In this episode you will learn:

What is BMI

When is it measured in pregnancy?

Recommended weight gain in pregnancy

What complications might occur if someone has a high or low BMI

Does having a BMI change pregnancy and labour management?

[1:37] A listener request from someone who is 15 weeks pregnant and wants to know whether she should be concerned about being overweight in pregnancy.

[2:38] Dr Pat defines BMI or Body Mass Index and how it is an imperfect tool for someone who might be short but isn’t carrying a lot of extra body fat.

[3:32] A BMI is weight in kilograms divided by height in metres, squared. Brigid talks about how there are many BMI calculators online.

[4:02] Most women who are classed as overweight will generally have the same pregnancy management as someone classed as having a normal body weight. Dr Pat talks about what happens for someone with a BMI of 30 and 40+ and how for most women, their pregnancy management needs different considerations.

[4:44] Your BMI should be compared to people in your same genetic backgrounds. For example, Asian population classification of high BMI is lower than the non-Asian population.

[5:25] Dr Pat talks about the special risks that might apply for someone with a 30+ BMI. For example gestational diabetes, and preeclampsia.

[6:20] Dr Pat talks about the difficulties for some women with high BMIs to have Ultrasound surveillance of their baby.

[6:58] Some regional hospitals have BMI limits due to a resources issue where there is not enough specialised equipment or extra surgical training for women with high BMIs.

[7:59] Brigid asks Dr Pat if there are any complications or issues with a newborn if a mother has a high BMI. Dr Pat talks about the difficulty in diagnosing birth defects and how a growth restricted baby can sometimes be undiagnosed.

[10:44] Dr Pat talks about how a care provider needs to ‘throw more’ in to change the level of care. For example, a gestational diabetes test might be done earlier in pregnancy. Surveillance is higher.

[11:49] Obesity brings an increased risk of stillbirth and often an early induction at 38 and 39 weeks is recommended even if there is no other indication.

[13:05] Brigid relays that 45% pregnant women in Australia are overweight or obese.

[13:36] Dr Pat talks about having a low BMI due to body shape, e.g taller or if there is malnutrition or drugs and alcohol. The main complications with someone with a low BMI is perineal tears.

[16:39] Brigid asks Dr Pat if someone with a 30+ BMI can still have a healthy pregnancy and birth.

[18:07] Do we treat someone who is overweight or obese differently? Dr Pat talks about how in labour we need to still be encouraging someone to be active during labouring.

[20:57] Dr Pat talks about how the heavier you are the harder it is for your cervix to dilate.  A woman with a high BMI may need more augmentation through syntocinon drip which may impact the baby.

[22:40] How a water bath for low intervention pain management is often not available for someone with high BMI.

[23:37] Dr Pat talks about how difficult an epidural is to do with someone with a BMI over 40+ and how special equipment is needed and why an epidural may not be as effective.

[25:00] Dr Pat talks about when a Caesarean section might be recommended.

[25:59] Dr Pat talks about how a provider talks to women who is recommended to have a Caesarean due to a high BMI.

[27:38] Extra risks for vaginal and Caesarean birth of deep venous thrombosis and pulmonary embolus and how anti-coagulation is often recommended

[28:43] After Caesarean, there is an increased risk of infection in the Caesar wound and how after Caesarean, a woman with a high BMI may stay longer in hospital.

[30:26] Myth or fact: Do pregnant women need to eat for two? 300 extra calories ½ half avocado and toast.