysis.
        Am J Clin Nutr. 2011; 94: 1225-1231
        • Nohr EA
        • Vaeth M
        • Baker JL
        • et al.
        Combined associations of prepregnancy body mass index and gestational weight gain with the outcome of pregnancy.
        Am J Clin Nutr. 2008; 87: 1750-1759
        • Choi J
        • Fukuoka Y
        • Lee JH
        The effects of physical activity and physical activity plus diet interventions on body weight in overweight or obese women who are pregnant or in postpartum: a systematic review and meta-analysis of randomized controlled trials.
        Prev Med. 2013; 56: 351-364
        • Harvey SB
        • Zhang Y
        • Wilson-Grady J
        • et al.
        O-glycoside biomarker of apolipoprotein C3: responsiveness to obesity, bariatric surgery, and therapy with metformin, to chronic or severe liver disease and to mortality in severe sepsis and graft vs host disease.
        J Proteome Res. 2009; 8: 603-612
        • Armstrong MJ
        • Mottershead TA
        • Ronksley PE
        • et al.
        Motivational interviewing to improve weight loss in overweight and/or obese patients: a systematic review and meta-analysis of randomized controlled trials.
        Obes Rev. 2011; 12: 709-723
        • Phelan S
        • Phipps MG
        • Abrams B
        • et al.
        Randomized trial of a behavioral intervention to prevent excessive gestational weight gain: the Fit for Delivery Study.
        Am J Clin Nutr. 2011; 93: 772-779
        • Wiltheiss GA
        • Lovelady CA
        • West DG
        • et al.
        Diet quality and weight change among overweight and obese postpartum women enrolled in a behavioral intervention program.
        J Acad Nutr Diet. 2013; 113: 54-62
        • Steinig J
        • Nagl M
        • Linde K
        • et al.
        Antenatal and postnatal depression in women with obesity: a systematic review.
        Arch Womens Ment Health. 2017; 20: 569-585
        • Ertel KA
        • Huang T
        • Rifas-Shiman SL
        • et al.
        Perinatal weight and risk of prenatal and postpartum depressive symptoms.
        Ann Epidemiol. 2017; 27: 695-700.e1
        • Molyneaux E
        • Poston L
        • Ashurst-Williams S
        • et al.
        Obesity and mental disorders during pregnancy and postpartum: a systematic review and meta-analysis.
        Obstet Gynecol. 2014; 123: 857-867
        • Avila C
        • Holloway AC
        • Hahn MK
        • et al.
        An overview of links between obesity and mental health.
        Curr Obes Rep. 2015; 4: 303-310
        • Han SY
        • Brewis AA
        • Wutich A
        Body image mediates the depressive effects of weight gain in new mothers, particularly for women already obese: evidence from the Norwegian Mother and Child Cohort Study.
        BMC Public Health. 2016; 16: 664
        • Sahrakorpi N
        • Koivusalo SB
        • Stach-Lempinen B
        • et al.
        “The burden of pregnancy”; heavier for the heaviest? The changes in health related quality of life (HRQoL) assessed by the 15D instrument during pregnancy and postpartum in different body mass index groups: a longitudinal survey.
        Acta Obstet Gynecol Scand. 2017; 96: 352-358
        • Whitty R
        • Maxwell C
        • Carvalho J
        Complications of neuraxial anesthesia in an extreme morbidly obese patient for Cesarean section.
        Int J Obstet Anesth. 2007; 16: 139-144
        • Hope P
        • Breslin S
        • Lamont L
        • et al.
        Fatal shoulder dystocia: a review of 56 cases reported to the Confidential Enquiry into Stillbirths and Deaths in Infancy.
        BJOG. 1998; 105: 1256-1261
        • Sienas LE
        • Hedriana HL
        • Wiesner S
        • et al.
        Decreased rates of shoulder dystocia and brachial plexus injury via an evidence‐based practice bundle.
        Int J Gynaecol Obstet. 2017; 136: 162-167
        • Hollesen RVB
        • Johansen RLR
        • Rorbye C
        • et al.
        Successfully reducing newborn asphyxia in the labour unit in a large academic medical centre: a quality improvement project using statistical process control.
        BMJ Qual Saf. 2018; 27: 633-642
        • Carter EB
        • Temming LA
        • Fowler S
        • et al.
        Evidence-based bundles and cesarean delivery surgical site infections: a systematic review and meta-analysis.
        Obstet. 2017; 130: 735-746
        • Noble NL
        • Sweeney NL
        Barriers to the use of assistive devices in patient handling.
        Workplace Health Saf. 2018; 66: 41-48
        • Janga D
        • Akinfenwa O
        Work-related repetitive strain injuries amongst practitioners of obstetric and gynaecological ultrasound worldwide.
        Arch Gynecol Obstet. 2012; 286: 353-356
        • Alberga A
        • Pickering B
        • Alix Hayden K
        • et al.
        Weight bias reduction in health professionals: a systematic review.
        Clin Obes. 2016; 6: 175-188
        • Obesity Action Coalition
        People-first language.
        Obesity Action Coalition, Tampa, FL2018 (Available at:)
        • Mensinger JL
        • Tylka TL
        • Calamari ME
        Mechanisms underlying weightstatus and healthcare avoidance in women: a study of weight stigma, body-related shame and guilt, and healthcare stress.
        Body Image. 2018; 25: 139-147

      Linked Article

      • Correction to Guideline 392
        Journal of Obstetrics and Gynaecology Canada Vol. 42Issue 3
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          The 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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