Obesity

Obesity is recognized as a chronic relapsing disease that has genetic, environmental, metabolic, and behavioral components. Body mass index is commonly used to risk stratify an individual's weight. Optimization of maternal weight should occur before pregnancy. Even small changes in a woman's weight prior to pregnancy can improve pregnancy outcomes. Pregnancy is associated with many physiological and endocrine changes. Under normal circumstances, pregnancy is characterized by progressive insulin resistance. In overweight and obese pregnant patients, insulin resistance is further increased, which is deleterious. Excess gestational weight gain has been associated with multiple co‐morbidities, fetal macrosomia, operative deliveries, and neonatal complications. Maternal complications associated with obesity include gestational diabetes, preeclampsia, indicated preterm delivery, cesarean delivery, deep venous thrombosis, severe maternal morbidity, and maternal mortality. Obesity is a risk factor for venous thromboembolism. Mechanical thromboprophylaxis is recommended for all women before and after delivery along with early ambulation.