Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate®

Obesity in pregnancy: Complications and maternal management

Patrick S Ramsey, MD, MSPH
Robert S Schenken, MD
Section Editors
Charles J Lockwood, MD, MHCM
F Xavier Pi-Sunyer, MD, MPH
Deputy Editor
Vanessa A Barss, MD, FACOG


Obese pregnant women are at increased risk for an array of maternal and perinatal complications, and the risks are amplified with increasing degrees of maternal obesity [1-3]. Among the adverse effects on the fetus are an increased risk of childhood and adult obesity [4,5]. Obstetric providers should be aware of these risks and modify patient care before pregnancy, during pregnancy, and postpartum to optimize maternal and offspring outcomes [6,7].

This topic will discuss issues related to obesity and pregnancy. Obesity in the nonpregnant population is reviewed separately. (See "Obesity in adults: Prevalence, screening, and evaluation" and "Obesity in adults: Health consequences" and "Obesity in adults: Overview of management".)


Adipose tissue is an active endocrine organ; when present in excess, it can have dysregulatory effects on metabolic, vascular, and particularly inflammatory pathways in many organ systems, and thereby affect obstetric outcomes [8]. For example, obesity-related insulin resistance and abnormalities in inflammatory pathways can affect placental growth and function [9], and have been linked to development of preeclampsia [10,11]. The observation that some obesity-related pregnancy complications increase with greater degrees of obesity support this hypothesis [12]. Maternal genotype may also play a role [13].

Epigenetic changes induced by fetal exposure to increased levels of glucose, insulin, lipids, and inflammatory cytokines may play a role in the long-term outcome of offspring. These in utero effects may result in permanent or transient changes in metabolic programming, leading to adverse health outcomes in adult life (fetal origins of adult disease theory [Barker hypothesis]) [14]. The potential programming effects of maternal overnutrition are difficult to study, however, because of the complex relationships between the maternal metabolic milieu and the developing fetus and the influence of postnatal factors, including lifestyle and environment [15].


Obesity is defined as body mass index (BMI) ≥30 kg/m2 (table 1) [7]. It is further stratified by class: class I (BMI 30.0 to 34.9 kg/m2), class II (BMI 35.0 to 39.9 kg/m2), and class III (BMI ≥40 kg/m2).


Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Mar 2017. | This topic last updated: Apr 05, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Torloni MR, Betrán AP, Horta BL, et al. Prepregnancy BMI and the risk of gestational diabetes: a systematic review of the literature with meta-analysis. Obes Rev 2009; 10:194.
  2. Scott-Pillai R, Spence D, Cardwell CR, et al. The impact of body mass index on maternal and neonatal outcomes: a retrospective study in a UK obstetric population, 2004-2011. BJOG 2013; 120:932.
  3. Blomberg M. Maternal obesity, mode of delivery, and neonatal outcome. Obstet Gynecol 2013; 122:50.
  4. Rooney BL, Mathiason MA, Schauberger CW. Predictors of obesity in childhood, adolescence, and adulthood in a birth cohort. Matern Child Health J 2011; 15:1166.
  5. Gaillard R. Maternal obesity during pregnancy and cardiovascular development and disease in the offspring. Eur J Epidemiol 2015; 30:1141.
  6. Gunatilake RP, Perlow JH. Obesity and pregnancy: clinical management of the obese gravida. Am J Obstet Gynecol 2011; 204:106.
  7. ACOG Practice Bulletin No 156: Obesity in Pregnancy. Obstet Gynecol 2015; 126:e112.
  8. Ramsay JE, Ferrell WR, Crawford L, et al. Maternal obesity is associated with dysregulation of metabolic, vascular, and inflammatory pathways. J Clin Endocrinol Metab 2002; 87:4231.
  9. Catalano PM, Shankar K. Obesity and pregnancy: mechanisms of short term and long term adverse consequences for mother and child. BMJ 2017; 356:j1.
  10. Hauth JC, Clifton RG, Roberts JM, et al. Maternal insulin resistance and preeclampsia. Am J Obstet Gynecol 2011; 204:327.e1.
  11. Roberts JM, Bodnar LM, Patrick TE, Powers RW. The Role of Obesity in Preeclampsia. Pregnancy Hypertens 2011; 1:6.
  12. Marshall NE, Guild C, Cheng YW, et al. Maternal superobesity and perinatal outcomes. Am J Obstet Gynecol 2012; 206:417.e1.
