Obesity in Pregnancy

Definition:Pre-pregnancy BMI ≥30. Severe/morbid obesity: BMI ≥40. Obesity affects >30% of pregnant women in the US. Maternal risks (multiple and compounding): - Gestational diabetes: 2–8× increased risk (adipose tissue insulin resistance + HPL) - Preeclampsia: 4× increased risk (endothelial dysfunction, hypertension predisposition) - Venous thromboembolism: 4–5× increased risk (immobility, hypercoagulability, venous stasis) - Cesarean delivery: 2× higher C-section rate; higher wound complication rate - Anesthesia difficulties: intubation challenges, spinal/epidural placement difficulty, dosing challenges - Sleep apnea: worsened by pregnancy; mandates CPAP therapy - Postpartum hemorrhage: uterine atony risk higher Fetal/neonatal risks: - Neural tube defects: 2× higher even with normal folic acid intake (altered folate metabolism in obese women → recommend 5 mg folic acid/day) - Macrosomia (LGA): shoulder dystocia risk - Stillbirth: significantly higher risk - Congenital heart defects: association with obesity - NICU admission: higher rates from complications Assessment challenges: - Fundal height measurement less reliable in obese patients - Ultrasound image quality impaired by adipose tissue - Fetal heart tones may be harder to auscultate - External fetal monitoring may require internal monitors (IUPC, fetal scalp...