Information for Pregnancies with Increased BMI

What is your BMI? Body Mass Index or BMI is calculated by your weight to height ratio

When is your BMI calculated? At your booking appointment the midwife will measure your weight and height; this will be entered onto the computer system which automatically calculates your BMI. If your BMI is greater than 30 you will be booked for Consultant led care.

What does it mean for your pregnancy? Pregnancies in women with increased BMI can be more complicated and require greater monitoring throughout. If your BMI is greater than 30 you will be booked for Consultant Led Care and advised to give birth in hospital. This is because research has shown that women with higher BMI’s at the start of their pregnancy are at higher risk of complications whilst pregnant and when in labour. Your consultant obstetrician will need to discuss the risks with you and your partner and develop a specific plan of care for your pregnancy and the birth of your baby.

What conditions may occur more frequently in pregnancy? The following conditions occur more commonly during pregnancy with increased BMI

Miscarriage Fetal Abnormalities particularly neural tube defects including spina bifida Increased blood pressure Diabetes Increased rate of induction Increased rates of operative delivery including caesarean section Anaesthetic problems Bleeding after delivery Thrombosis (blood clots in legs) Greater rate of admission to special baby/neonatal unit

Why is taking Folic Acid tablets important? You should consider commencing folate tablets (5 mgs) before pregnancy and continue to 14 weeks as this has been found to reduce the risk of spina bifida. Your GP can prescribe this for you. After 14 weeks you should change to Healthy Start vitamins (contains Folic, Vits C+D). They are available at your local health centre and should be taken for the remainder of their pregnancy.

Why is taking Aspirin tablets important? You may be prescribed low dose Aspirin (75 mgs) daily throughout your pregnancy, if you are assessed to be at risk of high blood pressure. This will help reduce your risk of developing preeclampsia during pregnancy.

Advice about your diet is important You will be offered an appointment to attend the dietician for advice regarding your diet during pregnancy. This is to support you in healthy eating during the pregnancy which helps both you and the baby. What additional tests will you have arranged in pregnancy? It is important to have detailed scan at 18 – 20 weeks to carefully assess your baby and ensure normal development. This is often more difficult in women with higher BMI`s and occasionally complete examination of your baby may not always be possible. During your pregnancy you may also be at higher risk of gestational (in pregnancy) diabetes a glucose tolerance test GTT is offered to exclude this and is performed at 28 weeks. If your BMI is equal to or greater than 35 you will be offered an additional scan at 28 and 34 weeks to assess your baby’s growth as sometimes it can be more difficult to confirm your baby is gaining weight normally.

Some mothers may be referred to see the Anaesthetist before labour Because the need for an anaesthetic during delivery may occur more frequently it may be necessary to see the consultant anaesthetist during the antenatal period to discuss any potential problems. This will be arranged by your consultant obstetrician.

How is the risk of getting a blood clot in your legs reduced? The risk of having a blood clot in your legs is increased especially after delivery and you may be prescribed medication to reduce this risk occurring. This usually involves daily injections and patients are usually taught to self-administer the injection. If these injections are required before labour they may prevent the use of an epidural anaesthetic for pain relief in labour, you can discuss this further with the anaesthetist.

How will my baby be monitored in labour? Monitoring in labour may be difficult. This may mean that the baby may need to be monitored using an internal clip which is attached to the baby’s head so that your baby can be monitored more clearly and safely throughout your labour.

If you have any concerns please contact your midwife If you have any concerns regarding your pregnancy please contact your midwife who will be happy to discuss any issue with you or will arrange for you to attend the hospital for a discussion with your Obstetrician

Important information Please remember that this leaflet is intended as general information only. It is not definitive. We aim to make the information as up to date and accurate as possible, but please be warned that it is always subject to change. Please, therefore, always check specific advice on the procedure or any concerns you may have with your midwife or doctor.

If you have any queries re any information in this leaflet please contact: ANC at COCH Tel 01244 365106

Author Mr J McCormack Consultant Obstetrician/Gynaecologist Revised July 2011