  13. Tyrrell J, Richmond RC, Palmer TM, et al. Genetic Evidence for Causal Relationships Between Maternal Obesity-Related Traits and Birth Weight. JAMA 2016; 315:1129.
  14. Reynolds RM, Allan KM, Raja EA, et al. Maternal obesity during pregnancy and premature mortality from cardiovascular event in adult offspring: follow-up of 1 323 275 person years. BMJ 2013; 347:f4539.
  15. O'Reilly JR, Reynolds RM. The risk of maternal obesity to the long-term health of the offspring. Clin Endocrinol (Oxf) 2013; 78:9.
  16. LaCoursiere DY, Bloebaum L, Duncan JD, Varner MW. Population-based trends and correlates of maternal overweight and obesity, Utah 1991-2001. Am J Obstet Gynecol 2005; 192:832.
  17. Flegal KM, Carroll MD, Kit BK, Ogden CL. Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999-2010. JAMA 2012; 307:491.
  18. National Center for Health Statistics. Prevalence of obesity among adults and youth: United States, 2011 to 2014. http://www.cdc.gov/nchs/data/databriefs/db219.htm (Accessed on August 10, 2016).
  19. Lu GC, Rouse DJ, DuBard M, et al. The effect of the increasing prevalence of maternal obesity on perinatal morbidity. Am J Obstet Gynecol 2001; 185:845.
  20. Boots C, Stephenson MD. Does obesity increase the risk of miscarriage in spontaneous conception: a systematic review. Semin Reprod Med 2011; 29:507.
  21. Landres IV, Milki AA, Lathi RB. Karyotype of miscarriages in relation to maternal weight. Hum Reprod 2010; 25:1123.
  22. Bellver J, Cruz F, Martínez MC, et al. Female overweight is not associated with a higher embryo euploidy rate in first trimester miscarriages karyotyped by hysteroembryoscopy. Fertil Steril 2011; 96:931.
  23. Bellver J, Melo MA, Bosch E, et al. Obesity and poor reproductive outcome: the potential role of the endometrium. Fertil Steril 2007; 88:446.
  24. Glueck CJ, Wang P, Goldenberg N, Sieve-Smith L. Pregnancy outcomes among women with polycystic ovary syndrome treated with metformin. Hum Reprod 2002; 17:2858.
  25. Palomba S, Falbo A, Chiossi G, et al. Low-grade chronic inflammation in pregnant women with polycystic ovary syndrome: a prospective controlled clinical study. J Clin Endocrinol Metab 2014; 99:2942.
  26. Ehrenberg HM, Dierker L, Milluzzi C, Mercer BM. Prevalence of maternal obesity in an urban center. Am J Obstet Gynecol 2002; 187:1189.
  27. Gross T, Sokol RJ, King KC. Obesity in pregnancy: risks and outcome. Obstet Gynecol 1980; 56:446.
  28. Sebire NJ, Jolly M, Harris JP, et al. Maternal obesity and pregnancy outcome: a study of 287,213 pregnancies in London. Int J Obes Relat Metab Disord 2001; 25:1175.
  29. Chu SY, Callaghan WM, Kim SY, et al. Maternal obesity and risk of gestational diabetes mellitus. Diabetes Care 2007; 30:2070.
  30. Catalano PM, Kirwan JP, Haugel-de Mouzon S, King J. Gestational diabetes and insulin resistance: role in short- and long-term implications for mother and fetus. J Nutr 2003; 133:1674S.
  31. Robinson HE, O'Connell CM, Joseph KS, McLeod NL. Maternal outcomes in pregnancies complicated by obesity. Obstet Gynecol 2005; 106:1357.
  32. Sibai BM, Gordon T, Thom E, et al. Risk factors for preeclampsia in healthy nulliparous women: a prospective multicenter study. The National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units. Am J Obstet Gynecol 1995; 172:642.
  33. Sibai BM, Ewell M, Levine RJ, et al. Risk factors associated with preeclampsia in healthy nulliparous women. The Calcium for Preeclampsia Prevention (CPEP) Study Group. Am J Obstet Gynecol 1997; 177:1003.
