Living with overweight, being pregnant and giving birth

What is considered 'overweight' or 'obese'?

Your weight can impact your health. It is an important measure of your wellbeing during pregnancy and birth. The terms 'overweight' and 'obese' are defined by a calculation of your height and weight, known as the body mass index (BMI).

A pre-pregnancy BMI between 25 and 30kg/m2 means you are living with overweight.

A pre-pregnancy BMI of 30kg/m2 or more shows you are living with obesity.

Some Australians are at higher risk of obesity because of where they live, work, play and age. You may be unfairly affected by overweight and obesity, for example, because of circumstances or conditions beyond your control.

Living with overweight or obesity while pregnant and giving birth means you may face some additional challenges. This is over and above the usual excitement of looking forward to your new baby.

How is weight gain managed during pregnancy if I live with overweight or obesity?

If you live with overweight or obesity, the recommended weight gain during pregnancy is less than if you have a BMI within a healthy weight range.

Here are the recommendations for weight gain during pregnancy based on BMI:

• Healthy weight range (pre-pregnancy BMI between 18 and 24.9): aim to gain 11.5kg to 16.0kg.
• Living with overweight (pre-pregnancy BMI 25 to 30): aim to gain 6.8kg to 11.3kg.
• Living with obesity (pre-pregnancy BMI above 30): aim to gain 5.0kg to 9.1kg.
• If your pre-pregnancy BMI is above 50: minimal to no weight gain is usually recommended.

If you are concerned about your weight , ask your doctor or midwife how they can help you.

The best way you can prevent too much weight gain during pregnancy is by maintaining a healthy diet and staying physically active.

A dietitian can help you with a nutrition plan. A nutrition plan should suit your nutritional needs, lifestyle and health conditions.

Physiotherapists or exercise physiologists can also help you manage your weight

NEED TO LOSE WEIGHT? — Use the BMI Calculator to find out if your weight and waist size are in a healthy range.

Is it safe to go on a diet or lose weight during pregnancy?

In most cases, weight loss is not recommended during pregnancy. If you are pregnant and living with obesity, you should aim to limit weight gain during pregnancy, but not necessarily to lose weight.

Weight-loss medicines (including prescribed, herbal or non-prescribed medicines) are not recommended during pregnancy.

What are the complications of living with overweight or obesity while pregnant?

If you are living with overweight or obesity, you may be at a higher risk of developing some health complications during pregnancy. Possible complications include:

• Gestational diabetes (high blood sugar levels) — Living with obesity or having a family history of gestational diabetes increases this risk.
• Pre-eclampsia — This is a medical complication of pregnancy that includes high blood pressure, fluid retention and protein in the urine and is more common if you are living with obesity.
• Pelvic pain — You are more likely to have pregnancy-related pelvic pain. This may limit you from moving about normally during pregnancy.
• Influenza (or 'the flu') — The chance of developing complications from the flu is higher during pregnancy, especially if you are living with obesity.
• Nutritional deficiencies — Vitamin D or iron deficiencies are more common among people living with obesity.

Possible complications of living with overweight or obesity while giving birth include:

• Heavy bleeding (primary postpartum haemorrhage — PPH) —This is defined as losing 500ml or more of blood in the first 24 hours after the birth. There is a higher risk of PPH among people living with obesity.
• Induction of labour — Obesity increases the chances your doctors will try to induce your labour. Obesity also lowers the chances of successfully starting labour with medicines.
• Assisted birth — Medical techniques or instruments to help during the birth, such as caesarean sections and vacuum birth, are more likely to be needed for people with a high BMI.
• Anaesthetic complications — People living with obesity are more likely to have complications with epidural pain relief during labour. There is also greater difficulty with intubation (a preparation for general anaesthetic).

Living with overweight or obesity means that you may experience a longer first stage of labour. A high BMI will not usually impact the length of your second stage of labour (giving birth).

How will doctors and midwives manage my pregnancy?

Your healthcare team will likely take some extra precautions with your pregnancy if you are living with overweight or obesity.

