Body Mass Index >40 and Pregnancy

Published Date: 19th July 2016

Publication Authors: Suttenwood HSL, Srivastava N, Ramachandran N

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Objective 

Review current practice in pregnancy management of women with obesity at a DGH.

Method 

Retrospective case-note survey of over 70% of women with a booking BMI > 40.

Results 

The UK prevalence of women with a known BMI ≥ 35 at any point in pregnancy is approximately 38 500 a year. The Health Survey for England data show that between 1993 and 2011, the prevalence of morbid obesity (BMI > 40) among women increased from 1.4% in 1993 to 3.2% in 2011. Out of the 3544 live births we had from April 2011 to March 2012, 105 women with a BMI > 40 booked at our DGH; a total of 3% of our pregnant population and 0.3% compared to the national average. This translates that we are managing an increasing population of pregnant women with maternal obesity. We retrospectively analysed over 70% of the clinical notes. In keeping with national data our review showed that in addition to pre-existing comorbidities these women also developed pregnancy related complications like hypertension and diabetes. We identified a few areas for improvement. These include commencing clinically obese women on high dose folic acid and Vitamin D; referring them to dietitian; monitoring them for pre-eclampsia; assessing them for an appropriate thromboprophylaxis regime during antenatal, perinatal and postnatal periods; and improving communication with, as well as, advice to the GP and community teams for ongoing postnatal care.

Conclusion 

Pregnancy management of women with high BMI remains a challenge. The complications have far reaching effects on the mother and the fetus. Despite small numbers, our review has identified several key areas for improvement. Establishment of a specialist service in the unit has already helped tackle some of these issues. We are currently working on training relevant clinicians and implementing a care pathway for women with high BMI. This would include the recommendations from the joint committee and also incorporate guidance on thrombo-prophylaxis and pre-eclampsia, which remain key areas for improvement.

Robertson, L; Suttenwood, HSL, Ramachandran, N; Srivastava; N. (2013).  Managing and supporting women with body mass index (BMI) > 40 throughout their pregnancy . BJOG: An International Journal of Obstetrics and Gynaecology. 120 (Supplement S1), 469

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