  34. O'Brien TE, Ray JG, Chan WS. Maternal body mass index and the risk of preeclampsia: a systematic overview. Epidemiology 2003; 14:368.
  35. Weiss JL, Malone FD, Emig D, et al. Obesity, obstetric complications and cesarean delivery rate--a population-based screening study. Am J Obstet Gynecol 2004; 190:1091.
  36. HAPO Study Cooperative Research Group. Hyperglycaemia and Adverse Pregnancy Outcome (HAPO) Study: associations with maternal body mass index. BJOG 2010; 117:575.
  37. Gaillard R, Steegers EA, Hofman A, Jaddoe VW. Associations of maternal obesity with blood pressure and the risks of gestational hypertensive disorders. The Generation R Study. J Hypertens 2011; 29:937.
  38. Stuebe AM, Landon MB, Lai Y, et al. Maternal BMI, glucose tolerance, and adverse pregnancy outcomes. Am J Obstet Gynecol 2012; 207:62.e1.
  39. Maggard MA, Yermilov I, Li Z, et al. Pregnancy and fertility following bariatric surgery: a systematic review. JAMA 2008; 300:2286.
  40. Wolf M, Kettyle E, Sandler L, et al. Obesity and preeclampsia: the potential role of inflammation. Obstet Gynecol 2001; 98:757.
  41. Bodnar LM, Ness RB, Harger GF, Roberts JM. Inflammation and triglycerides partially mediate the effect of prepregnancy body mass index on the risk of preeclampsia. Am J Epidemiol 2005; 162:1198.
  42. Lockwood CJ, Huang SJ, Chen CP, et al. Decidual cell regulation of natural killer cell-recruiting chemokines: implications for the pathogenesis and prediction of preeclampsia. Am J Pathol 2013; 183:841.
  43. McDonald SD, Han Z, Mulla S, et al. Overweight and obesity in mothers and risk of preterm birth and low birth weight infants: systematic review and meta-analyses. BMJ 2010; 341:c3428.
  44. Cnattingius S, Villamor E, Johansson S, et al. Maternal obesity and risk of preterm delivery. JAMA 2013; 309:2362.
  45. Yamamoto M, Feigenbaum SL, Crites Y, et al. Risk of preterm delivery in non-diabetic women with polycystic ovarian syndrome. J Perinatol 2012; 32:770.
  46. Feigenbaum SL, Crites Y, Hararah MK, et al. Prevalence of cervical insufficiency in polycystic ovarian syndrome. Hum Reprod 2012; 27:2837.
  47. Usha Kiran TS, Hemmadi S, Bethel J, Evans J. Outcome of pregnancy in a woman with an increased body mass index. BJOG 2005; 112:768.
  48. Halloran DR, Cheng YW, Wall TC, et al. Effect of maternal weight on postterm delivery. J Perinatol 2012; 32:85.
  49. Johnson JW, Longmate JA, Frentzen B. Excessive maternal weight and pregnancy outcome. Am J Obstet Gynecol 1992; 167:353.
  50. Stotland NE, Washington AE, Caughey AB. Prepregnancy body mass index and the length of gestation at term. Am J Obstet Gynecol 2007; 197:378.e1.
  51. Denison FC, Price J, Graham C, et al. Maternal obesity, length of gestation, risk of postdates pregnancy and spontaneous onset of labour at term. BJOG 2008; 115:720.
  52. Bak GS, Sperling L, Källén K, Salvesen KÅ. Prospective population-based cohort study of maternal obesity as a source of error in gestational age estimation at 11-14 weeks. Acta Obstet Gynecol Scand 2016; 95:1281.
  53. Simic M, Wåhlin IA, Marsál K, Källén K. Maternal obesity is a potential source of error in mid-trimester ultrasound estimation of gestational age. Ultrasound Obstet Gynecol 2010; 35:48.
  54. Kullinger M, Wesström J, Kieler H, Skalkidou A. Maternal and fetal characteristics affect discrepancies between pregnancy-dating methods: a population-based cross-sectional register study. Acta Obstet Gynecol Scand 2017; 96:86.
  55. Naeye RL. Maternal body weight and pregnancy outcome. Am J Clin Nutr 1990; 52:273.
  56. Reddy UM, Branum AM, Klebanoff MA. Relationship of maternal body mass index and height to twinning. Obstet Gynecol 2005; 105:593.