Some precautions your healthcare professionals may take include:

• advice on how to manage weight gain during pregnancy
• recommendations for nutrition supplements to suit your circumstances
• additional ultrasound scans
• glucose tolerance testing for gestational diabetes, which may be done early in your pregnancy and may be repeated later on
• more frequent monitoring for pre-eclampsia
• anaesthetic assessment, in case you will need a caesarean section

Ask your doctor or midwife how often you should come in for a pregnancy health check, or if you should see a specialist obstetrician.

Where can I have my baby if I am living with overweight or obesity?

If you are living with overweight or obesity, not every hospital will meet your needs during labour. You may need specialist care or equipment (for example, hoists or limb lifters). You may also need anaesthetists or surgeons familiar with potential medical complications that are more likely to occur during labour.

Hospitals have different 'levels', which set the level of care they can provide:

• If you live with overweight, you can give birth at hospitals that are level 3 and above.
• If you live with obesity, you can give birth at hospitals that are level 4 and above.

Generally, home births are not recommended for people living with obesity. You may have different options. It is important that you speak to your doctor or midwife before deciding where you want to give birth.

What precautions may your doctor or midwife take during labour?

During labour, you doctor or midwife may monitor your baby's position and heart rate by using an ultrasound machine. If you have a BMI above 40, they may recommend continuous electronic fetal monitoring (CEFM).

Sometimes, it can be difficult to monitor your baby's heart rate if you are living with obesity. If your healthcare team has difficulties, they may recommend monitoring your baby's heart rate internally, rather than externally

External monitoring involves placing a device on your stomach. If you agree, internal monitoring involves placing a device through your vagina and directly onto your baby's scalp. Monitoring is safe and will not harm your baby.

Will being overweight or obese affect my baby?

If you are living with obesity, you baby has an increased risk of developing some health complications. These include:

• large birth weight of 4kg or more (fetal macrosomia)
• shoulder dystocia
• lower Apgar scores (a measure of newborn health)
• low blood sugar levels
• birth differences, stillbirth or neonatal death

Your baby is more likely to need to spend some time in the neonatal intensive care unit (NICU).

Your baby also has a higher chance of developing diabetes and obesity during childhood and/or adulthood.

Remember, if you are living with obesity, even a small amount of weight loss before conception can improve your and your baby's health.

Will I be able to breastfeed my baby if I am living with overweight or obesity?

Many people living with overweight and obesity successfully breastfeed their babies, though you may experience some additional challenges. You may struggle positioning and latching your baby to your breast. You may find it helpful to use nipple shields and use pillows to help with positioning.

If you are having difficulty initiating breastfeeding, ask your midwife to refer you to a lactation consultant for breastfeeding support.

What can I do to maximise my chance of having a healthy pregnancy and birth?

It is important to create a healthy lifestyle for yourself and for your baby by eating well and exercising regularly.

Try to maintain a balanced diet as recommended by the Australian Guide to Healthy Eating. Eat a range of vegetables, fruit, wholegrain foods (such as wholegrain bread and crackers), low-fat milk products (such as light milk and low-fat cheese), non-fatty meat and oily fish. These foods give you important vitamins, minerals and proteins to keep your body healthy and functioning well. Eating healthy food also means you feel less hungry for 'junk food' which you should eat only occasionally.

Make sure you drink enough water. If you are pregnant it's recommended you drink 7 to 9 cups of water per day.

Try to remain active during your pregnancy. Aim for at least 30 minutes of physical activity a day, most days of the week. You can chose to do these at one time or in several shorter sessions. Walking and swimming are good exercise options if you are pregnant. It's best to speak to your doctor or dietitian before making any lifestyle changes.

It can be very challenging to change old habits. Any improvements can help you have a more comfortable pregnancy and easier birth. This will also improve your baby's health.

It is also important to feel mentally well in the lead-up to birth. Depression can lead to weight gain. Professional counselling may help you achieve your goal weight and improve your mental wellbeing.

FIND A HEALTH SERVICE — The Service Finder can help you find doctors, pharmacies, hospitals and other health services.

Resources and support

Learn more about being active during pregnancy on The Royal Women's Hospital Active Pregnancy webpage.

Do you prefer to read in languages other than English?

Royal Hospital for Women (NSW) website has information pages in Arabic, Chinese, Spanish and Bengali with information about planning a healthy pregnancy.