BMI >= 25 during pregnancy


There is now much data that shows that the following risks are increased if the BMI is >= 25:


During pregnancy


1. Miscarriages

2. Fetal anomalies (e.g. neural tube defects, cleft lip / palate, hydrocephalus, limb reduction, cardiac defects) - the ultrasound images are also less clear when the ultrasound scan is performed on a woman with increased BMI compared to a woman with normal BMI.

3. Preterm birth

4. Large baby at birth - this increases the risk of difficult vaginal delivery.

5. Stillbirth

6. Higher risks of medical problems during pregnancy e.g. gestational diabetes mellitus, gestational hypertension, pre-eclampsia, anxiety, depression, venous thromboembolism.


Close monitoring during pregnancy is recommended.


Delivery


1. Labour problems (e.g. longer labour, shoulder dystocia, Caesarean section, higher need for induction of labour, higher failure rates for induction of labour, and wound infections)

2. Caesarean section - Caesarean section rates are higher than women with low BMI


After delivery


1. Wound infections

2. Neonatal problems - low blood sugar levels, respiratory distress. These issues may require usually short admissions to the ICU for monitoring and treatment.


What to do?


The Institute of Medicine in the US suggests that the weight gain during the pregnancy should be within 5-9 kg. Other authorities have suggested that 0-5 kg may be appropriate especially if the BMI is >=30.


Interventions


1. Dietary restriction of excessive carbohydrates

2. Regular physical exercise