  57. Nylander PP. The factors that influence twinning rates. Acta Genet Med Gemellol (Roma) 1981; 30:189.
  58. Wolfe KB, Rossi RA, Warshak CR. The effect of maternal obesity on the rate of failed induction of labor. Am J Obstet Gynecol 2011; 205:128.e1.
  59. Nuthalapaty FS, Rouse DJ, Owen J. The association of maternal weight with cesarean risk, labor duration, and cervical dilation rate during labor induction. Obstet Gynecol 2004; 103:452.
  60. Vahratian A, Zhang J, Troendle JF, et al. Maternal prepregnancy overweight and obesity and the pattern of labor progression in term nulliparous women. Obstet Gynecol 2004; 104:943.
  61. Buhimschi CS, Buhimschi IA, Malinow AM, Weiner CP. Intrauterine pressure during the second stage of labor in obese women. Obstet Gynecol 2004; 103:225.
  62. Kominiarek MA, Zhang J, Vanveldhuisen P, et al. Contemporary labor patterns: the impact of maternal body mass index. Am J Obstet Gynecol 2011; 205:244.e1.
  63. Zhang J, Bricker L, Wray S, Quenby S. Poor uterine contractility in obese women. BJOG 2007; 114:343.
  64. Robinson BK, Mapp DC, Bloom SL, et al. Increasing maternal body mass index and characteristics of the second stage of labor. Obstet Gynecol 2011; 118:1309.
  65. Norman SM, Tuuli MG, Odibo AO, et al. The effects of obesity on the first stage of labor. Obstet Gynecol 2012; 120:130.
  66. Chin JR, Henry E, Holmgren CM, et al. Maternal obesity and contraction strength in the first stage of labor. Am J Obstet Gynecol 2012; 207:129.e1.
  67. Young TK, Woodmansee B. Factors that are associated with cesarean delivery in a large private practice: the importance of prepregnancy body mass index and weight gain. Am J Obstet Gynecol 2002; 187:312.
  68. Fyfe EM, Anderson NH, North RA, et al. Risk of first-stage and second-stage cesarean delivery by maternal body mass index among nulliparous women in labor at term. Obstet Gynecol 2011; 117:1315.
  69. Poobalan AS, Aucott LS, Gurung T, et al. Obesity as an independent risk factor for elective and emergency caesarean delivery in nulliparous women--systematic review and meta-analysis of cohort studies. Obes Rev 2009; 10:28.
  70. Gunatilake RP, Smrtka MP, Harris B, et al. Predictors of failed trial of labor among women with an extremely obese body mass index. Am J Obstet Gynecol 2013; 209:562.e1.
  71. Brost BC, Goldenberg RL, Mercer BM, et al. The Preterm Prediction Study: association of cesarean delivery with increases in maternal weight and body mass index. Am J Obstet Gynecol 1997; 177:333.
  72. Owens LA, O'Sullivan EP, Kirwan B, et al. ATLANTIC DIP: the impact of obesity on pregnancy outcome in glucose-tolerant women. Diabetes Care 2010; 33:577.
  73. Cnattingius S, Bergström R, Lipworth L, Kramer MS. Prepregnancy weight and the risk of adverse pregnancy outcomes. N Engl J Med 1998; 338:147.
  74. Jensen DM, Damm P, Sørensen B, et al. Pregnancy outcome and prepregnancy body mass index in 2459 glucose-tolerant Danish women. Am J Obstet Gynecol 2003; 189:239.
  75. Kaiser PS, Kirby RS. Obesity as a risk factor for cesarean in a low-risk population. Obstet Gynecol 2001; 97:39.
  76. Witter FR, Caulfield LE, Stoltzfus RJ. Influence of maternal anthropometric status and birth weight on the risk of cesarean delivery. Obstet Gynecol 1995; 85:947.
  77. Ranta P, Jouppila P, Spalding M, Jouppila R. The effect of maternal obesity on labour and labour pain. Anaesthesia 1995; 50:322.
  78. Tonidandel A, Booth J, D'Angelo R, et al. Anesthetic and obstetric outcomes in morbidly obese parturients: a 20-year follow-up retrospective cohort study. Int J Obstet Anesth 2014; 23:357.
  79. Vricella LK, Louis JM, Mercer BM, Bolden N. Impact of morbid obesity on epidural anesthesia complications in labor. Am J Obstet Gynecol 2011; 205:370.e1.
