Apart from inadequate weight gain, excessive gestational weight gain may portend greater risks for the obese mother. Berggren and coworkers (2016) noted that overweight and obese women accrued maternal fat rather than lean mass with excessive gestational weight gain. From another analysis, overall higher rates of hypertensive disorders, cesarean delivery, and fetal overgrowth as well as lower rates of spontaneous preterm birth and fetal undergrowth were found among women gaining more than recommended Oohnson, 2013). However, when analyzed according to BMI category, significantly higher rates of preeclampsia, cesarean delivery, and fetal overgrowth were identified among the 1937 overweight women, but not for the 1445 obese women, who gained excess weight.
During pregnancy, overweight and obese women gain more weight than recommended compared with normal-weight gravidas (Endres, 2015). Moreover, overweight and obese women have excessive postpartum weight retention at 1 year, and one third retain at least 20 pounds more than their prep regnancy weight.
Several dietary interventions can help limit and achieve the weight-gain targets listed in the previous section. Options include lifestyle interventions and physical activity. In one randomized trial of exercise in 300 overweight women, risks for gestational diabetes were lowered (Wang, 2017). That said, in another trial, 75 overweight women were randomly assigned to routine care or to a 16-week moderate-intensity stationary cycling program starting after midpregnancy. NIaternal and neonatal outcomes did not difer between groups (Seneviratne, 2016). Also, a Cochrane database analysis of 11,444 women suggests that lifestyle interventions confer only a modest reduction in maternal weight gain, and their benefits for fetal overgrowth, cesarean delivery rate, and adverse neonatal outcome are not significant (Muktabhant, 2015). Regarding neonatal outcomes, the poor success of lifestyle interventions during pregnancy has been attributed to their late introduction, that is, after early gene expression within the placenta has already been programmed (Catalano, 2015).
Close prenatal monitoring detects most early signs of diabetes or hypertension. Standard screening tests for fetal anomalies are suicient, while remembering the sonographic limitations for fetal anomaly detection in this group. Accurate fetal growth surveillance in obese women usually requires serial sonographic assessment. Antepartum external fetal heart rate monitoring is likewise more diicult.
Obese women are at increased risk for multiple labor or intrapartum complications. These include postterm pregnancy or labor abnormalities (Carpenter, 2016). In one study of 143,519 women, the odds of spontaneous labor at term in obese women was approximately half that of normal-weight women (Denison, 2008). In an analysis of more than 5000 parturients, women with a Bh11 >30 kg/mrhad a longer duration of and slower early progression in first-stage labor (Norman, 2012).