Complications and challenges in management of the obese expectant mother

Obesity is increasing worldwide, especially in the USA. This is reflected in the pregnant population, with up to a third of women classified as obese during their pregnancy. It poses a challenge to the practitioners throughout pregnancy, labor and delivery, as well as in postpartum care. Obesity is also a risk factor for multiple pregnancy complications including gestational diabetes, hypertensive disorders of pregnancy, iatrogenic preterm birth, fetal macrosomia and intrauterine fetal demise. Antenatal care challenges, including limitation of fetal ultrasound evaluation, contribute to a greater number of undetected anomalies and poor fetal weight estimation. Maternal risks such as increased rates of cesarean section, and subsequent postoperative complications such as wound infection and venous thromboembolic events, are increasing in prevalence. Optimal prenatal care requires knowledge of and attention to each of these risks and appropriate patient counseling.