  80. Perlow JH, Morgan MA. Massive maternal obesity and perioperative cesarean morbidity. Am J Obstet Gynecol 1994; 170:560.
  81. Soens MA, Birnbach DJ, Ranasinghe JS, van Zundert A. Obstetric anesthesia for the obese and morbidly obese patient: an ounce of prevention is worth more than a pound of treatment. Acta Anaesthesiol Scand 2008; 52:6.
  82. Kevane B, Donnelly J, D'Alton M, et al. Risk factors for pregnancy-associated venous thromboembolism: a review. J Perinat Med 2014; 42:417.
  83. Blondon M, Harrington LB, Boehlen F, et al. Pre-pregnancy BMI, delivery BMI, gestational weight gain and the risk of postpartum venous thrombosis. Thromb Res 2016; 145:151.
  84. Edwards LE, Dickes WF, Alton IR, Hakanson EY. Pregnancy in the massively obese: course, outcome, and obesity prognosis of the infant. Am J Obstet Gynecol 1978; 131:479.
  85. Bianco AT, Smilen SW, Davis Y, et al. Pregnancy outcome and weight gain recommendations for the morbidly obese woman. Obstet Gynecol 1998; 91:97.
  86. Myles TD, Gooch J, Santolaya J. Obesity as an independent risk factor for infectious morbidity in patients who undergo cesarean delivery. Obstet Gynecol 2002; 100:959.
  87. Molyneaux E, Poston L, Ashurst-Williams S, Howard LM. Obesity and mental disorders during pregnancy and postpartum: a systematic review and meta-analysis. Obstet Gynecol 2014; 123:857.
  88. Stothard KJ, Tennant PW, Bell R, Rankin J. Maternal overweight and obesity and the risk of congenital anomalies: a systematic review and meta-analysis. JAMA 2009; 301:636.
  89. Rasmussen SA, Chu SY, Kim SY, et al. Maternal obesity and risk of neural tube defects: a metaanalysis. Am J Obstet Gynecol 2008; 198:611.
  90. Cai GJ, Sun XX, Zhang L, Hong Q. Association between maternal body mass index and congenital heart defects in offspring: a systematic review. Am J Obstet Gynecol 2014; 211:91.
  91. Werler MM, Louik C, Shapiro S, Mitchell AA. Prepregnant weight in relation to risk of neural tube defects. JAMA 1996; 275:1089.
  92. Hendler I, Blackwell SC, Bujold E, et al. The impact of maternal obesity on midtrimester sonographic visualization of fetal cardiac and craniospinal structures. Int J Obes Relat Metab Disord 2004; 28:1607.
  93. Catanzarite V, Quirk JG. Second-trimester ultrasonography: determinants of visualization of fetal anatomic structures. Am J Obstet Gynecol 1990; 163:1191.
  94. Wolfe HM, Sokol RJ, Martier SM, Zador IE. Maternal obesity: a potential source of error in sonographic prenatal diagnosis. Obstet Gynecol 1990; 76:339.
  95. Cragan JD, Khoury MJ. Effect of prenatal diagnosis on epidemiologic studies of birth defects. Epidemiology 2000; 11:695.
  96. Dashe JS, McIntire DD, Twickler DM. Effect of maternal obesity on the ultrasound detection of anomalous fetuses. Obstet Gynecol 2009; 113:1001.
  97. Thornburg LL, Miles K, Ho M, Pressman EK. Fetal anatomic evaluation in the overweight and obese gravida. Ultrasound Obstet Gynecol 2009; 33:670.
  98. Paladini D. Sonography in obese and overweight pregnant women: clinical, medicolegal and technical issues. Ultrasound Obstet Gynecol 2009; 33:720.
  99. Aagaard-Tillery KM, Flint Porter T, Malone FD, et al. Influence of maternal BMI on genetic sonography in the FaSTER trial. Prenat Diagn 2010; 30:14.
  100. Pasko DN, Wood SL, Jenkins SM, et al. Completion and Sensitivity of the Second-Trimester Fetal Anatomic Survey in Obese Gravidas. J Ultrasound Med 2016; 35:2449.
  101. Best KE, Tennant PW, Bell R, Rankin J. Impact of maternal body mass index on the antenatal detection of congenital anomalies. BJOG 2012; 119:1503.
  102. Persson M, Johansson S, Villamor E, Cnattingius S. Maternal overweight and obesity and risks of severe birth-asphyxia-related complications in term infants: a population-based cohort study in Sweden. PLoS Med 2014; 11:e1001648.
  103. Aune D, Saugstad OD, Henriksen T, Tonstad S. Maternal body mass index and the risk of fetal death, stillbirth, and infant death: a systematic review and meta-analysis. JAMA 2014; 311:1536.
  104. Salihu HM, Dunlop AL, Hedayatzadeh M, et al. Extreme obesity and risk of stillbirth among black and white gravidas. Obstet Gynecol 2007; 110:552.
  105. Yao R, Ananth CV, Park BY, et al. Obesity and the risk of stillbirth: a population-based cohort study. Am J Obstet Gynecol 2014; 210:457.e1.
  106. Abrams BF, Laros RK Jr. Prepregnancy weight, weight gain, and birth weight. Am J Obstet Gynecol 1986; 154:503.
  107. Frentzen BH, Dimperio DL, Cruz AC. Maternal weight gain: effect on infant birth weight among overweight and average-weight low-income women. Am J Obstet Gynecol 1988; 159:1114.
  108. Calandra C, Abell DA, Beischer NA. Maternal obesity in pregnancy. Obstet Gynecol 1981; 57:8.
  109. Forno E, Young OM, Kumar R, et al. Maternal obesity in pregnancy, gestational weight gain, and risk of childhood asthma. Pediatrics 2014; 134:e535.
  110. Edlow AG. Maternal obesity and neurodevelopmental and psychiatric disorders in offspring. Prenat Diagn 2017; 37:95.
  111. Villamor E, Tedroff K, Peterson M, et al. Association Between Maternal Body Mass Index in Early Pregnancy and Incidence of Cerebral Palsy. JAMA 2017; 317:925.
  112. Moos MK, Dunlop AL, Jack BW, et al. Healthier women, healthier reproductive outcomes: recommendations for the routine care of all women of reproductive age. Am J Obstet Gynecol 2008; 199:S280.
  113. Practice Committee of the American Society for Reproductive Medicine. Obesity and reproduction: a committee opinion. Fertil Steril 2015; 104:1116.
  114. Dodd JM, Grivell RM, Crowther CA, Robinson JS. Antenatal interventions for overweight or obese pregnant women: a systematic review of randomised trials. BJOG 2010; 117:1316.
  115. Ronnberg AK, Nilsson K. Interventions during pregnancy to reduce excessive gestational weight gain: a systematic review assessing current clinical evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. BJOG 2010; 117:1327.
  116. Getahun D, Kaminsky LM, Elsasser DA, et al. Changes in prepregnancy body mass index between pregnancies and risk of primary cesarean delivery. Am J Obstet Gynecol 2007; 197:376.e1.
  117. Getahun D, Ananth CV, Peltier MR, et al. Changes in prepregnancy body mass index between the first and second pregnancies and risk of large-for-gestational-age birth. Am J Obstet Gynecol 2007; 196:530.e1.
  118. Jain AP, Gavard JA, Rice JJ, et al. The impact of interpregnancy weight change on birthweight in obese women. Am J Obstet Gynecol 2013; 208:205.e1.
  119. Callegari LS, Sterling LA, Zelek ST, et al. Interpregnancy body mass index change and success of term vaginal birth after cesarean delivery. Am J Obstet Gynecol 2014; 210:330.e1.
  120. Cnattingius S, Villamor E. Weight change between successive pregnancies and risks of stillbirth and infant mortality: a nationwide cohort study. Lancet 2016; 387:558.
  121. Glazer NL, Hendrickson AF, Schellenbaum GD, Mueller BA. Weight change and the risk of gestational diabetes in obese women. Epidemiology 2004; 15:733.
  122. Institute of Medicine (IOM) and National Research Council Committee to Reexamine IOM Pregnancy Weight Guidelines. Weight Gain During Pregnancy: Reexamining the Guidelines, Rasmussen KM, Yaktine AL (Eds), National Academies Press, Washington, DC 2009.
  123. Kapadia MZ, Park CK, Beyene J, et al. Weight Loss Instead of Weight Gain within the Guidelines in Obese Women during Pregnancy: A Systematic Review and Meta-Analyses of Maternal and Infant Outcomes. PLoS One 2015; 10:e0132650.
