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What to Know About Pregnancy for Larger Women

Reviewed by Dany Paul Baby, MD on April 07, 2022

Pregnancy is the happiest of times, but it can be a dangerous time, too. If you're overweight and pregnant, your physician will tell you about additional precautions needed with a plus size pregnancy. With good care, pregnancy for larger women can lead to a healthy plus size birth. Successful obese pregnancy needs extra caution, but your healthcare providers can oversee your pregnancy progression to keep you and your baby healthy. 

Pregnancy Planning for Larger Women

You may want to meet an obstetrician when you're planning to get pregnant. They may refer you to a nutrition consultant to help you lose weight. This may be valuable if you're having fertility problems. Losing weight helps you get pregnant and reduces additional risks to you and your baby. Also, you'll reduce your risk of gestational diabetes and diabetes in future pregnancies and later life. 

Start care early. It's best to meet an obstetrician when planning a pregnancy. They may advise some preconception vitamins. You will need higher doses of folate, which protects your baby against some birth defects. 

Pregnancy for Larger Women

Women with a body mass index (BMI) of 30 or more are considered obese. There may be difficulty getting pregnant because obesity suppresses ovulation. Once pregnant, you'll be able to carry your baby to term and deliver. But you should be aware that you are at higher risk for pregnancy complications.

  • Pregnancy loss: miscarriage, stillbirth, and repeated miscarriage.
  • Preeclampsia: a dangerous condition of high blood pressure and damage to kidneys and liver. It can progress to eclampsia (seizures, coma, and even mortality).
  • Diabetes. Diabetes during pregnancy (gestational diabetes) is more likely if you're obese.
  • Sleep apnea 
  • Heart disease
  • Blood clots
  • Heavier bleeding after the birth

Plus Size Pregnancy — Risks for Your Baby

Birth defects like congenital heart defects and neural tube defects (involving brain and spinal cord) are more common with plus size pregnancies. Your physician may advise detailed anatomy ultrasonography and fetal echocardiography at 18 to 20 weeks. 

Other risks for your baby:

  • Being larger than average
  • Poor growth in the womb
  • Childhood obesity
  • Childhood asthma
  • Premature labor and delivery

Successful Obese Pregnancy Management

Regular antenatal visits. This is advised for all pregnancies, of course. Plus size pregnancies have a higher risk of complications, so regular antenatal visits are essential.

Be more active. Physical activity reduces the risks of preeclampsia, gestational diabetes, back pain, and constipation. Choose safe activities like swimming, low-impact aerobics, and walking. Try to do 150 minutes (2½ hours) of activity a week.

Planned weight gain. Though you are overweight, you should gain some weight during pregnancy. If you are carrying one baby, you should gain 11 to 20 pounds. If you are having twins or multiples, you should gain 25 to 42 pounds. Avoiding weight gain could prevent your baby's growth and lead to a low birth weight.

Avoid hazards. Smoking, recreational drugs, and alcohol are all unsafe during pregnancy. If you're on any medication or supplements, talk to your physician about them. Reduce your caffeine (coffee, soft drinks, and energy drinks) and sugar intake.

Overweight and Pregnant — Special Care

Your physician may advise special care to keep you safe.

Gestational diabetes screening. A glucose challenge test will require you to drink a quantity of glucose and then give repeated blood and urine samples to check how your body responds to sugar. The test is usually done during 24 to 28 weeks of pregnancy. However, if you are overweight, your physician may recommend you get tested earlier, and even if your results are normal you may still have to take the test again.

Obstructive sleep apnea screening. This condition causes your breathing to stop for 10 to 30 seconds at a time during sleep. It's dangerous by itself and increases your likelihood of preeclampsia. If your test shows you have sleep apnea, your physician will refer you to a sleep medicine specialist.

Nutrition and diet. Do not try to lose weight during pregnancy. It doesn't reduce your risks but may reduce the nutrition available to your baby. Try to stick to the planned weight gain advised by your physician.

A dietician can advise you about a diet plan that provides enough nutrition for you and your baby without excessive weight gain. It's important to eat a balanced diet with fruits, vegetables, whole grains, lean protein, and low-fat dairy.

Plus Size Birth

The birth can have its own share of complications, so plan ahead to minimize them.

Safe delivery location. Pregnancy for larger women carries higher risks for birth complications including having a prolonged labor. Your physician may advise you to deliver in a hospital with access to expert medical care. Birthing centers and home delivery may not be suitable for you. 

Shoulder dystocia. Your baby's shoulder getting stuck in the birth canal is also more likely. This usually happens because your baby is large. 

Delivery interventions. Being overweight increases your likelihood of having a cesarean section, or a delivery using forceps or vacuum. Anesthetic complications and wound infections are also more likely.

Plus Size Birth Aftercare

You'll be busy with your little one after delivery, but don't neglect yourself. Plus size pregnancy risks persist after the pregnancy, and caution is still needed.

Blood pressure monitoring. If you had high blood pressure during pregnancy, it could continue for several weeks after birth. 

Blood clot concerns. Pregnancy for larger women carries an increased risk of blood clots. This risk persists for some weeks after the birth. You should try to be active as soon as possible and wear compression stockings. Your physician may prescribe blood thinning injections (low molecular weight heparin).

Breastfeeding. Feeding decisions are personal. If you decide to breastfeed, being overweight is no barrier. You can ask for a lactation consultant to visit you after the birth.

Healthy diet and exercise. Now that your pregnancy is over, your dietician and you can work on a plan for getting to a healthy weight. You can also step up your exercise program safely now. 

Most larger women have a smooth pregnancy and a healthy baby. Don't ignore the risks but try to manage them by following the guidance of your healthcare team for a safe and healthy pregnancy.

Show Sources

SOURCES:
Centers for Disease Control and Prevention: "Tracking Your Weight For Women Who Begin Pregnancy with Obesity."
Mayo Clinic: "Pregnancy and obesity: Know the risks."
National Health Service: "Obesity and pregnancy."
The Royal College of Obstetricians and Gynecologists: "Being overweight in pregnancy and after birth."
Sanford health: "You can have a happy and healthy plus-size pregnancy."

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