Opinion: Obesity in pregnancy really is a weighty issue

In the past 2 months we have had two patients deliver at Yale-New Haven Hospital with BMI's over 80 kg/m² ! Not surprisingly they each had numerous postoperative wound complications. Indeed, pregnant, obese patients present a great variety of challenges, including, but certainly not limited to:

1. Increased risk of spontaneous abortion.²

3. Increased risk of fetal neural tube defects (OR, 1.87; 95% CI, 1.62–2.15), spina bifida (OR, 2.24; 95% CI, 1.86–2.69), cardiovascular anomalies (OR, 1.30; 95% CI, 1.12–1.51), septal anomalies (OR, 1.20; 95% CI, 1.09–1.31), cleft palate (OR, 1.23; 95% CI, 1.03–1.47), cleft lip and palate (OR, 1.20; 95% CI, 1.03–1.40), anorectal atresia (OR, 1.48; 95% CI, 1.12-1.97), hydrocephaly (OR, 1.68; 95% CI, 1.19–2.36), and limb reduction anomalies (OR, 1.34; 95% CI, 1.03–1.73),⁴ all compounding the detection problem.

4. Increased risk of gestational hypertension and preeclampsia.⁵

5. Increased risk of gestational diabetes and fetal macrosomia.⁵

6. Increased risk of cesarean delivery when compared with a BMI of less than 30. In this same study, the cesarean delivery rate was 20.7% for women with a BMI of 29.9 or less, 33.8% for women with a BMI of 30–34.9, and 47.4% for women with a BMI of 35–39.9.⁵ Not only are obese women at higher risk of cesarean delivery, but also they are at risk for a plethora of complications from the procedure including an increased incidence of hemorrhage, wound infection, endometritis, and anesthesia complications.

It is clear to me that obese women would benefit most from a multidisciplinary approach to treatment. Potential members of the care team may include: