February 2009 · Vol. 21, No. 02PART 1 OF 2: For the obese gravida, try strong counseling and close follow-up
Obese gravidas need to be apprised of the many risks they incur with pregnancy—and be monitored closely to avert disaster
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Fast Track
The most important strategy to prevent obesity-related complications is prepregnancy weight loss of 10% of body weight over 6 months
Obese women are more likely to be anovulatory and have irregular cycles, so the utility of determining the last menstrual period to establish gestational age is limited
A BMI above 29 appears to double the risk of neural tube defects
For every 5 to 7 kg/m2 increase in prepregnancy BMI, the risk of preeclampsia doubled
Check for nutritional deficiencies in women who have undergone bariatric surgery, especially malabsorptive procedures
The likelihood of stillbirth increased 40% in obese women
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Julie
Phillips,
MD;
Janice
Henderson,
MDDr. Phillips is a Fellow in Maternal–Fetal Medicine in the Department of Obstetrics, Gynecology, and Reproductive Sciences at the University of Vermont in Burlington, Vt.
Dr. Henderson is Assistant Professor in the Department of Gynecology/Obstetrics, Division of Maternal–Fetal Medicine, at Johns Hopkins Hospital in Baltimore, Md.
The authors report no financial relationships relevant to this article.
Hear Dr Phillips discuss the key points of this series
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