  124. Stang J, Huffman LG. Position of the Academy of Nutrition and Dietetics: Obesity, Reproduction, and Pregnancy Outcomes. J Acad Nutr Diet 2016; 116:677.
  125. Muktabhant B, Lumbiganon P, Ngamjarus C, Dowswell T. Interventions for preventing excessive weight gain during pregnancy. Cochrane Database Syst Rev 2012; :CD007145.
  126. Magro-Malosso ER, Saccone G, Di Mascio D, et al. Exercise during pregnancy and risk of preterm birth in overweight and obese women: a systematic review and meta-analysis of randomized controlled trials. Acta Obstet Gynecol Scand 2017; 96:263.
  127. Thornburg LL, Mulconry M, Post A, et al. Fetal nuchal translucency thickness evaluation in the overweight and obese gravida. Ultrasound Obstet Gynecol 2009; 33:665.
  128. Glanc P, O'Hayon BE, Singh DK, et al. Challenges of pelvic imaging in obese women. Radiographics 2012; 32:1839.
  129. Louis J, Auckley D, Miladinovic B, et al. Perinatal outcomes associated with obstructive sleep apnea in obese pregnant women. Obstet Gynecol 2012; 120:1085.
  130. LeFevre ML, U.S. Preventive Services Task Force. Low-dose aspirin use for the prevention of morbidity and mortality from preeclampsia: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2014; 161:819.
  131. American College of Obstetricians and Gynecologists. Practice advisory on low-dose aspirin and prevention of preeclampsia: Updated recommendations. http://www.acog.org/About-ACOG/News-Room/Practice-Advisories/Practice-Advisory-Low-Dose-Aspirin-and-Prevention-of-Preeclampsia-Updated-Recommendations (Accessed on July 25, 2016).
  132. Wax J, Minkoff H, Johnson A, et al. Consensus report on the detailed fetal anatomic ultrasound examination: indications, components, and qualifications. J Ultrasound Med 2014; 33:189.
  133. Donofrio MT, Moon-Grady AJ, Hornberger LK, et al. Diagnosis and treatment of fetal cardiac disease: a scientific statement from the American Heart Association. Circulation 2014; 129:2183.
  134. American College of Obstetricians and Gynecologists' Committee on Practice Bulletins--Obstetrics. Practice Bulletin No. 161: External Cephalic Version. Obstet Gynecol 2016; 127:e54.
  135. Cohen WR, Hayes-Gill B. Influence of maternal body mass index on accuracy and reliability of external fetal monitoring techniques. Acta Obstet Gynecol Scand 2014; 93:590.
  136. Schuster M, Madueke-Laveaux OS, Mackeen AD, et al. The effect of the MFM obesity protocol on cesarean delivery rates. Am J Obstet Gynecol 2016; 215:492.e1.
  137. James A, Committee on Practice Bulletins—Obstetrics. Practice bulletin no. 123: thromboembolism in pregnancy. Obstet Gynecol 2011; 118:718.
  138. Girsen AI, Osmundson SS, Naqvi M, et al. Body mass index and operative times at cesarean delivery. Obstet Gynecol 2014; 124:684.
  139. Pulman KJ, Tohidi M, Pudwell J, Davies GA. Emergency Caesarean Section in Obese Parturients: Is a 30-Minute Decision-to-Incision Interval Feasible? J Obstet Gynaecol Can 2015; 37:988.
  140. Yao R, Goetzinger KR, Crimmins SD, et al. Association of Maternal Obesity With Maternal and Neonatal Outcomes in Cases of Uterine Rupture. Obstet Gynecol 2017; 129:683.
  141. Rasmussen KM, Kjolhede CL. Prepregnant overweight and obesity diminish the prolactin response to suckling in the first week postpartum. Pediatrics 2004; 113:e465.
  142. http://www.cdc.gov/reproductivehealth/contraception/pdf/summary-chart-us-medical-eligibility-criteria_508tagged.pdf (Accessed on August 14, 2016).
  143. Davies GA, Maxwell C, McLeod L, et al. SOGC Clinical Practice Guidelines: Obesity in pregnancy. No. 239, February 2010. Int J Gynaecol Obstet 2010; 110:167.
Topic Outline